Chance of Alzheimers based on frequent and also unusual innate alternatives

INTRODUCTION Minimally invasive surgery in the treatment of lumbar disc herniation has gained popularity in recent years. As two dominant techniques, percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) obtained comparable short-term clinical outcomes. However, the mid-and-long term efficacy and re-operative rate are still in debate. METHODS An electronic retrieval from Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, Ovid and EBSCO was performed. STATA 14.0 was used for statistical analysis. Odds ratio (OR) and 95% confidence interval (CI) were pooled to quantify the strength of the statistical differences. RESULTS A total of 9 studies (468 patients in the PELD group and 516 patients in the MED group) with high methodological quality met the selection criteria. No differences were found in leg pain VAS score before surgery and at any follow-up time after surgery. PELD obtained better outcomes in low back pain VAS score, ODI score and excellent and good ratio after 24 months postoperatively (OR=-0.856, 95% CI -1.488 to -0.224, P=0.008; OR=-0.425, 95% CI -0.724 to -0.127, P=0.005; OR=3.034; 95% CI 1.254 to 7.343; P=0.014) compared with MED, while no difference was found within 24 months postoperatively. No significant differences were found in complication, recurrence and reoperation rates within and after 2 years postoperatively. CONCLUSION Both PELD and MED can offer relatively effective and safe treatment for the low back pain and radiculopathy associated with a herniated disc. And PELD could obtain better mid-and-long term clinical outcomes compared with MED. BACKGROUND Chin-on-chest kyphotic cervical deformity can be debilitating. Surgical deformity correction serves to decompress neural elements and restore lordosis. find more This can be achieved through multiple osteotomies with instrumentation and fusion, sometimes requiring a staged approach. Such procedures carry a high risk of neurological injury. Here we present examples of transient neurological dysfunction not previously reported in the common literature. CASE DESCRIPTION The authors present three patients who underwent extreme cervical deformity correction for chin-on-chest deformity. Deformity correction in all cases was obtained through multiple osteotomies with multi-level cervicothoracic posterior instrumentation and arthrodesis. On postoperative examination, all three patients developed transient ataxia, dysmetria, and decreased proprioception in all four extremities - exam findings consistent with dorsal column dysfunction. All symptoms resolved within two to three weeks post-operatively. CONCLUSION Incomplete spinal cord syndromes such as posterior cord syndrome can be caused by compression or stretching of the ascending dorsal spinal tracts. Considering the large degree of correction obtained, we hypothesize the resulting shortening of the dorsal columns as the pathomechanism. Providers should be aware and patients should be counseled pre-operatively that these symptoms may occur. If these symptoms are present postoperatively, appropriate diligence is warranted with the understanding that these deficits may be transient. INTRODUCTION Neurosurgical training usually requires long hours on hands-on procedures, making it difficult for inexperienced surgeons to quickly learn in an error-proof environment. OBJECTIVE To propose a puzzle-like new model for neurosurgical education, that simulates craniosynostosis correction (scaphocephaly type) using Renier's H technique. A model of a 3D anatomical simulator for craniosynostosis training will be presented and evaluated. METHODS The cranial model was created using 1-mm CT scan images from patients with scaphocephaly in the DICOM format. This information was processed using an algorithm to generate a three-dimensional (3D) bio model in resin. The puzzle model and its variable training models were assessed qualitatively by a team of expert neurosurgeons. Next, the model was applied in trainees and was evaluated using specific questionnaires. RESULTS Experts and trainees evaluated the model. The mean of attempts without errors was 2.3 (SD0.675), for one error was 2.2 (SD0.918) and for two errors 1.3 (SD 0.707). The mean of the score of the simulator was 9.2 (SD0.421). Twelve residents (second evaluation) answered the questionnaire with a positive assessment of diagnosis capabilities, appropriateness of the model, time commitment, adequate environment, reliable 3D reconstruction and teaching method. Three participants have ever used a 3D simulator previously and the simulator was evaluated obtaining 9.9 final average (0-10 graduation). CONCLUSION The puzzle may be a complementary tool for surgical training. It allows several degrees of immersion and realism, offering symbolic, geometric and dynamic information with 3D visualization. It provides additional data to support the practice of complex surgical procedures without exposing real patients to undue risk. BACKGROUND Cervical myelomeningocele (MMC) is a very rare type of neural type defect that is usually discovered and managed in childhood. It is best described as a closed type of spinal dysraphism, where the posterior portion of the cervical thecal sac forms a pouch that bulges out through a narrow posterior spina bifida and contains spinal neural tissue with or without cerebrospinal fluid (CSF). CASE DESCRIPTION We report a 47-year-old male patient who presented with neck pain and decreased ability to use his fingers that has progressed over 3 years prior to presentation. Cervical spine MRI revealed a posterior bulge between the spinous processes of C4 and C6, absence of the spinous process of C5, and presence of CSF and spinal cord tissue and nerve roots within the bulging sac, suggestive of MMC. Simple untethering of the cord tissue was sufficient to halt the progression and allow for improvement in neurological deficits. CONCLUSION Cervical MMC is extremely rare in adults, the symptomatic progression of which is most likely due to cord tethering by fibrotic tissue formation over years. Early surgical correction and release of the tethered cord is relatively safe and prevents the evolution of neurological symptoms.