Journal of spine surgery (Hong Kong)
-
Combination of surgery and radiotherapy in the treatment of primary spine tumour can be indicated in some cases where a satisfactory oncological margin cannot be achieved. The presence of metal hardware has always limited post-operative radiotherapy due to the scattering effects of ionizing radiation or particles. The use of a fixation system (including rods and screw) fully made in PEEK embedded Carbon fiber (CFR-PEEK) could make easier and more effective the post-operative radiotherapy as it is radiolucent and does not interfere with ionizing radiation and accelerated particles. ⋯ The CFR-PEEK fixation system is comparable to standard titanium system in term of intraoperative complications, stability at weight bearing and at functional recovery. Thanks to radiolucency CFR-PEEK stabilization devices are more suitable in patients eligible for RT: the absence of image artifacts together with significantly less dose perturbation improve the treatment accuracy. Moreover the radiolucency is useful in the follow-up of patients thus allowing early detection of LR.
-
Case Reports
Hypoglossal nerve paresis secondary to anterior approach of upper cervical spine followed by spontaneous recovery.
We describe an exceptional complication of cervical spine surgery in a 63-year-old male. He suffered the impact of a beam to the top of his head. During evaluation in the emergency room he reported intense neck pain with no other neurological symptoms or findings on physical examination. ⋯ After surgery the patient presented dysphagia, dysarthria and limitation tongue mobility to the right side. These findings were consistent with hypoglossal neuropraxia probably related to soft tissue traction generated by the upper part of the self-retaining retractor. After discharge the patient experienced spontaneous improvement of hypoglossal paresis.
-
Lumbar lateral recess stenosis that results from a degenerative bulging of the disc and overgrowth of the facet is a very common cause for lumbar radiculopathy in the elderly. The standard surgical treatment for symptomatic lumbar lateral recess stenosis often requires a laminectomy or hemi-laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for contralateral endoscopic access to the lateral recess pathology that is truly minimally invasive and spares most of the facet joint complex: 6 patient cases are described where lateral recess stenosis pathology was accessed from a contralateral sublaminar endoscopic approach.
-
While there are variations in techniques and surgical approaches to spinal fusion, there is not a defined consensus on a recommended surgical approach. The aim of this study is to determine if there was a difference in intra- and post-operative complication rates between different surgical approaches after elective spinal fusion (≥3 levels) for adult spine deformity. ⋯ Our study suggests that posterior approaches to spinal fusion may lead to a higher incidence of complications compared to anterior or combined anterior/posterior approaches.
-
Lumbar transforaminal epidural steroid injection is a common and effective tool for managing lumbar radicular pain, although accidental intravascular injection can rarely result in paralysis. The purpose of this study is to determine the safest needle tip position for computed tomography (CT)-guided lumbar transforaminal epidural steroid injections as determined by incidence of intravascular injection. ⋯ An extraforaminal needle position for CT-fluoroscopic lumbar transforaminal epidural steroid injections decreases the risk of intravascular injection and therefore may be safer than other needle tip positions.