World Neurosurg
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We sought to measure the coronal alignment of the lumbar spine of patients in the right lateral decubitus position on a hinged Jackson operating table with the following 3 table positions: neutral and right and left 20-degree flexion. ⋯ The coronal alignment of the lumbar spine of patients in the right lateral decubitus position on a flat operating table (neutral position) was convex. The right 20-degree flexion position of the hinged operating table yielded less coronal plane lumbar spine deformity, with greater deformity in women.
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The neurointerventional field is moving towards transradial access (TRA). Among the favorable indications for TRA is for posterior circulation/vertebrobasilar interventions. For some neurointerventions, a triaxial system (guide catheter, distal access catheter [DAC], and microcatheter) is typically used for optimal support. We describe application of a new technique in which we forgo use of the guide catheter, using the DAC only for coaxial access via the radial approach and its potential advantages. ⋯ TRA with a distal access catheter provides support equivalent to a triaxial system with a coaxial construct in the posterior circulation. This has the advantage of using a smaller system in the radial and vertebrobasilar artery without losing stability. This technique can be used effectively and safely for a variety of posterior circulation neuroendovascular interventions.
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A better understanding of the risks and reasons for unplanned readmission is an essential component in reducing costs in the health care system and in optimizing patient safety and satisfaction. The reasons for unplanned readmission vary between different disciplines and procedures. The aim of this study was to identify reasons for readmission in view of different diagnoses in cranial neurosurgery. ⋯ Reasons and predictors for an unplanned readmission differ considerably among the index diagnosis groups. In addition to well-known reasons for readmission, we identified social indication, meaning a lack of home care, which is particularly prevalent in oncologic and elderly patients. A transitional care program could benefit these vulnerable patients.
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The lateral lumbar interbody fusion (LLIF) was a revolutionary approach devised by Luiz Pimenta that allowed the surgeon to access the lumbar spine through the major psoas muscle. Although the traditional LLIF had enabled enormous advances, the technique has its drawbacks. A new concept to perform the traditional LLIF has been proposed, with the patient being prone to decubitus with slightly extended legs. Our study aims to analyze the early outcomes of patients who had undergone the prone transpsoas (PTP) for degenerative spine pathologies including the L4/5 level. ⋯ The prone transpsoas is safe and feasible for approaching the L4/5 disk, presenting with a low rate of complication and new-onset neurologic deficits.
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To determine if 2-in-1 patient-specific laminectomy and drill guides can be safely used to perform laminectomy and pedicle screw insertion. ⋯ This study has explored the development of novel 2-in-1 patient-specific, 3D-printed laminectomy guides with integrated pedicle screw drill guides, which are accurate and safe in the laboratory setting. These instruments have the potential to simplify complex surgical steps, and improve accuracy, time, and cost.