World Neurosurg
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Flexible stabilization has been utilized to maintain spinal mobility in patients with early-stage lumbar spinal stenosis (LSS). Previous literature has not yet established any nonfusion solution as a viable treatment option for patients with severe posterior degeneration of the lumbar spine. This feasibility study evaluates the mean 5-year outcomes of patients treated with the Total Posterior Spine System (TOPS) facet replacement system in the surgical management of lumbar spinal stenosis and degenerative spondylolisthesis. ⋯ The TOPS implant maintains clinical improvement and motion in the surgical management of LSS and spondylolisthesis, suggesting that it can be considered an option for these indications.
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Spinal epidural abscess (SEA) patients have increased medical comorbidities and risk factors for infection compared with those without SEA. However, the association between frailty and SEA patients has not been documented. ⋯ Patients with SEA were more frail compared with the control back pain patients. Frailty was determined to be an independent risk factor for SEA, outside of the CRFs. The use of the mFI could be potentially useful in predicting the diagnosis, prognosticating, and guiding SEA treatment.
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The literature is scarce for studies evaluating the anatomy of cervical vessels in patients with stroke. We sought to investigate the effect of vessel tortuosity in procedural, angiographic, and functional outcomes in patients with acute ischemic stroke treated with mechanical thrombectomy (MT). ⋯ Patients with a TI <10 are significantly more likely to achieve early successful reperfusion after MT for the treatment of acute ischemic stroke.
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Distal transradial access (dTRA) has several advantages compared with proximal transradial access (pTRA) for cerebral angiography. The learning curve for transitioning from pTRA to dTRA has not been described. ⋯ Transitioning from pTRA to dTRA for diagnostic cerebral angiography is feasible and safe. The learning curve is overcome between procedures 11 and 33, and further refinement in performance occurs through procedures 40-50.
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Case Reports
Giant myxoid spindle cell neoplasm presenting with abdominal swelling and concurrent weight loss.
Retroperitoneal sarcomas may grow extremely large before becoming clinically symptomatic, and curative resection often has high associated morbidity. An 83-year-old man presented with insidious-onset abdominal pain and weight loss owing to a 16.3 × 13.1 × 25.8-cm retroperitoneal high-grade myxoid spindle cell sarcoma. ⋯ Older patients with large, high-grade lesions and multiple associated comorbidities are often poor surgical candidates, as the associated surgical morbidity outweighs the potential survival benefit. While the ultimate treatment plan relies on shared decision making by the patient and the healthcare provider, the decision to pursue surgical intervention should take into consideration the patient's broader clinical condition.