World Neurosurg
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To introduce a modified percutaneous endoscopic lumbar diskectomy (PELD) technique to remove extraforaminal disk herniation at the L5-S1 segment, including the technical essentials and preliminary results. ⋯ We introduced a modified PELD technique to remove extraforaminal disk herniation at the L5-S1 segment. This technique was less invasive, effective, and safe. We also summarized a detailed protocol to identify and remove the herniated disk for nerve protection.
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Cervical spinal cord stimulation is a safe and effective treatment for chronic axial neck pain and upper limb neuropathic pain. We report our novel institutional experience with performing cervical spinal cord stimulation trials with patients placed in an upright sitting position. This allows easy access to the cervical epidural space and has the added benefit of unobstructed access to the airway. ⋯ Cervical spinal cord stimulation trials performed in an upright, sitting position allow for easy epidural access and an unobstructed airway with reasonable setup time.
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After subarachnoid hemorrhage, delayed onset vasospasm can result in devastating ischemic stroke. The phenomenon of delayed cerebral ischemia (DCI) is not yet fully understood, and the correlation of angiographic vasospasm and cerebral infarction is still unclear. Therefore, we investigated the effect of endovascular treatment on the angiographic response and occurrence of DCI. ⋯ The discrepancy of excellent angiographic results and the high incidence of DCI might stem from an inaccurate or a delayed diagnosis of impending ischemia. In view of the limited time window, optimized peri-interventional management and continuous cerebral multimodality neuromonitoring might be crucial for the ideal timing of endovascular procedures to prevent cerebral infarctions.
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Comparative Study
Clinical and Radiologic Outcomes of Direct Versus Indirect Decompression with Lumbar Interbody Fusion: A Matched-Pair Comparison Analysis.
To compare the radiologic and clinical outcomes between oblique lumbar interbody fusion (OLIF) without laminectomy and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). ⋯ OLIF may achieve equivalent clinical and radiologic outcomes compared with MI-TLIF when the stenosis is minimal because the decompression performed is indirect. Furthermore, the OLIF shows less blood loss and shorter operative time, better restoration of DH, and earlier time to fusion than the MI-TLIF.
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Thoracic ossification of the ligamentum flavum (OLF) is a common cause of thoracic myeloradiculopathy. Thoracolumbar kyphosis derived from abnormal embryonic development of the spine vertebrae often progresses continuously and causes neurologic deterioration. These conditions are presented separately in most cases. A diagnosis of both OLF and thoracolumbar kyphosis in the same patient is rare, and no definite principle of surgical strategy for this case could be found in the literature. ⋯ For patients with thoracic OLF and thoracolumbar kyphosis derived from wedged vertebrae, 1-stage laminectomy and kyphosis correction has a risk that may lead to a negative outcome. Staging operation should be taken into consideration when planning a surgical strategy for the treatment of kyphosis associated with concurrent compressive myelopathy.