Journal of neurosurgery. Spine
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Case Reports
Urological injury as a complication of the transpsoas approach for discectomy and interbody fusion.
Transpsoas discectomy and interbody fusion has become an increasingly popular method of achieving lumbar interbody fusion, but reports of neurological, vascular, and gastrointestinal complications associated with this procedure have been described in the literature. To date, however, ureteral complications have not been reported with this procedure. The authors report 2 cases of ureteral injury and 1 case of renal injury following this procedure. A low index of suspicion is warranted to work up any patient having flank or abdominal symptoms after undergoing transpsoas discectomy and interbody fusion.
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The treatment of adult spinal deformity (ASD) remains a challenge for the spine surgeon. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained elusive in cases involving the MIS approach. This report describes the evolution of an MIS method for treating ASD with attention to sagittal correction. ⋯ An expanding body of evidence suggests that sagittal balance remains a keystone for good outcomes after ASD surgery. Minimally invasive surgery that involves a combination of osteotomies, interbody height restoration, and advanced fixation techniques may achieve this goal in patients with less severe deformities. While feasibility will have to be proven with larger series and improved surgical methods, the present technique holds promise as a means of reducing the significant morbidity associated with surgery in the ASD population.
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Minimally invasive lateral transpsoas interbody fusion (LTIF) has emerged as a popular surgical technique in a remarkably short period of time. The authors' experience with this procedure and anecdotal evidence in the literature suggest that the iliac crest may occasionally prevent access to the L4-5 interspace during minimally invasive LTIF. The authors propose that removal of a minimal amount of ilium would allow for successful exposure of the L4-5 interspace in those cases with a "high-riding" iliac crest. Therefore, the objective of this study was to evaluate the feasibility of iliac osteotomy to enhance exposure of the L4-5 interspace for minimally invasive LTIF. ⋯ A significant portion of patients may have a high-riding iliac crest and that may have had an impact on minimally invasive LTIF in this series; L4-5 cases are rare in relation to midlumbar spine cases in most minimally invasive LTIF patient series. Significant caudal displacement of the tubular system was achieved with minimal iliac osteotomy, ensuring access to the L4-5 interspace in all specimens while maintaining the minimally invasive philosophy behind minimally invasive LTIF.
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The aim in this study was to determine whether granulocyte-macrophage colony-stimulating factor (GM-CSF) leads to sensory improvement in rat spinal cord injury (SCI) models. ⋯ Treatment with GM-CSF results in functional recovery, improving tactile and cold sense recovery in a rat SCI model. Granulocyte-macrophage colony-stimulating factor also minimizes abnormal sprouting of sensory nerves after SCI.