| |
|
 |
Endoscopic thoracic sympathectomy
In the treatment of sympathetically mediated disorders, minimally invasive techniques for thoracoscopic sympathectomy have equivalent outcomes to those reported previously for open surgical techniques; however, the associated morbidity rate and the LOS are substantially reduced when utilizing these newer techniques. We recommend that surgeons receive formal training in these procedures, with didactic and laboratory training, followed by work with an experienced surgeon who performs these procedures on a regular basis.
 Download Full Publication
|
|
Anterior Cervical Foraminotomy for Unilateral Radicular Disease
Anterior cervical foraminotomy for cervical radiculopathy is effective in well-selected candidates. Initially, the procedure is more technically demanding but it can be performed safely when the appropriate techniques are used.
Download Full Publication
|
|
Thoracoscopic Microdiscectomy
Thoracoscopic microdiscectomy procedures have several distinct advantages over alternative approaches that include the standard thoracotomy and posterolateral approaches. Adequate training and the surgical experience needed to obtain and maintain the skills required in these complex operations are essential for surgeons who perform thoracoscopic spine surgery.
Download Full Publication
|
|
Treatment of posttraumatic syringomyelia with extradural decompressive surgery Posttraumatic syringomyelia, although uncommon, is a cause of delayed-onset neurological deterioration in spinal cord-injured patients, and it is becoming more frequently recognized due to physician awareness and the availability of MR imaging. It is considered to be caused by the obstruction of subarachnoid CSF flow, and recent surgical treatment has evolved toward procedures that reestablish subarachnoid CSF flow. The anatomical abnormalities that contribute to the pathogenesis of PTS can be intradural and/or extradural in origin. In cases of significant spinal canal stenosis or an osseous lesion the patients should be considered initially for decompression of the extradural mass, which may result in reduction of the syrinx and resolution of neurological deficits. Our experience justifies making an effort to achieve anatomical correction of acute- and late-onset traumatic spinal deformities for the management of this delayed complication.
Download Full Publication
|
|
Endoscopic thoracic discectomy
Thoracoscopic discectomy procedures have several distinct advantages over alternative procedures primarily related to reduced surgery-related pain, morbidity, LOS, and complications. The need for adequate training and consistant annual surgical experience to maintain effective skills are necessary for surgeons performing thoracoscopy. The alternative costotransversectomy, transpedicular, and transthoracic procedures clearly remain viable and effective techniques for surgeons experienced in these procedures and have limited experience with thoracoscopic
discectomy procedures.
Download Full Publication
|
|
Effect of frameless stereotaxy on the accuracy of C1–2 transarticular screw placement Previously C1–2 transarticular screw placement was not considered technically feasible or safe in 20% of cases due to anomalous VA anatomy within the C-2 pars interarticularis. We conducted cadaveric studies in which we demonstrated that stereotactic guidance significantly reduces this incidence to 5.9% because of the precision afforded by this technology, which allows accurate preplanning and intraoperative trajectory modification, thereby increasing the safety of screw placement in patients requiring C1–2 fixation.
Download Full Publication
|
|
Frameless stereotaxy for anterior spinal procedures
The results of this study confirm the feasibility of performing anterior spinal stereotactic procedures. Despite the lack of distinct anatomical landmarks, there was no statistically significant difference between the overall registration error and the actual measured error in any region of the spine. These findings validate the accuracy of our study and indicate the potential use of anterior spinal stereotaxy in clinical practice.
Download Full Publication
|
|
INVESTIGATIONS OF A MINIMALLY INVASIVE METHOD FOR TREATMENT OF SPINAL MALIGNANCIES WITH LINAC STEREOTACTIC RADIATION THERAPY: ACCURACY AND ANIMAL STUDIES A new method for stereotactic irradiation of spinal malignancies is presented, with evaluations of the theoretic and practical limitations of localization accuracy and the implementation of the method in swine.
Download Full Publication
|
|
Posterior atlantoaxial stabilization: new alternative to C1–2 transarticular screws Atlantoaxial fixation can be accomplished using this unique technique for C-1 lateral mass and C-2 pedicle screw/rod placement. Rigid reconstruction, previously unattainable in this problematic region of the spinal column, can now be achieved. Biomechanical testing is indicated to assess the stability of this construct compared with that used in other fusion procedures. In addition, greater experience and longer follow-up periods are indicated to assess fusion rates and clinical outcomes as well as the safety of this procedure.
Download Full Publication
|
|
Vascular complications in anterior thoracolumbar spinal reconstruction
Vascular complications can and do arise in patients undergoing anterior spinal reconstruction procedures in which mobilization and retraction of major vascular structures are often required. Although such complications are uncommon, our experience suggests that acute or delayed vascular complications can arise when performing these approaches. The risk of venous injury is small and is associated
with mobilization of the common iliac vein at L4–5, particularly in patients who have undergone previous anterior spinal surgery or those with osteomyelitis. Arterial injuries are even more infrequent; however, they are most likely to occur in elderly patients with underlying vascular disease. In summary, we have found that if one does not pay
meticulous attention to the surgical techniques involved (that is, side of surgery, site of reconstruction, retraction of vascular structures, and placement of hardware), such
inattentiveness will increase the potential risk of causing major vascular complications. Careful planning regarding surgical techniques and early recognition with rapid treatment of all complications regardless of the cause can reduce potential morbidity and mortality.
Download Full Publication
|
|
Forestier disease associated with a retroodontoid mass causing
cervicomedullary compression Forestier disease most commonly presents in the elderly population, causing dysphagia, and FD-associated neurological deficits are rare. The development of a soft-tissue retroodontoid hypertrophic pannus in association with progressive neurological deficit is caused by altered biomechanics at the atlantoaxial junction. The typical degenerative hypertrophy of the soft tissues in the retroodontoid region in FD patients is distinctly different from other well-known causes. There should be a heightened suspicion for CVJ lesions of this nature in patients with FD who present with cervical myelopathy.
Download Full Publication
|
|
Spinal neurocysticercosis
Spinal NCC is very rare compared with intracranial NCC, which has a relatively high incidence in endemic regions of the world. Spinal NCC should be considered
in the differential diagnosis in high-risk populations in which patients present with new symptoms suggestive of a spinal mass lesion. Subarachnoid spinal NCC occurs in
80% of cases, and 20% are intramedullary lesions. Signs and symptoms may include myelopathy, radiculopathy, or cauda equina syndrome, depending on location of the
cyst. The inflammatory arachnoiditis resulting from cyst degeneration may severely limit recovery despite successful excision of the lesion. Medical therapy may be considered in patients with stable symptoms but is unlikely to alleviate acute and progressive spinal NCC symptoms, which should be addressed surgically.
Download Full Publication
|
|
Imaging features and surgery-related outcomes in intraventricular neurocysticercosis Intraventricular NCC lesions produce symptoms by obstruction of CSF pathways, and most are found in the fourth ventricle to which they tend to migrate. Magnetic resonance imaging clearly demonstrates these poorly defined
lesions, and the presence of Gd enhancement is associated with a higher rate of treatment failure requiring reoperation. If Gd enhancement is absent on MR imaging,
craniotomy combined with cyst excision is the preferred initial treatment, and if enhancement is present shunt surgery is possibly the preferred treatment.
Download Full Publication
|
|
UNIPORTAL AND BIPORTAL ENDOSCOPIC THORACIC
SYMPATHECTOMY - SYMPATHECTOMY FOR TREATMENT of hyperhidrosis and pain syndromes of the
upper extremities has recently evolved from invasive open procedures to endoscopic
procedures. These minimally invasive techniques also have evolved, from complex
staged procedures with multiple ports to more simplified biportal and uniportal procedures
that require minimal tissue disruption and more limited yet effective sympathectomy
procedures. We describe our techniques, experience, and results using endoscopic
sympathectomy procedures with further reduced invasiveness, morbidity, and
complications.
KEY WORDS: Endoscopic, Hyperhidrosis, Minimally invasive, Thoracic sympathectomy
Download Full Publication
|
|
The future of spinal arthroplasty: a biomaterial perspective
With the emerging technology of spinal arthroplasty, a variety of new clinical problems may arise in the very near future. The purpose of this paper was to review the design
of disc prostheses, the materials used for their manufacture, and technical and theoretical concerns that remain regarding their use in vivo. We have focused on the effects of particulate and ionic debris associated with spinal implants. Meticulous clinical follow-up evaluation of these patients will be necessary to identify not only gross mechanical failure but also less obvious loosening associated with a debris-induced immune response. In addition, we will have to continue to monitor potential systemic effects resulting from disc arthroplasty vigilantly, as is currently done for similar orthopedically implanted materials.
Download Full Publication
|
|
Neurological complications of lumbar artificial disc replacement and comparison of clinical results with those related to lumbar arthrodesis in the literature: results of a multicenter, prospective, randomized investigational device exemption study of Charité intervertebral disc
The Charité intervertebral disc is safe and effective for the treatment of mechanical back pain caused by one-level DDD at L4-5 or L5–S1. Clinical outcomes at 2 years are
equivalent to those resulting from one-level BAK fusion. Clinical outcomes are equivalent or better than those related to 360° or stand-alone interbody fusion reported in the literature; however, there is the added benefit of restoring and maintaining segmental motion 2 years postoperatively. The incidence of major neurological complications was exceedingly low and equivalent to those demonstrated in
control individuals in the BAK fusion group. Accurate placement of the device within the intervertebral space is important for proper functioning of the prosthesis. The
Charité artificial disc should be used in properly selected patients, and surgeon training is essential for good clinical and functional outcomes. Further follow-up evaluation
beyond 2 years is recommended to corroborate the longterm results demonstrated in Europe.
Download Full Publication
|
|
Sagittal alignment and the Bryan cervical artificial disc
Cervical disc arthroplasty has the potential to allow surgeons
to treat patients with symptomatic degenerative disc
disease with a motion-preserving procedure. Among the
many technical issues involving the device’s design and
placement is restoration and maintenance of sagittal balance.
The Bryan disc placement and vertebral endplate
milling procedures may require revisions to optimize the
function of this unique arthroplasty implant.
Download Full Publication
|
|
Sciatica of nondisc origin and piriformis syndrome:
diagnosis by magnetic resonance neurography and
interventional magnetic resonance imaging with
outcome study of resulting treatment
In this study we demonstrated that piriformis muscle
syndrome can be accurately diagnosed and treated; additionally,
it is the most common cause of persistent sciatica
in patients in whom a proper diagnosis could not be
established and in whom treatment by the routine spinecentered
approach failed for this representative group of
patients. A rational and reliable diagnostic and management
approach including MR neurography and appropriate
imaging-guided injection techniques is capable of
establishing the correct diagnosis and guiding management
for both pelvic sciatic entrapment and nonstandard
lumbar entrapment.
Because an accurate diagnosis is not established in more
than 1 million patients with severe sciatica (80% of the total
affected population) each year when using the reference
standard diagnostic paradigm, our new technologies and
the expanded diagnostic criteria merit careful consideration
by those primary and specialist physicians charged with the
evaluation and management of these patients.
Download Full Publication
|
|
The changing role for neurosurgeons and the treatment of
spinal deformity
The roles of neurosurgery and spinal deformity continue
to evolve in relation to the discipline of spinal surgery.
Orthopedic surgeons have traditionally been involved in
the care of spinal deformity, making major contributions
to our understanding of biomechanical factors; however,
neurosurgeons have been involved in the care of a subset
of patients with spinal deformity making similar and parallel
advances in the understanding of spinal disorders.
The combined efforts of the two disciplines in recent years
have resulted in a synergy of innovations and patient care
that will push the frontiers of spinal surgery to levels beyond
imagination.
Download Full Publication
|
|
Endoscopic thoracic microdiscectomy
The literature on prospective neurological outcome data
for thoracic spine surgery is lacking and only a small series
of retrospective studies have been published. It is essential
to compare newer techniques such as thoracoscopy
with those (such as thoracotomy) that are already established
as the gold standard.
We conducted a prospective nonrandomized study in
which we collected quantifiable operative and neurological
outcomes data. Based on our experience, we conclude
that one- and two-level thoracic lesions are ideally treated
using endoscopic techniques, because the minimal incision-
related pain and morbidity are markedly different
from those associated with a thoracotomy. Patients undergoing
thoracoscopic discectomy experienced reduced
surgery-related pain, morbidity, LOS, and complications.
The need for adequate training and consistent surgical experience
are paramount for spine surgeons performing this
technically demanding procedure. The alternative techniques
(transthoracic, modified costotransversectomy or
lateral extracavitary, and the transpedicular or transfacet
approaches) clearly remain viable and effective for surgeons
experienced in these procedures who have limited
experience with thoracoscopic spine surgery.
Download Full Publication
|
