Journal of neurosurgery. Spine
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OBJECTIVEThe cortical bone trajectory (CBT) technique for pedicle screw placement has gained popularity among spinal surgeons. It has been shown biomechanically to provide better fixation and improved pullout strength compared to a traditional pedicle screw trajectory. The CBT technique also allows for a less invasive approach for fusion and may have lower incidence of adjacent-level disease. ⋯ A common reason for the nonidealized trajectories was the obscuration of patient anatomy secondary to severe degenerative changes. CONCLUSIONSCBT screws were placed ideally or safely 78% of the time in a virtual simulation model. A 22% rate of unsafe freehand trajectories suggests that the CBT technique requires use of image-guided navigation or x-ray guidance and that reliable freehand CBT screw insertion based on anatomical landmarks is not reliably feasible in the lumbar spine.
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Optimal surgical strategies for intramedullary spinal cord cavernous malformations (ISCCMs) are not optimized and remain problematic. In this study the authors identify rational surgical strategies for ISCCMs and predictors of outcomes after resection. ⋯ Resection performed with an individualized surgical approach remains the primary therapeutic option in ISCCMs. Performing surgery in patients with mild symptoms at the thoracolumbar level and embedded located lesions requires more discretion.
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The objective of this study was to evaluate the incidence and risk factors for 90-day readmission and reoperation after elective surgery for lumbar spinal stenosis (LSS). ⋯ AKI = acute kidney injury; BPH = benign prostate hyperplasia; CAD = coronary artery disease; CHF = congestive heart failure; CI = confidence interval; CMS = Centers for Medicare and Medicaid Services; COPD = chronic obstructive pulmonary disease; DM = diabetes mellitus; EBL = estimated blood loss; LOS = length of stay; LSS = lumbar spinal stenosis; OR = odds ratio; POUR = postoperative urinary retention; SSI = surgical site infection; UTI = urinary tract infection.
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The aim of this study was to obtain an unbiased causal treatment estimate of the between-group difference of surgery versus nonoperative treatment with respect to outcomes on quality of life, pain, and disability in patients with degenerative lumbar spinal stenosis (DLSS) 12 months after baseline. ⋯ DLSS = degenerative lumbar spinal stenosis; HADS = Hospital Anxiety and Depression Scale; ITT = intention-to-treat; LSOS = Lumbar Stenosis Outcome Study; MCID = minimal clinically important difference; RCT = randomized controlled trial; SMD = standardized mean difference; SSM = Spinal Stenosis Measure.
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With the costs related to the United States medical system constantly rising, efforts are being made to turn traditional inpatient procedures into outpatient same-day surgeries. In this study the authors looked at the various comorbidities and perioperative complications and their impact on readmission rates of patients undergoing outpatient versus inpatient 3- and 4-level anterior cervical discectomy and fusion (ACDF). ⋯ This study demonstrates the safety and effectiveness of 3- and 4-level ACDF surgery, although various comorbidities and perioperative complications may lead to higher readmission rates. Patient selection for outpatient 3- and 4-level ACDF cases might play a role in the safety of performing these procedures in the ambulatory setting, but further studies are needed to accurately identify which factors are most pertinent for appropriate selection.