World Neurosurg
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The purpose of this study was to assess the feasibility of minimally invasive transforaminal lumbar interbody fusion (TLIF) and bilateral decompression via a unilateral approach that was performed with a novel working retractor with an endoscopic system for degenerative lumbar spondylolisthesis associated with spinal stenosis, to minimize surgical trauma without compromising the quality of the treatment outcome. ⋯ The use of navigation-assisted endoscopic TLIF with bilateral decompression via a unilateral approach appears safe and feasible. The endoscopic surgical procedure may be an alternative surgical option for degenerative lumbar disease.
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Intraoperative neuromonitoring (IONM) has been reported to be sensitive and specific in the detection of neurologic injury during spinal surgery. The purpose of this study was to clarify the incidence of C5 palsy using multimodality IONM and to compare the accuracy of multimodality IONM to predict postoperative C5 palsy with isolated transcranial motor evoked potentials (MEPs). ⋯ Incidence of any neurologic deficit, including C5 palsy, during laminoplasty while using multimodality IONM was relatively low. MEP alerts in the deltoids or biceps had 100% sensitivity and 98.4% specificity for predicting a postoperative deficit. Somatosensory evoked potentials did not appear to be helpful in predicting postoperative deficits.
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Primary spinal cord (PSC) glioblastoma multiforme (GBM) is extremely rare and accounts for only 1.5% of all spinal cord tumors. Therefore, its treatment is still ill defined. To elucidate prognostic factors, we performed a single-institutional retrospective review of the largest series to date of patients with PSC GBM who underwent surgical resection in West China Hospital between 2008 and 2014. A total of 14 patients with PSC GBM were reviewed. ⋯ According to our study, the combination of postoperative radiotherapy and temozolomide chemotherapy can improve prognosis and may serve as a feasible postoperative adjuvant treatment of PSC GBM.
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To investigate the baseline patient characteristics, nonoperative modalities, surgical procedures, and complications rates of surgical cervical spondylotic myelopathy (CSM) patients. To evaluate risk factors for developing complications and compare the changes in health-related quality of life (HRQOL) from baseline to 2 years postoperatively. ⋯ The overall complication rate was 7.4% for the cohort. Baseline clinical information, comorbidities, use of nonoperative treatment modalities, and procedure type were not significantly associated with an increased risk of complications. Previous cervical spine surgery increased the risk of complications by 9-fold. The patients showed significantly improved SF-36 PCS, SF-36 MCS, and NDI scores at 2 years after surgery.
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Case Reports
Novel Technique of Percutaneous Fat Graft for Repair of Persistent Large Pseudomeningocele.
Pseudomeningocele is an uncommon but problematic complication in lumbar spine surgery. Initial conservative measures frequently are successful, but persistence requires additional management. The current surgical approach can involve a range of techniques, including blood patches, hydrogel/fibrin sealants, drains, open surgical repair of the dura, or a combination of the all techniques if symptoms persist. This report demonstrates a novel technique for repair via a percutaneous approach to deliver an autologous fat graft into the pseudomeningocele. ⋯ At 3 months postoperatively, the patient's symptoms were resolved with no clinical or radiographic findings of nerve root or thecal sac impingement and complete obliteration of the pseudomeningocele. This less-invasive approach offers the option of open surgical repair for persistent pseudomeningocele with the use of autologous graft material.