The spine journal : official journal of the North American Spine Society
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The published literature has not characterized the surgeon's learning curve with the technically demanding technique of a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). ⋯ The MIS TLIF is a technically difficult procedure to the practicing spine surgeon with regard to intra- and perioperative parameters of surgical time, estimated blood loss, intravenous fluid, and duration of anesthesia. Operative time and proficiency improved with understanding the minimally invasive technique. Further studies are warranted to delineate the methods to minimize the complications associated with the learning curve.
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Abnormal somatosensory evoked potential (SEP) (ie, prolonged latency) has been associated with poor surgical prognosis of cervical spondylotic myelopathy (CSM). ⋯ Spinal tracts were not uniformly affected in the myelopathic cervical cord. Changes in diffusion indices could delineate focal or extensive myelopathic lesions in CSM, which could account for abnormal SEP. DTI analysis of spinal tracts might provide additional information not available from conventional diagnostic tools for prognosis of CSM.
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Although there are many techniques for occipitocervical fixation, there have been no reports regarding occipitocervical fixation via the use of an anterior anatomical locking plate system. ⋯ The anterior occiput-to-axis locking titanium plate system proved superior to the anterior occiput-to-axis screw system both in the stress distribution and fixation stability based on finite element analysis. It provides a new clinical option for anterior occipitocervical fixation.
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False-positive loss of transcranial electrical motor evoked potentials (TCe-MEPs) limits the efficacy of motor tract monitoring during spine surgery. Although total intravenous anesthesia (TIVA) is widely regarded as the optimal regimen for TCe-MEPs, inhalational anesthesia is an alternative regimen. ⋯ Use of inhalation anesthesia during adult spinal surgery is associated with significantly higher rates of false-positive changes compared with TIVA during TCe-MEP monitoring. This relationship appears independent of preoperative motor status. Further study and multivariate analysis of anesthetic agents, diagnosis, and symptoms is necessary to elucidate the impact of these variables. The potential confounding effects of inhalational anesthesia on TCe-MEP monitoring should be considered when determining anesthetic regimen.
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Among different types of cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fractures, leaks into the spinal canal are considered to be the most common complication. One potential structure causing this type of cement leakage is the potential connection between the basivertebral foramen and the intravertebral cleft, which is revealed clearly on magnetic resonance (MR) images, but is often ignored in the literature. ⋯ Type B leaks are more common in vertebrae with an intravertebral cleft, which supports the presence of a connection between an intravertebral cleft and the basivertebral foramen. Thus, care must be taken when PKP is performed in these patients to avoid direct cement leakage into the spinal canal through the basivertebral foramen.