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Kee-Yong Ha, Eung-Ha Kim, Young-Hoon Kim, Hae-Dong Jang, Hyung-Youl Park, Chang-Hee Cho, Ryu-Kyoung Cho, and Sang-Il Kim

OBJECTIVE

The most catastrophic symptom of proximal junctional failure (PJF) following long instrumented fusion surgery for adult spinal deformity (ASD) is neurological deficits. Although previous reports have shown that PJF usually developed during the early postoperative period, some patients showed late neurological deficits. The aim of this study was to report the incidence, characteristics, and surgical outcomes of PJF with late neurological deficits.

METHODS

Patients surgically treated for ASD at a single institution were retrospectively reviewed. Among them, the patients requiring revision surgery for newly developed neurological deficits at least 6 months after the initial surgery were included. Patient demographic, radiographic, surgical, and clinical data were investigated. Neurological status was assessed using the Frankel grading system.

RESULTS

PJF with late neurological deficits developed in 18 of 385 patients (4.7%). The mean age at the onset of neurological deficits was 72.0 ± 6.0 years, and the median time from the initial surgery was 4.5 years. The most common pathology of PJF was adjacent disc degeneration and subsequent canal stenosis (11 patients). Five patients showed disc degeneration with aseptic bone destruction. Fractures at the upper instrumented vertebra (UIV), UIV + 1, and UIV + 2 occurred in 2, 3, and 2 patients, respectively. Ossification of the yellow ligament, which had not been found at the first surgery, was identified in 6 patients. Eight patients showed improvement of their neurological deficits and 10 patients showed no improvement by the final follow-up. Perioperative major complications occurred in 8 of 18 patients.

CONCLUSIONS

The incidence of PJF with late neurological deficits following ASD surgery was 4.7% in this cohort. The patients showed several morphological features. After revision surgery, perioperative complications were common and the prognosis for improved neurological status was not favorable.

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Dae Won Kim, Won Sik Eum, Sang Ho Jang, Jinseu Park, Dong-Hwa Heo, Seung-Hoon Sheen, Hae-Ran Lee, Haeyong Kweon, Seok-Woo Kang, Kwang-Gill Lee, Se Youn Cho, Hyoung-Joon Jin, Yong-Jun Cho, and Soo Young Choi

Object

To improve the safety of dura repair in neurosurgical procedures, a new dural material derived from silk fibroin was evaluated in a rat model with a dura mater injury.

Methods

The authors prepared new, transparent, artificial dura mater material using silk fibroin from the silkworm, Bombyx mori. The cytotoxic and antiinflammatory effects of the artificial dura mater were examined in vitro and in vivo by histological examination, western blotting, and reverse transcription polymerase chain reaction analyses.

Results

The novel artificial dura mater was not cytotoxic. However, it efficiently reduced cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase expression as well as the expression of the proinflammatory cytokines IL-1β, IL-6, and tumor necrosis factor–α. Cerebrospinal fluid leakage did not occur after repair of the brain of craniotomized rats with the artificial dura mater material.

Conclusions

The new artificial dura mater described in this study appears to be safe for application in neurosurgical procedures and can efficiently inhibit inflammation without side effects or CSF leakage. Although the long-term effects of this artificial dura mater material need to be validated in larger animals, the results from this study indicate that it is suitable for application in neurosurgery.