World Neurosurg
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Various approaches are advocated for symptomatic thoracic disc herniation (TDH). The aim of this series is to demonstrate the feasibility, safety, and results of posterior transfacet or transpedicular approaches for excision of all types of extradural TDH. We report a consecutive series of patients undergoing posterior approach surgery for TDH. ⋯ TDH including large central calcified discs can be safely removed through posterior transfacet or transpedicular approaches with reduced morbidity in comparison with more invasive anterior approaches. Careful microsurgical technique and use of specialized instruments are important for successful excision of TDH from a posterior approach.
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We assessed the contribution of a dynamic surgical guidance (DSG) probe in the accurate placement of thoracic and lumbar pedicle screws (PSs) in patients with spinal deformity. ⋯ Despite having more patients with severe deformities in the DSG group, PS insertion was significantly more accurate with DSG. This technique also reduced the severe unacceptable lateral misplacement rate (>4 mm) and, consequently, the incidence of intraoperative screw revisions even in patients with severe deformities.
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To analyze postoperative changes in cervical alignment in patients with adolescent idiopathic scoliosis (AIS) with different curve patterns. ⋯ Correlations between the improvement of CL and TK highlight the importance of restoration of patients with normal TK or AIS. Reciprocal changes in cervical alignment may happen if the TK was also simultaneously restored in patients with AIS. For patients with different curve patterns, the cervical sagittal parameters tend to be similar during follow-up.
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Metal allergies affect a significant portion of the population; intracranial flow diverters contain many of the most commonly allergenic metals. Prior literature has suggested patch testing for all patients with documented or suspected metal allergies before intracranial flow diverter placement; however, there remains a paucity of reports of patients with documented metal allergies undergoing intracranial flow diversion. ⋯ In 2 patients with known nickel allergies and intracranial aneurysms treated with the PED, there were no clinically or radiographically apparent allergic reactions at greater than 2 years of follow-up.
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We sought to develop a new posterior fusion technique composed of bilateral C1 titanium cables and C2 pedicle screw-rods for treatment of atlantoaxial instability not suitable for C1 screw placement. ⋯ Posterior atlantoaxial fixation using C1 titanium cables and C2 pedicle screw-rod construct appears to be an effective and safe technique for treatment of atlantoaxial instability, which could be an alternative method for cases unsuitable for C1 screw placement when using C1-C2 screw fixation.