World Neurosurg
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There is a paucity of studies on readmission rates in elderly patients over a period of 360 days after spinal surgery. ⋯ We found that electrocardiographic abnormalities, male sex, low hemoglobin levels, asthma, heart disease, intensive care unit admission, low aspartate aminotransferase level, high body mass index, and high platelet level were risk factors for readmission. As the postoperative observational period became longer, the reasons for readmission tended to be more related to non-surgical site-related problems than to surgical-related problems.
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Onyx (ethylene vinyl alcohol, ev3, Irvine, California, USA) is commonly used to treat dural arteriovenous fistulas (DAVFs) and presents several advantages over n-butyl cyanoacrylate glue (Codman Neurovascular Inc, Raynham, Massachusetts, USA) including slower, more controlled injections and better penetration via radial casting. However, Onyx is nonthrombogenic and may result in incomplete casting, recanalization, and DAVF recurrence. Here, we demonstrate glue embolization with guide catheter dextrose push of a recurrent DAVF previously embolized with Onyx. ⋯ Dextrose 5% in water was concomitantly injected through the guide catheter to ensure distal migration of the glue and occlusion of the draining vein. Glue embolization with dextrose push is a valuable treatment option for DAVF, especially in smaller recurrent feeders that can fill in the Onyx recanalized cast. The 6-month follow-up angiogram showed persistent occlusion of the dural fistula (Video 1).
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Arachnoiditis ossificans (AO) is a rare entity characterized by the presence of calcified plaques formed by the metaplasia of arachnoid cells. Over 50 cases of AO have been reported, with predisposing factors including spinal trauma, hemorrhage, vascular abnormalities, and infection. The administration of oil-based contrast during myelography as an independent risk factor or in conjunction with other spinal pathology has been described in 9 cases. ⋯ In addition to acute inflammation, oil-based contrast myelography also leads to arachnoiditis, calcification, and retained mass lesions because of its chronic inflammatory properties and slow resorptive rate. Three decades after its replacement with water-based contrast material, the chronic sequelae of oil-based contrast myelography may continue to manifest clinically and on CT imaging. Because of calcifications often encasing the spinal cord or nerve roots, management of AO is challenging, and neurologic deficits may persist even after surgery.
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Meralgia paresthetica, a pain syndrome that is caused by injury to the lateral femoral cutaneous nerve, is a well-documented complication after anterior hip arthroplasty (THA). Traditional treatment of this peripheral nerve entrapment syndrome can be complicated in patients who have had THA via an anterior approach owing to the presence of scar in the postoperative bed. ⋯ Minimally invasive intra-abdominal treatment of meralgia paresthetica following anterior THA results in durable pain relief. This approach is a helpful alternative to traditional techniques of decompression or section of the lateral femoral cutaneous nerve below the inguinal ligament.