World Neurosurg
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An anterior dislocation of the L5 vertebral body from the sacrum and decent into the pelvis is considered as spondyloptosis. The surgical treatment of L5-S1 spondyloptosis remains challenging and controversial. We present a case of lumbosacral spondyloptosis with multiple pedicle defects treated through a combined anterior and posterior approach. ⋯ The L5 spondylectomy shortens the spine to reduce the strain on the neural elements and facilitates correction of the lumbosacral kyphosis. When long instrumentation is mandatory, such as in multiple pedicle defects, sacropelvic fixation is recommended. Intraoperative 3D navigation is helpful in such a complex case.
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Improved postoperative care for renal transplant recipients has advanced both duration and overall quality of life. However, degenerative spinal pathology is increasingly prevalent after transplant. Outcomes following spinal fusion among the renal transplant population in the United States are rarely addressed. ⋯ History of renal transplant was associated with increased inpatient medical and socioeconomic complications following spinal fusion. Physicians and patients must understand and respect the potentially increased perioperative challenges facing KTRs.
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Chronic subdural hematoma evacuation can be achieved in select patients through bedside placement of the Subdural Evacuation Port System (SEPS; Medtronic, Inc., Dublin, Ireland). This procedure involves drilling a burr hole at the thickest part of the hematoma. Identifying this location is often difficult, given the variable tilt of available imaging and distant anatomic landmarks. This paper evaluates the feasibility and accuracy of a bedside navigation system that relies on visible light-based 3-dimensional (3D) scanning and image registration to a pre-procedure computed tomography scan. The information provided by this system may increase accuracy of the burr hole location. ⋯ A bedside cranial navigation system based on 3D scanning and image registration has been introduced. Such a system may increase the success rate of bedside procedures, such as SEPS placement. However, technical challenges such as the ability to scan hair and practical challenges such as minimization of patient movement during scans must be overcome.
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With little information available on axonal and myelin damage surrounding the contusion, the study of spinal cord injury (SCI) so far has focused on neuronal death. In this study, we investigated the role of iron overload in long-term oligodendroglia death and progressive white matter damage to rats after SCI using the iron chelator, deferoxamine (DFX). ⋯ Iron overload plays an important role in progressive white matter damage after SCI. DFX may be an effective treatment for white matter damage after SCI.
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Case Reports
Full endoscopic lumbar discectomy for lumbar disc herniation in the presence of a low-lying cord - A case report.
The distal extent of the spinal cord is most often at the level of the L1 or L2 vertebral body. In rare cases, a low-lying cord extends more distally. In this scenario, pathology that normally causes radiculopathy may cause myelopathy due to compression of the cord rather than nerve roots of the cauda equina. ⋯ In patients with spina bifida occulta who present with myelopathy, lumbar disk herniation should be considered if the patient has a low-lying cord. This is the first report of percutaneous endoscopic lumbar diskectomy for lumbar disk herniation in the presence of a low-lying spinal cord. We have demonstrated that this approach can treat this condition effectively and safely.