World Neurosurg
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Observational Study
How Prone Position Affects the Anatomy of Lumbar Nerve Roots and Psoas Morphology for Prone Transpsoas Lumbar Interbody Fusion.
Lumbar nerve root injury is a serious complication of transpsoas lumbar interbody fusion. Researchers have reported lumbar nerve roots and psoas muscle anatomy in the supine position, but no previous studies have used prone position magnetic resonance imaging to evaluate these structures. ⋯ Lumbar nerve roots, psoas morphology, and great vessel position were not affected by the prone position compared with the supine position.
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Subarachnoid hemorrhage (SAH) is a rare complication secondary to cerebrospinal fluid (CSF) leakage during spinal surgery, but the specific cause of bleeding is still unclear. In this retrospective single-center study, we studied cases of acute SAH after spinal surgery to identify the related risk factors for bleeding. ⋯ The rapid leakage of CSF caused by rupture of the dural sac during surgery and the rapid drainage of CSF after surgery were closely related to the occurrence of SAH. In addition, hypertension was a factor related to SAH during spinal surgery.
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Surgery for cervical spondylotic myelopathy (CSM) may use anterior or posterior approaches. Our objective was to compare baseline differences and validated postoperative patient-reported outcome measures between anterior and posterior approaches. ⋯ In the largest analysis to date of CSM surgery data, significant baseline differences existed for patients undergoing anterior versus posterior surgery for CSM. After adjusting for these differences, patients undergoing anterior surgery were more likely to achieve clinically significant improvement in NDI at short- and long-term follow-up.
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Delayed cerebral ischemia (DCI) contributes to poor outcomes after subarachnoid hemorrhage (SAH). The pathophysiology of DCI is not fully understood, which has hindered the adoption of a uniform definition. Furthermore, a reliable diagnostic test and an effective evidence-based treatment are lacking. This could lead to variations in care. ⋯ We found large variations in the definition, diagnosis, and treatment of DCI in the Netherlands. In the absence of evidence-based treatment, standardization of management seems warranted in an effort to optimize DCI care.
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Surgical resection of intracranial hemangioblastoma poses technical challenges that may be difficult to impart to trainees. Here, we introduce knowledge of tool-tissue forces in Newton (N), observed during hemangioblastoma surgery. ⋯ The quantification of tool-tissue forces during hemangioblastoma surgery with feedback to the surgeon, could well enhance surgical training and allow avoidance of bleeding associated with high force error.