World Neurosurg
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Selective dorsal rhizotomy (SDR) is used to improve spasticity, gait, and pain in children with spastic diplegia. There is growing evidence supporting its long-term benefits in terms of functional outcomes, independence, and quality of life. There is, however, little contemporary work describing the surgical morbidity of this irreversible procedure. The purpose of this study is to evaluate the surgical outcomes and complications of SDR at a single United Kingdom center. ⋯ SDR using a single-level approach is a safe procedure with low surgical morbidity. This study complements the growing evidence base in support of SDR for spastic diplegia and should help inform decisions when considering treatment options.
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Computer-assisted three-dimensional navigation often guides spinal instrumentation. Optical topographic imaging (OTI) offers comparable accuracy and significantly faster registration relative to current navigation systems in open posterior thoracolumbar exposures. We validate the usefulness and accuracy of OTI in minimally invasive spinal approaches. ⋯ OTI is a novel navigation technique previously validated for open posterior exposures and in this study has comparable accuracy for mini-open minimally invasive surgery exposures. The likelihood of successful registration is affected more by the geometry of the exposure than by its size.
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The purpose of this study was to identify predictors for postacute care facility discharge for patients undergoing posterior cervical decompression and fusion (PCDF) and to determine if discharge placement impacts postdischarge outcomes. ⋯ Results of this cross-sectional study suggest that patients with PCDF discharged to a postacute care facility have a higher likelihood of having a severe AE after discharge as well as a higher likelihood of being readmitted.
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Case Reports
Cauda Equina Syndrome as the first Manifestation of von Hippel-Lindau Disease: A Case Report.
Von-Hippel Lindau (VHL) disease is rare neurocutaneous disorder arising from an inactivating mutation of the VHL gene on chromosome 3p35. The disease is inherited in an autosomal dominant fashion and predominantly involves tissues originating from the ectodermal germ layer. Although hemangioblastomas of retina and cerebellum are the most common clinical features, multiple-organ involvement in the form of renal cell carcinomas, spinal hemangioblastomas, renal cysts, and pancreatic cysts have also been reported. Hemangioblastomas of the spinal canal could present as cauda equina syndrome. ⋯ To the best of our knowledge, this is the first case with cauda equina syndrome as the first manifestation of VHL disease. Laminectomy and partial resection of hemangioblastoma are safe and effective treatments to resolve impingement of the spinal cord. VHL disease resulting in hemangioblastoma in the spinal canal is rarely seen but should be included in the differential diagnosis of cauda equina syndrome to facilitate genetic counseling for the proband and offspring.
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Anterior or posterior decompression has been widely used to treat patients with ossification of the posterior longitudinal ligament (OPLL). However, when OPLL extends to the C2 level, the complex anatomic structures around the C2 vertebral body and postoperative destabilization or kyphosis would make it difficult to perform anterior or posterior surgery. This study proposed a novel technique named "shelter technique" to deal with C2 OPLL. ⋯ The shelter technique can be relatively effective and safe for patients with OPLL involving the C2 segment. However, further studies with more cases and longer follow-up will be required to reveal the surgical value of the technique.