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Setti S. Rengachary

The cellular and molecular events governing bone formation in the embryo, healing of a fractured bone, and induced bone fusion follow a similar pattern. Discovery, purification, and recombinant synthesis of bone morphogenetic proteins (BMPs) constiute a major milestone in the understanding of bone physiology. In this review the author discusses the mechanism of action, clinical applications, dosage, and optimum carriers for BMPs. The roles played by other growth factors are also discussed.

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Setti S. Rengachary and John J. Kepes

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Julie G. Pilitsis and Setti S. Rengachary

Many advances have been made in the treatment of metastatic spinal disease over the last few decades. Radiotherapy offers benefit and pain relief to many patients; however, this modality provides minimal vertebral stabilization. Surgical management consists of decompression and complex fusions. Vertebroplasty offers an adjuvant therapy to both radiotherapy and surgery by providing additional stabilization and pain relief. The results of case studies suggest that including vertebroplasty in the management of these patients is beneficial. In this article the authors review the role of vertebroplasty in metastatic spinal disease.

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Setti S. Rengachary and Daniel Murphy

✓ A case of conus and cauda equina compression caused by a subarachnoid hematoma is reported which was probably due to needle trauma during an attempted lumbar puncture.

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Setti S. Rengachary and Ali B. Manguoglu

✓ A simple and effective technique is described for the control of bone bleeding during the Cloward procedure for anterior cervical interbody fusion.

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Setti S. Rengachary and Raju Balabhandra

In this article the authors discuss the syndrome of isthmic spondylolisthesis occurring at the lumbosacral junction in adults, providing a description of the clinical syndrome, altered biomechanics, and imaging characteristics. The authors pose arguments in favor of reduction and instrument-assisted fusion. Their surgical technique is detailed. They describe transsacral interbody fusion in which fibular allograft and in situ fixation are used, which they consider the second-best alternative technique when attempts at reduction fail.

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Setti S. Rengachary and Raju S. V. Balabhadra

Internal disc disruption associated with axial back pain but not radicular pain is a disease entity that was recognized about two decades ago as a disorder that could potentially be treated by spinal fusion. In this article the authors describe the clinical syndrome, magnetic resonance imaging and discography findings of pathophysiological pain generation, and the available surgical options. Based on the current understanding of this disease entity, the optimum surgical procedure entails radical discectomy, anterior column support, adequate amounts of auto- or allograft bone, bone extenders and enhancers, and rigid stabilization of the motion segment.

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Setti Rengachary, Pulla R. S. Kishore and Itaru Watanabe

✓ The authors describe a patient with a giant occipital intradiploic epidermoid cyst with compression of the torcular and other posterior fossa structures.

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Intradiploic arachnoid cysts

Report of two cases

Martin E. Weinand, Setti S. Rengachary, Douglas H. McGregor and Itaru Watanabe

✓ Two patients are presented in whom cranial arachnoid cysts developed as diverticuli of the arachnoid membrane through small defects in the dura mater, eroded through the inner table, expanded within the diploe, and eroded the outer table of the skull. Based on observations at the time of surgery and the histological examination of these lesions, it is proposed that they are congenital in origin. Previously reported cases of “traumatic arachnoid cyst without fracture,” “intradiploic cerebrospinal fluid fistula,” and “middle fossa pitholes” appear to represent the same pathological process as the lesions reported in this paper. It is proposed that “intradiploic arachnoid cyst” is the most appropriate term by which these lesions should be described.