World Neurosurg
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Neurologic deficits from lumbar plexus nerve injuries commonly occur in patients undergoing lateral approaches. However, it is not yet clear what types of injury occur, where anatomically they are located, or what mechanism causes them. We aimed to study 1) the topographic anatomy of lumbar plexus nerves and their injuries in human cadavers after lateral transpsoas approaches to the lumbar spine, 2) the structural morphology of those injuries, and 3) the topographic anatomy of the lumbar plexus throughout the mediolateral approach corridor. ⋯ Lateral approaches can lead to structural nerve damage. Knowledge of the complex plexus anatomy, specifically its mediolateral course, is critical to avoid approach-related injuries.
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Spinal neuronavigation improves accuracy of pedicle screw placement but may increase operative time, and its use in oncologic operations remains relatively unstudied. We compared the use of two-dimensional (2D) fluoroscopy and three-dimensional (3D) spinal neuronavigation relative to operative time in instrumented oncology procedures. ⋯ There was no significant difference in length of operative time when neuronavigation was compared with fluoroscopy for instrumented oncologic spinal surgery. There was a trend toward a decrease in estimated blood loss in the neuronavigation cases.
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Thoracic spinal tuberculosis (TST) is a dangerous disease. Besides antituberculosis chemotherapy, surgery is also necessary for treating TST. To date, no study has focused on the prognostic factors for recovery of patients after surgery for TST. ⋯ This study supports the previously published evidence that nonparalysis, shorter duration of symptoms, and fewer involved vertebrae are favorable prognostic factors for recovery after surgery for TST. For a better recovery effect, the key points for treating TST were timely diagnosis and treatment. It is urgent for government to arouse attention and popularize the knowledge of spinal tuberculosis.
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Case Reports
Concomitant lumbosacral perimedullary arteriovenous fistula and spinal dural arteriovenous fistula: a case report.
Although multifocal spinal arteriovenous malformations (AVMs) have been reported before, the present case is the first case of 2 different types, including 1 perimedullary arteriovenous fistula and 2 spinal dural arteriovenous fistulas of lumbosacral AVMs, coexisting in 1 patient. We also report the use of hybrid techniques in treatment of concomitant lumbosacral spinal AVMs. ⋯ Multifocal spinal vascular malformations may coexist in 1 case, and standardized spinal digital subtraction angiography, including the bilateral internal iliac arteries and median sacral artery, should be performed to avoid a missed diagnosis. The concomitant phenomenon indicates that venous hypertension may be a risk factor for the development of arteriovenous fistulas. Hybrid techniques are effective in treatment of multifocal and complex spinal AVMs.