Neurosurg Focus
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The use of intraoperative neurophysiological monitoring (IONM) in surgical decompression surgery for myelopathy may assist the surgeon in taking corrective measures to reduce or prevent permanent neurological deficits. We evaluated the efficacy of IONM in cervical and cervicothoracic spondylotic myelopathy (CSM) cases. ⋯ The authors found a correlation between decreased intraoperative MEPs and postoperative new neurological deficits in patients with CSM. Sensitivity varies based on patient comorbidities, age, and preoperative neurological function. Monitoring of MEPs is a useful adjunct for CSM cases, and the authors have developed a checklist to standardize their responses to intraoperative MEP changes.
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Although the motion of the sacroiliac joints (SIJ) is minimal, pain can originate from the SIJ on mechanical loading and affect walking, sitting and sleep patterns. The SIJ refers to the pair of joints inferior to the L5-S1 joint, and functions as the inferior adjacent level after a L5-S1 fusion. SIJ pain has a clinical overlay of symptoms often similar to low back pain (LBP) generated by the lumbar spine. ⋯ The SI-Bone implants are triangular shaped titanium and have a rough surface for immediate stability. This rough surface is believed to aid in the osteo-fixation of the implants to the ilium and sacrum, as well as to long term fusion of the SIJ after its prolonged immobilization. The video can be found here: http://youtu.be/2YtFddohZRk.
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This video details a minimally invasive treatment of symptomatic adult kyphoscoliosis. Both anterior and posterior approaches are used to obtain sagittal and coronal balance. ⋯ The second portion of the video shows positioning, fluoroscopic positioning/guidance, exposure for percutaneous pedicle screw placement, rod insertion, and closure. The video can be found here: http://youtu.be/cHkTMtSXZ8A.
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Spinal epidural abscess (SEA) often requires prompt surgical decompression to prevent potential devastating neurological deficits. Dorsally located SEA usually can be evacuated via simple laminectomies. Ventral SEA often requires an anterior approach such as thoracotomy to achieve adequate exposure and decompression. ⋯ The patient had immediate and dramatic symptomatic improvement and was ambulatory on post-operative Day 1. The minimally invasive transpedicular approach avoids the surgical morbidity associated with anterior approach and is effective surgical alternative to treat ventral SEA. The video can be found The video can be found here: http://youtu.be/do-K1VWYhi4.
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Lumbar radiculopathy is a common problem. Nerve root compression can occur at different places along a nerve root's course including in the foramina. ⋯ This video demonstrates a minimally invasive approach to decompress the lumbar nerve root in the foramina with a lateral to medial decompression. The video can be found here: http://youtu.be/jqa61HSpzIA.