Journal of neurosurgery. Spine
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Case Reports
Vascular injury following microendoscopic lumbar discectomy treated with stent graft placement.
The risk of great vessel injury is low in microendoscopic lumbar discectomy applied in a favorable visual field. However, it is important to be aware of the depth of the pituitary rongeur. In this article, the authors report the case of a 55-year-old woman with lumbar disc herniation who underwent microendoscopic discectomy and subsequently presented with an aneurysm and arteriovenous fistula located at the bifurcation of the right common iliac artery. The patient was treated with endoscopic placement of a stent graft and recovered uneventfully.
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Vertebral hemangiomas are benign lesions and are often asymptomatic. Most vertebral hemangiomas that cause cord compression and neurological symptoms are located in the thoracic spine and involve a single vertebra. The authors report the rare case of lumbar hemangiomas in a 60-year-old woman presenting with severe back pain and rapidly progressive neurological signs attributable to 2 noncontiguous lesions. ⋯ At 3 months postoperatively, her symptoms and neurological deficits had improved completely. To the authors' knowledge, this is the first description of 2 noncontiguous extensive lumbar hemangiomas presenting with neurological symptoms managed by such combined treatment. The combined management seems to be an effective method for treating symptomatic vertebral hemangiomas.
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Case Reports
Bow hunter's syndrome: the use of dynamic magnetic resonance angiography and intraoperative fluorescent angiography.
Bow hunter's syndrome is a diagnosis typically made using dynamic digital subtraction angiography. The authors present the case of a 68-year-old woman who presented with symptoms consistent with bow hunter's syndrome that was accurately diagnosed utilizing noninvasive dynamic MR angiography. The dynamic MR angiogram clearly illustrated unilateral vertebral artery compression upon turning of the head. ⋯ It can also be used to confirm sufficient postoperative decompression and monitor for recurrence. Intraoperative fluorescent angiography has been previously used in the evaluation of intracranial and extracranial vascular patency. This report is the first to show that fluorescent angiography can offer rapid and reliable intraoperative evaluation of vertebral artery decompression in bow hunter's syndrome.
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Although multimodal intraoperative spinal cord monitoring provides greater accuracy, transcranial electrical stimulation motor evoked potential (TcMEP) monitoring became the gold standard for intraoperative spinal cord monitoring. However, there is no definite alarm point for TcMEPs because a multicenter study is lacking. Thus, based on their experience with 48 true-positive cases (that is, a decrease in potentials followed by a new neurological motor deficit postoperatively) encountered between 2007 and 2009, the authors set a 70% decrease in amplitude as the alarm point for TcMEPs. ⋯ This study is the first prospective multicenter study to investigate the alarm point of TcMEPs. The authors recommend the designation of an alarm point of a 70% decrease in amplitude for routine spinal cord monitoring, particularly during surgery for spinal deformity, OPLL, and extramedullary spinal cord tumor.
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Randomized Controlled Trial
Unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach compared with conventional bilateral pedicle screw fixation for single-segment degenerative lumbar instability: a prospective randomized study.
Treatment of patients with single-segment degenerative lumbar instability using unilateral pedicle screw fixation can achieve stability and fusion rates similar to those of bilateral pedicle screw fixation. The aim of this study was to analyze the clinical outcome of using unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach to treat single-segment degenerative lumbar instability. ⋯ Unilateral pedicle screw fixation through a tubular retractor via the Wiltse approach appears to be as safe and effective as bilateral pedicle screw fixation for the treatment of single-segment degenerative lumbar instability.