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Moon, Myung-Sang, Sung-Soo Kim, Young-Wan Moon, Hanlim Moon, and Sung-Sim Kim. "Surgery-Related Complications and Sequelae in Management of Tuberculosis of Spine." Asian Spine Journal 8, no. 4 (2014): 435. http://dx.doi.org/10.4184/asj.2014.8.4.435.
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Ekinci, Safak, Faruk Akyildiz, and Omer Ersen. "Response to: Surgery-Related Complications and Sequelae in Management of Tuberculosis of Spine." Asian Spine Journal 9, no. 1 (2015): 153. http://dx.doi.org/10.4184/asj.2015.9.1.153.
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Xi, Zhuo, Shane Burch, Praveen V. Mummaneni, Rory Richard Mayer, Charles Eichler, and Dean Chou. "The effect of obesity on perioperative morbidity in oblique lumbar interbody fusion." Journal of Neurosurgery: Spine 33, no. 2 (August 2020): 203–10. http://dx.doi.org/10.3171/2020.1.spine191131.
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OBJECTIVEObese patients have been shown to have longer operative times and more complications from surgery. However, for obese patients undergoing minimally invasive surgery, these differences may not be as significant. In the lateral position, it is thought that obesity is less of an issue because gravity pulls the visceral fat away from the spine; however, this observation is primarily anecdotal and based on expert opinion. The authors performed oblique lumbar interbody fusion (OLIF) and they report on the perioperative morbidity in obese and nonobese patients.METHODSThe authors conducted a retrospective review of patients who underwent OLIF performed by 3 spine surgeons and 1 vascular surgeon at the University of California, San Francisco, from 2013 to 2018. Data collected included demographic variables; approach-related factors such as operative time, blood loss, and expected temporary approach-related sequelae; and overall complications. Patients were categorized according to their body mass index (BMI). Obesity was defined as a BMI ≥ 30 kg/m2, and severe obesity was defined as a BMI ≥ 35 kg/m2.RESULTSThere were 238 patients (95 males and 143 females). There were no significant differences between the obese and nonobese groups in terms of sex, levels fused, or smoking status. For the entire cohort, there was no difference in operative time, blood loss, or complications when comparing obese and nonobese patients. However, a subset analysis of the 77 multilevel OLIFs that included L5–S1 demonstrated that the operative times for the nonobese group was 223.55 ± 57.93 minutes, whereas it was 273.75 ± 90.07 minutes for the obese group (p = 0.004). In this subset, the expected approach-related sequela rate was 13.2% for the nonobese group, whereas it was 33.3% for the obese group (p = 0.039). However, the two groups had similar blood loss (p = 0.476) and complication rates (p = 0.876).CONCLUSIONSObesity and morbid obesity generally do not increase the operative time, blood loss, approach-related sequelae, or complications following OLIF. However, obese patients who undergo multilevel OLIF that includes the L5–S1 level do have longer operative times or a higher rate of expected approach-related sequelae. Obesity should not be considered a contraindication to multilevel OLIF, but patients should be informed of potentially increased morbidity if the L5–S1 level is to be included.
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Moon, Myung-Sang. "Letter to the Editor: Surgery-Related Complications and Sequelae in Management of Tuberculosis of Spine." Asian Spine Journal 8, no. 6 (2014): 864. http://dx.doi.org/10.4184/asj.2014.8.6.864.
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Rovlias, Aristedis, Emmanuel Pavlakis, and Serafim Kotsou. "Symptomatic pneumorachis associated with incidental durotomy during microscopic lumbar disc surgery." Journal of Neurosurgery: Spine 5, no. 2 (August 2006): 165–67. http://dx.doi.org/10.3171/spi.2006.5.2.165.
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✓ Unintended incidental durotomy is not a rare complication of lumbar microsurgery and is usually recognized and treated immediately. The reconstruction process can be complicated further by unpredictable factors. To their knowledge, the authors report the first case of a symptomatic pneumorachis associated with the accidental awakening of a patient during reconstruction of an incidental durotomy following lumbar microdiscectomy. Incomplete cauda equina syndrome developed in the patient on awakening from surgery after reconstruction of an unintended incidental dural tear that occurred during lumbar microdiscectomy. Symptomatic pneumorachis was revealed on an emergency computed tomography scan, and the patient underwent immediate repeated operation to remove air and decompress the spinal canal. The increasing number and complexity of surgical procedures in the lumbar spine contribute to the growing incidence of unintended durotomy. The surgeon should be aware of rare complications that may arise. Development of a vacuum phenomenon in conjunction with a ball–valve mechanism may lead to pneumorachis during durotomy repair. If this rare complication is promptly recognized and confronted, the outcome will not be associated with long-term sequelae.
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Travers, Sarah S., and Thorkild V. Norregaard. "Spinal cord stimulator failure: Migration of a thoracic epidural paddle to the cervical spine." Surgical Neurology International 10 (June 25, 2019): 118. http://dx.doi.org/10.25259/sni-302-2019.
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Background: Spinal cord stimulators successfully treat a number of pain syndromes but carry a risk of hardware complications. Here, we present a case of cranial migration of a thoracic epidural paddle to the cervical spine. Case Description: A 53-year-old male underwent uncomplicated spinal cord stimulator placement at the T10– T11 with initially favorable results. However, postoperatively, he complained of paresthesias in his arms. An X-ray demonstrated cranial migration of the thoracic epidural paddle to the cervical spine. The stimulator/new paddle was placed again at the T10–T11 level, but the leads were now secured to the caudal lamina utilizing a cranial plating system. The patient subsequently did well without further sequelae. Conclusions: A thoracic epidural paddle (T10–T11) migrated postoperatively into the cervical spine. It was subsequently removed and replaced into the thoracic region, but the leads were now secured in place with a novel caudal lamina/cranial plating system.
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Jewett, GA, D. Yavin, P. Dhaliwal, T. Whittaker, J. Krupa, and S. Du Plessis. "Intrathecal morphine in lumbar spine surgery: a novel injection technique." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 42, S1 (May 2015): S49—S50. http://dx.doi.org/10.1017/cjn.2015.222.
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Background: Intrathecal morphine (ITM) is an efficacious method of providing post-operative analgesia. Despite adoption in many surgical fields, ITM has yet to become a standard of care in lumbar spine surgery. This may in part be attributed to concerns over precipitating a cerebrospinal fluid (CSF) leak following dural puncture. Methods: The dural sac is penetrated obliquely at a 30° angle to prevent overlap of dural and arachnoid puncture sites. Oblique injection in instances of limited dural exposure is made possible by introducing a 60° bend to a standard 30-gauge needle. Participating spinal surgeons were provided with brief instructions outlining the injection technique. Adherence and complications were collected prospectively. Results: The technique was applied to 98 cases of elective lumbar fusion at our institution. Two cases (2.0%) of non-adherence followed pre-injection dural tear. 96 cases of oblique ITM injection resulted in no attributable instances of post-operative CSF leakage. Two cases (2.1%) of transient, self-limited CSF leakage immediately following ITM injection were observed without associated sequelae or requirement for further intervention. Conclusions: Oblique dural puncture is not associated with increased incidence of post-operative CSF leakage. This safe and reliable method of delivery of ITM should be routinely considered in lumbar spine surgery.
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Jewett, Gordon A. E., Daniel Yavin, Perry Dhaliwal, Tara Whittaker, JoyAnne Krupa, and Stephan Du Plessis. "Oblique Intrathecal Injection in Lumbar Spine Surgery: A Technical Note." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 5 (May 8, 2017): 514–17. http://dx.doi.org/10.1017/cjn.2017.45.
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AbstractObjectives: Intrathecal morphine (ITM) is an efficacious method of providing postoperative analgesia and reducing pain associated complications. Despite adoption in many surgical fields, ITM has yet to become a standard of care in lumbar spine surgery. Spine surgeons’ reticence to make use of the technique may in part be attributed to concerns of precipitating a cerebrospinal fluid (CSF) leak. Methods: Herein we describe a method for oblique intrathecal injection during lumbar spine surgery to minimize risk of CSF leak. The dural sac is penetrated obliquely at a 30° angle to offset dural and arachnoid puncture sites. Oblique injection in instances of limited dural exposure is made possible by introducing a 60° bend to a standard 30-gauge needle. Results: The technique was applied for injection of ITM or placebo in 104 cases of lumbar surgery in the setting of a randomized controlled trial. Injection was not performed in two cases (2/104, 1.9%) following preinjection dural tear. In the remaining 102 cases no instances of postoperative CSF leakage attributable to oblique intrathecal injection occurred. Three cases (3/102, 2.9%) of transient CSF leakage were observed immediately following intrathecal injection with no associated sequelae or requirement for postsurgical intervention. In two cases, the observed leak was repaired by sealing with fibrin glue, whereas in a single case the leak was self-limited requiring no intervention. Conclusions: Oblique dural puncture was not associated with increased incidence of postoperative CSF leakage. This safe and reliable method of delivery of ITM should therefore be routinely considered in lumbar spine surgery.
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Miscusi, Massimo, Antonio Currà, Carlo Della Rocca, Paolo Missori, and Vincenzo Petrozza. "Acute motor-sensory axonal neuropathy after cervical spine surgery." Journal of Neurosurgery: Spine 17, no. 1 (July 2012): 82–85. http://dx.doi.org/10.3171/2012.4.spine11932.
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The authors report the case of a 55-year-old man who presented with acute motor-sensory axonal neuropathy (AMSAN), a variant of Guillain-Barré syndrome with a poor prognosis, immediately after surgery for resection of a cervical chondroma. A misdiagnosis of spinal cord shock due to an acute surgical or vascular postoperative complication was initially made in this patient. Nevertheless, there was continuous transient improvement that was followed by progressive worsening, and further investigation was necessary. The diagnosis of AMSAN, associated with acute colitis caused by Helicobacter pylori, was made based on neurophysiological examinations and colonoscopy. Interestingly, the patient also developed nephrotic syndrome, which was thought to be a further complication of the autoimmune reaction. Delayed administration of immunoglobulins (400 mg/kg/day), mesalazine (800 mg 3×/day), and meropenem (3 g/day) was used to treat the Helicobacter infection and the autoimmune reaction, leading to restoration of renal function and slight neurological improvement. The patient's general condition and neurological status improved slightly, but he remained seriously disabled (Frankel Grade C). This case demonstrates that a new onset of neurological symptoms in the early postoperative period after spine surgery could be related to causes other than iatrogenic myelopathy, and that an early diagnosis can reduce neurological sequelae, leading to a better outcome.
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Uribe, Juan S., Elias Dakwar, Rafael F. Cardona, and Fernando L. Vale. "Minimally Invasive Lateral Retropleural Thoracolumbar Approach: Cadaveric Feasibility Study and Report of 4 Clinical Cases." Operative Neurosurgery 68, suppl_1 (March 1, 2011): ons32—ons39. http://dx.doi.org/10.1227/neu.0b013e318207b6cb.
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Abstract BACKGROUND: Traditional anterior and posterior approaches to the thoracolumbar spine are associated with significant morbidity. In an effort to eliminate these drawbacks, minimally invasive retropleural approaches have been developed. OBJECTIVE: To demonstrate the feasibility and clinical experience of a minimally invasive lateral retropleural approach to the thoracolumbar spine. METHODS: Seven cadaveric dissections were performed in 7 fresh specimens to determine the feasibility of the technique. In each specimen, the lateral aspect of the vertebral body was accessed retropleurally, and a corpectomy was performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the extent of decompression. As an adjunct, 3 clinical cases of thoracic fractures and 1 neurofibroma were treated with this minimally invasive approach. Operative results, complications, and early outcomes were assessed. RESULTS: In the cadaveric study, adequate exposure was obtained to perform a lateral corpectomy and to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases without conversion to conventional approaches. A pleural tear was noted in the first clinical case, and a chest tube was placed without any long-term sequelae. CONCLUSION: Our early experience suggests that the minimally invasive lateral retropleural approach allows adequate vertebrectomy and canal decompression without the tissue disruption associated with posterolateral approaches. This approach may improve the complication rates that accompany open or endoscopic approaches for thoracolumbar corpectomies.
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Rometsch, Elke, Maarten Spruit, Jack E. Zigler, Venugopal K. Menon, Jean A. Ouellet, Christian Mazel, Roger Härtl, Kathrin Espinoza, and Frank Kandziora. "Screw-Related Complications After Instrumentation of the Osteoporotic Spine: A Systematic Literature Review With Meta-Analysis." Global Spine Journal 10, no. 1 (January 3, 2019): 69–88. http://dx.doi.org/10.1177/2192568218818164.
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Study Design: Systematic literature review with meta-analysis. Objective: Osteoporosis is common in elderly patients, who frequently suffer from spinal fractures or degenerative diseases and often require surgical treatment with spinal instrumentation. Diminished bone quality impairs primary screw purchase, which may lead to loosening and its sequelae, in the worst case, revision surgery. Information about the incidence of spinal instrumentation-related complications in osteoporotic patients is currently limited to individual reports. We conducted a systematic literature review with the aim of quantifying the incidence of screw loosening in osteoporotic spines. Methods: Publications on spinal instrumentation of osteoporotic patients reporting screw-related complications were identified in 3 databases. Data on screw loosening and other local complications was collected. Pooled risks of experiencing such complications were estimated with random effects models. Risk of bias in the individual studies was assessed with an adapted McHarm Scale. Results: From 1831 initial matches, 32 were eligible and 19 reported screw loosening rates. Studies were heterogeneous concerning procedures performed and risk of bias. Screw loosening incidences were variable with a pooled risk of 22.5% (95% CI 10.8%-36.6%, 95% prediction interval [PI] 0%-81.2%) in reports on nonaugmented screws and 2.2% (95% CI 0.0%-7.2%, 95% PI 0%-25.1%) in reports on augmented screws. Conclusions: The findings of this meta-analysis suggest that screw loosening incidences may be considerably higher in osteoporotic spines than with normal bone mineral density. Screw augmentation may reduce loosening rates; however, this requires confirmation through clinical studies. Standardized reporting of prespecified complications should be enforced by publishers.
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Soukup, Jan, Jan Cerny, Martin Cegan, Petr Kelbich, and Tomas Novotny. "Toxocariasis as a Rare Parasitic Complication of a Transthoracic Spine Surgery Procedure." Medicina 57, no. 12 (December 3, 2021): 1328. http://dx.doi.org/10.3390/medicina57121328.
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Human toxocariasis is a helminthozoonosis caused by the migration of Toxocara species larvae through an organism. The infection in humans is transmitted either by direct ingestion of the eggs of the parasite, or by consuming undercooked meat infested with Toxocara larvae. This parasitosis can be found worldwide, but there are significant differences in seroprevalence in different areas, depending mainly on hot climate conditions and on low social status. However, the literature estimates of seroprevalence are inconsistent. Infected patients commonly present a range of symptoms, e.g., abdominal pain, decreased appetite, restlessness, fever, and coughing. This manuscript presents a case report of a polytraumatic patient who underwent a two-phase spinal procedure for a thoracolumbar fracture. After the second procedure, which was a vertebral body replacement via thoracotomy, the patient developed a pathologic pleural effusion. A microscopic cytology examination of this effusion revealed the presence of Toxocara species larvae. Although the patient presented no specific clinical symptoms, and the serological exams (Enzyme–linked immunosorbent assay (ELISA), Western blot) were negative, the microscopic evaluation enabled a timely diagnosis. The patient was successfully treated with albendazole, with no permanent sequelae of the infection.
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Harel, Ran, Maya Nulman, and Nachshon Knoller. "Intraoperative imaging and navigation for C1-C2 posterior fusion." Surgical Neurology International 10 (July 26, 2019): 149. http://dx.doi.org/10.25259/sni_340_2019.
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Background: Cervical axial spine fusion is challenging as the anatomy is extremely variable, and screw misplacement can lead to severe complications. C1 lateral mass screws and C2 pedicle screws are routinely placed under either fluoroscopic guidance or imaging-assisted navigation. Here, we compared the two for axial screw placement. Methods: We retrospectively evaluated patients’ treated from 2011–2016 utilizing the Harm’s procedure for C1-C2 screw fixation performed under either fluoroscopic guidance (nine patients) or image-assisted O-arm navigation (five patients). The groups had similar demographic and risk factors. Variables studied included operative time, estimated blood loss (EBL), accuracy of screw placement, screw reposition rates, and reoperation rates. Results: The mean EBL was 555CC and 260CC, respectively (not a significant difference) utilizing fluoroscopic versus O-arm navigation. Of interest, the mean surgical duration was 27 min longer in the O-arm versus fluoroscopy group (P = 0.03). Ten C2 pedicle screws were performed using O-arm navigation. Alternatively, as 9 of 18 C2 pedicles were considered “risky” for the placement of fluoroscopic-guided pedicle screws, laminar screws were utilized. Although the accuracy rate of C1 and C2 screw placement was higher for the navigated group, this finding was not significant. Similarly, despite complications involving two unacceptably placed screws from the fluoroscopic guidance group, there were no neurological sequelae. Conclusion: Axial cervical spine instrumentation is challenging. Utilization of Imaging-assisted navigation increases the accuracy and safety of screw placement.
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McMahon, Paul, Marina Dididze, and Allan D. Levi. "Incidental durotomy after spinal surgery: a prospective study in an academic institution." Journal of Neurosurgery: Spine 17, no. 1 (July 2012): 30–36. http://dx.doi.org/10.3171/2012.3.spine11939.
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Object Incidental durotomies (IDs) are an unfortunate but anticipated potential complication of spinal surgery. The authors surveyed the frequency of IDs for a single spine surgeon and analyzed the major risk factors as well as the impact on long-term patient outcomes. Methods The authors conducted a prospective review of elective spinal surgeries performed over a 15-year period. Any surgery involving peripheral nerve only, intradural procedures, or dural tears due to trauma were excluded from analysis. The incidence of ID was categorized by surgery type including primary surgery, revision surgery, and so forth. Incidence of ID was also examined in the context of years of physician experience and training. Furthermore, the incidence and types of sequelae were examined in patients with an ID. Results Among 3000 elective spinal surgery cases, 3.5% (104) had an ID. The incidence of ID during minimally invasive procedures (3.3%) was similar, but no patients experienced long-term sequelae. The incidence of ID during revision surgery (6.5%) was higher. There was a marked difference in incidence between cervical (1.3%) and thoracolumbar (5.1%) cases. The incidence was lower for cases involving instrumentation (2.4%). When physician training was examined, residents were responsible for 49% of all IDs, whereas fellows were responsible for 26% and the attending for 25%. Among all of the cases that involved an ID, 7.7% of patients went on to experience a neurological deficit as compared with 1.5% of those without an ID. The overall failure rate of dural repair was 6.9%, and failure was almost 3 times higher (13%) in revision surgery as compared with a primary procedure (5%). Conclusions The authors established a reliable baseline incidence for durotomy after spine surgery: 3.5%. They also identified risk factors that can increase the likelihood of a durotomy, including location of the spinal procedure, type of procedure performed, and the implementation of a new procedure. The years of physician training or resident experience did not appear to be a major risk for ID.
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Faissal, Zahrawi, Manzi Brian, and Sager Jill. "Comparative Retrospective Analysis of Accuracy of Robotic-Guided versus Fluoroscopy-Guided Percutaneous Pedicle Screw Placement in Adults with Degenerative Spine Disease." Open Orthopaedics Journal 12, no. 1 (December 31, 2018): 576–82. http://dx.doi.org/10.2174/1874325001812010576.
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Background:Robotic-guidance for pedicle screws can reportedly increase placement accuracies and surgical efficiencies especially in percutaneous approaches.Objective:The study aimed to compare the accuracy of percutaneous pedicle screw placement and post-operative course of robotic-guidance versus fluoroscopy-guidance performed by a surgeon experienced in performing fluoroscopy-guided MIS spinal fusions.Study Design:This is a retrospective medical chart review of 2 cohorts of consecutive patients operated by the same surgeon.Methods:Medical records of adults suffering from degenerative spine disease treated by percutaneous spinal fusion surgeries with robotic-guidancevs. fluoroscopy-guidance were reviewed. Endpoints included pedicle screw placement accuracy (on post-operative CTs) and surgical complications and revisions.Results:Ninety-nine patients were reviewed in each arm which were similar in demographics and surgical indications. The robotic arm had 5.8 screws per case on average and 6.0 in the control arm (p=0.65). No significant differences were found in postoperative complication rates revision surgeries length of stay duration of surgery screw implantation times blood loss or results of Oswestry Disability Index questionnaires.Post-operative CTs were available for 52 patients (293 screws) in the robotic arm and 70 (421 screws) in the freehand controls. In the robotic arm 100% of screws were found accurately placed within the “safe zone”vs. 410 screws (97.4%) in the control arm (p=0.005). Of 11 breaching screws in the control arm one breached by 6mm but the patient did not suffer from any sequelae (12-month follow-up). The average follow up period was 9.2±4 months in the robotic-guided arm and 10.5±3 in the control arm. There were no significant differences in complications or revisions.Conclusion:A modest yet statistically significant increase in pedicle screw placement accuracy was observed with robotic-guidance compared to freehand. Larger prospective studies are needed to demonstrate differences in clinical outcomes.
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Rajaraman, Viswanathan, Roy Vingan, Patrick Roth, Robert F. Heary, Lisa Conklin, and George B. Jacobs. "Visceral and vascular complications resulting from anterior lumbar interbody fusion." Journal of Neurosurgery: Spine 91, no. 1 (July 1999): 60–64. http://dx.doi.org/10.3171/spi.1999.91.1.0060.
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Object. The literature on abdominal and general surgery—related complications following anterior lumbar interbody fusion (ALIF) is scant. In this retrospective review of 60 patients in whom ALIF was performed at their institutions between 1996 and 1998, the authors detail the associated complications and their correlation with perioperative factors. The causes, strategies for their avoidance, and the clinical course of these complications are also discussed. Methods. The study group was composed of 31 men and 29 women whose mean age was 42 years (range 29–71 years). The preoperative diagnosis was discogenic back pain in 33 patients (55%); failed back syndrome in 11 (18.3%); pseudarthrosis in five (8.3%); postlaminectomy syndrome in four (6.6%); spondylolisthesis in three (5%); burst fracture in two (3.3%); and malignancy in two (3.3%). A retroperitoneal approach to the spine was used in 57 of the 60 patients. One interspace was exposed in 28 patients (46.6%), two in 28 (46.6%), and three in four (6.6%). Discectomy and interbody fusion in which the authors placed titanium cages or bone dowels was performed in 56 patients and corpectomy with instrumentation in four. Seven (11.6%) of 60 patients had undergone previous abdominal surgery and 29 (48.3%) had undergone previous spinal surgery. The follow-up period averaged 12 ± 4 months (mean ± standard deviation). Twenty-four general surgery—related complications occurred in 23 patients (38.3%), including sympathetic dysfunction in six; vascular injury in four; somatic neural injury in three; sexual dysfunction in three; prolonged ileus in three; wound incompetence in two; and deep venous thrombosis, acute pancreatitis, and bowel injury in one patient each. There were no deaths. The incidence of complications was not associated with underlying diagnosis (p > 0.1), age (p > 0.5), previous abdominal or spinal surgery (p > 0.1), or the number of levels exposed (p > 0.1). Conclusions. This report provides a detailed analysis of the general surgery—related complications following ALIF. Although many of these complications have been recognized in the literature, the significance of sympathetic dysfunction appears to have been underestimated. The high incidence of complications in this series likely reflects the strict criteria. Many of these complications were minor and resolved over time without long-term sequelae.
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Amarante, Matthew A., Jeffrey A. Shrensel, Krystal L. Tomei, Peter W. Carmel, and Chirag D. Gandhi. "Management of urological dysfunction in pediatric patients with spinal dysraphism: review of the literature." Neurosurgical Focus 33, no. 4 (October 2012): E4. http://dx.doi.org/10.3171/2012.7.focus12232.
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An intact, fully functional spine is the result of a complex sequence of embryological events involving both nervous and musculoskeletal system precursors. Deviations from this highly ordered system can result in congenital abnormalities ranging from clinically insignificant cosmetic changes to CNS malformations that are incompatible with life. Closure of the neural tube, which is believed to be the embryological event gone awry in these cases, is complete by just 28 days' gestation, often before pregnancy is detected. Although progress has been made to help prevent neural tube defects in the children of those attempting to conceive, these congenital deformities unfortunately continue to affect a startling number of infants worldwide each year. Furthermore, the precise mechanisms governing closure of the neural tube and how they might be interrupted remain elusive. What is known is that there are a large number of individuals who must deal with congenital spine dysraphism and the clinical sequelae on a daily basis. Bladder and urinary dysfunction are frequently encountered, and urological care is a critical, often neglected, component in the lifelong multidisciplinary approach to treatment. Although many treatment strategies have been devised, a need remains for evidence-based interventions, analysis of quality of life, and preemptive education of both caregivers and patients as they grow older. Pediatric neurosurgeons in particular have the unique opportunity to address these issues, often in the first few days of life and throughout pre- and postoperative evaluation. With proper management instituted at birth, many patients could potentially delay or avoid the potential urological complications resulting from congenital neurogenic bladder.
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Kwan, Kevin, Julia R. Schneider, Victor Du, Lukas Falting, John A. Boockvar, Jonathan Oren, Mitchell Levine, and David J. Langer. "Lessons Learned Using a High-Definition 3-Dimensional Exoscope for Spinal Surgery." Operative Neurosurgery 16, no. 5 (August 14, 2018): 619–25. http://dx.doi.org/10.1093/ons/opy196.
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Abstract BACKGROUND The operative microscope has significantly advanced modern neurosurgical spine surgery but continues to be limited by high costs, suboptimal optics, poor ergonomics, and difficulties with maneuverability. We believe the novel 4K high-definition (4K-HD) 3-dimensional (3D) exoscope (EX), may improve the surgical corridor through advancements in illumination, ergonomics, magnification, and depth of field and has the potential to be utilized in neurosurgical education and training. OBJECTIVE To evaluate the surgical potential of a novel 3D EX system in spinal surgery. METHODS Retrospective analysis over 6 mo of all patients who have undergone spinal surgery at Northwell Health using the 3D EX. Nuances of surgical theater positioning, advantages/disadvantages of the EX and clinical sequelae of the patients were analyzed. RESULTS All 10 patients who underwent spinal surgery utilizing the EX experienced excellent surgical and clinical outcomes without complications. The low-profile EX allowed for excellent operative corridors and instrument maneuverability. The large monitor also resulted in an immersive surgical experience, and gave team members the same 3D vision as the operator. CONCLUSION This study demonstrates the feasibility of utilizing the 3D 4K-HD EX system and highlights potential technical assets of this novel technology in regard to optics, ergonomics, and maneuverability. Further clinical research is needed to examine the clinical effectiveness of the EX system for different surgical approaches through quantitative methodology.
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Mahajan, Neetin, Sunny Sangma, Jayesh Mhatre, and Pritam Talukder. "Case Series of the Management of Surgical Site Infection following Thoracic Spinal Surgeries during COVID Pandemic." Back Bone Journal 3, no. 1 (2022): 24–31. http://dx.doi.org/10.13107/bbj.2022.v03i01.036.
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Introduction: Post-operative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and post-operative care, wound infection continues to compromise patient outcome after spinal surgery. This kind of infection places the patient at risk for pseudoarthrosis, adverse neurologic sequelae, chronic pain, deformity, and even death. In spite of all preventive measures, the SSI following spinal surgeries are 1% among operated spinal instrumentation. Case Series: Here, we present a series of three patients who presented to us with post-operative surgical site infection (SSI) in spine surgery in the form of wound, discharge, and other complaints. Out of all, two of them were operated with debridement and skin closure followed by broad spectrum IV antibiotics and one of them managed with vacuum-assisted closure dressing and high antibiotics sensitive to organisms found in wound culture. Optimization by building up hemoglobin, supplementing micronutrients including Vitamin C, D, and B12 and high protein diet was started as adjuvant therapy and all of them was discharged with healthy wound. Conclusion: SSI in spine surgery is a common but challenging complication, particularly after instrumental spinal arthrodesis. Using meticulous aseptic technique, intra-operative irrigation, prophylactic antibiotics, and optimizing patient factors preoperatively are key to preventing a SSI. In patients who still develop an infection despite efforts at prevention, timely diagnosis and treatment are critical. Instrumentation can be retained while still successfully clearing an early infection, although following fusion, instrumentation can be removed if lifetime oral antibiotic suppression is either not indicated or undesirable. Keywords: Spine surgery, Postoperative infections, Surgical site infection, Spinal instrumentation.
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Ignacio, Jose Manuel Fernando, and Katrina Hannah Dizon Ignacio. "Pulmonary Embolism from Cement Augmentation of the Vertebral Body." Asian Spine Journal 12, no. 2 (April 30, 2018): 380–87. http://dx.doi.org/10.4184/asj.2018.12.2.380.
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<p>Pulmonary cement embolism (PCE) can follow cement augmentation procedures for spine fractures due to osteoporosis, traumatic injuries, and painful metastatic lesions. PCE is underreported and it is likely that many cases remain undiagnosed. Risk factors for PCE have been identified, which can help alert clinicians to patients likely to develop the condition, and there are recommended techniques to reduce its incidence. Most patients with PCE are asymptomatic or only develop transient symptoms, although a few may exhibit florid cardiorespiratory manifestations which can ultimately be fatal. Diagnosis is mainly by radiographic means, commonly using simple radiographs and computed tomography scans of the chest with ancillary tests that assess the patient's cardiorespiratory condition. Management depends on the location and size of the emboli as well as the patient's symptomatology. The aim of this review is to raise awareness of the not uncommon complications of PCE following vertebral cement augmentation and the possibility of serious sequelae. Recommendations for the diagnosis and management of PCE are presented, based on the most recent literature.</p>
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Murase, Shuhei, Yasushi Oshima, Yujiro Takeshita, Kota Miyoshi, Kazuhito Soma, Naohiro Kawamura, Junichi Kunogi, et al. "Anterior cage dislodgement in posterior lumbar interbody fusion: a review of 12 patients." Journal of Neurosurgery: Spine 27, no. 1 (July 2017): 48–55. http://dx.doi.org/10.3171/2016.12.spine16429.
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OBJECTIVEInterbody fusion cages are widely used to achieve initial fixation and secure spinal fusion; however, there are certain technique-related complications. Although anterior cage dislodgement can cause major vascular injury, the incidence is extremely rare. Here, the authors performed a review of anterior cage dislodgement following posterior lumbar interbody fusion (PLIF) surgery.METHODSThe authors retrospectively reviewed the cases of 4625 patients who had undergone PLIF at 6 institutions between December 2007 and March 2015. They investigated the incidence and causes of surgery-related anterior cage dislodgement, salvage mechanisms, and postoperative courses.RESULTSAnterior cage dislodgement occurred in 12 cases (0.26%), all of which were caused by technical errors. In 9 cases, excessive cage impaction resulted in dislodgement. In 2 cases, when the cage on the ipsilateral side was inserted, it interacted and pushed out the other cage on the opposite side. In 1 case, the cage was positioned in an extreme lateral and anterior part of the intervertebral disc space, and it postoperatively dislodged. In 3 cases, the cage was removed in the same operative field. In the remaining 9 cases, CT angiography was performed postoperatively to assess the relationship between the dislodged cage and large vessels. Dislodged cages were conservatively observed in 2 cases. In 7 cases, the cage was removed because it was touching or compressing large vessels, and an additional anterior approach was selected. In 2 patients, there was significant bleeding from an injured inferior vena cava. There were no further complications or sequelae associated with the dislodged cages during the follow-up period.CONCLUSIONSAlthough rare, iatrogenic anterior cage dislodgement following a PLIF can occur. The authors found that technical errors made by experienced spine surgeons were the main causes of this complication. To prevent dislodgement, the surgeon should be cautious when inserting the cage, avoiding excessive cage impaction and ensuring cage control. Once dislodgement occurs, the surgeons must immediately address this difficult complication. First, the possibility of a large vessel injury should be considered. If the patient’s vital signs are stable, the surgeon should continue with the surgery without cage removal and perform CT angiography postoperatively to assess the cage location. Blind maneuvers should be avoided when the surgical site cannot be clearly viewed. When the cage compresses or touches the aortic artery or vena cava, it is better to remove the cage to avoid late-onset injury to major vessels. When the cage does not compress or touch vessels, its removal is controversial. The risk factors associated with performing another surgery should be evaluated on a case-by-case basis.
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Tsirikos, Athanasios I., and Sarah J. Wordie. "The surgical treatment of spinal deformity in children with non-ambulatory myelomeningocele." Bone & Joint Journal 103-B, no. 6 (June 1, 2021): 1133–41. http://dx.doi.org/10.1302/0301-620x.103b6.bjj-2020-2158.r1.
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Aims To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele. Methods We reviewed 12 consecutive patients (7M:5F; mean age 12.4 years (9.2 to 16.8)) including demographic details, spinopelvic parameters, surgical correction, and perioperative data. We assessed the impact of surgery on patient outcomes using the Spina Bifida Spine Questionnaire and a qualitative questionnaire. Results The mean follow-up was 5.4 years (2 to 14.9). Nine patients had kyphoscoliosis, two lordoscoliosis, and one kyphosis. All patients had a thoracolumbar deformity. Mean scoliosis corrected from 89.6° (47° to 151°) to 46.5° (17° to 85°; p < 0.001). Mean kyphosis corrected from 79.5° (40° to 135°) to 49° (36° to 65°; p < 0.001). Mean pelvic obliquity corrected from 19.5° (8° to 46°) to 9.8° (0° to 20°; p < 0.001). Coronal and sagittal balance restored to normal. Complication rate was 58.3% (seven patients) with no neurological deficits, implant failure, or revision surgery. The degree of preoperative spinal deformity, especially kyphosis and lordosis, correlated with increased blood loss and prolonged hospital/intensive care unit stay. The patients reported improvement in function, physical appearance, and pain after surgery. The parents reported decrease in need for everyday care. Conclusion Anterior spinal fusion achieved satisfactory deformity correction with high perioperative complication rates, but no long-term sequelae among children with high level myelomeningocele. This resulted in physical and functional improvement and high reported satisfaction. Cite this article: Bone Joint J 2021;103-B(6):1133–1141.
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Drazin, Doniel, George Hanna, Faris Shweikeh, Sunil Jeswani, Leah Lovely, Richard Sokolov, and John C. Liu. "Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature." Case Reports in Infectious Diseases 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/647486.
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Varicella-zoster virus and herpes simplex virus types 1 and 2 are neurotropic viruses that can be reactivated after a surgical or stressful intervention. Although such cases are uncommon, consequences can be debilitating, and variable treatment responses merit consideration. We describe a 41-year-old male with a history of varicella-mediated skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution following a C5-6 anterior cervical discectomy and fusion and epidural steroid injections. The operative course was uncomplicated and he was discharged home on postoperative day 1. Approximately ten days after surgery, the patient presented to the emergency department complaining of severe pain in his right upper extremity and a vesicular rash from his elbow to his second digit. He was started on Acyclovir and discharged home. On outpatient follow-up, his rash had resolved though his pain continued. The patient was started on a neuromodulating agent for chronic pain. This case adds to the limited literature regarding this rare complication, brings attention to the symptoms for proper diagnosis and treatment, and emphasizes the importance of prompt antiviral therapy. We suggest adding a neuromodulating agent to prevent long-term sequelae and resolve acute symptoms.
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Dakwar, Elias, Tien V. Le, Ali A. Baaj, Anh X. Le, William D. Smith, Behrooz A. Akbarnia, and Juan S. Uribe. "Abdominal wall paresis as a complication of minimally invasive lateral transpsoas interbody fusion." Neurosurgical Focus 31, no. 4 (October 2011): E18. http://dx.doi.org/10.3171/2011.7.focus11164.
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Object The minimally invasive lateral transpsoas approach for interbody fusion has been increasingly employed to treat various spinal pathological entities. Gaining access to the retroperitoneal space and traversing the abdominal wall poses a risk of injury to the major nervous structures. Nerve injury of the abdominal wall can potentially lead to paresis of the abdominal musculature and bulging of the abdominal wall. Abdominal wall nerve injury resulting from the minimally invasive lateral retroperitoneal transpsoas approach has not been previously reported. The authors describe a case series of patients presenting with paresis and bulging of the abdominal wall after undergoing a minimally invasive lateral retroperitoneal approach. Methods The authors retrospectively reviewed all patients who underwent a minimally invasive lateral transpsoas approach for interbody fusion and in whom development of abdominal paresis developed; the patients were treated at 4 institutions between 2006 and 2010. All data were recorded including demographics, diagnosis, operative procedure, positioning, hospital course, follow-up, and complications. The onset, as well as resolution of the abdominal paresis, was reviewed. Results The authors identified 10 consecutive patients in whom abdominal paresis developed after minimally invasive lateral transpsoas spine surgery out of a total of 568 patients. Twenty-nine interbody levels were fused (range 1–4 levels/patient). There were 4 men and 6 women whose mean age was 54.1 years (range 37–66 years). All patients presented with abdominal paresis 2–6 weeks postoperatively. In 8 of the 10 patients, abdominal wall paresis had resolved by the 6-month follow-up visit. Two patients only had 1 and 4 months of follow-up. No long-term sequelae were identified. Conclusions Abdominal wall paresis is a rare but known potential complication of abdominal surgery. The authors report the first case series associated with the minimally invasive lateral transpsoas approach.
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Alshareef, Mohammed Abdul, Gibson Klapthor, Stephen R. Lowe, Jessica Barley, David Cachia, and Bruce M. Frankel. "Strategies for posterior-only minimally invasive surgery in thoracolumbar metastatic epidural spinal cord compression." Surgical Neurology International 11 (December 22, 2020): 462. http://dx.doi.org/10.25259/sni_815_2020.
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Background: Metastatic epidural spinal cord compression (MESCC) is a debilitating sequela of cancer. Here, we evaluated various subtypes of posterior-only minimally invasive spinal (MIS) procedures utilized to address different cancers. Methods: Within this retrospective review, we analyzed the treatment of thoracolumbar MESCC treated with three MIS techniques: decompression and fusion (Subgroup A), partial corpectomy (Subgroup B), and full corpectomy (Subgroup C). Results: There were 51 patients included in the study; they averaged 58.7 years of age, and 51% were females. Most tumors were in the thoracic spine (51%). The average preoperative Frankel grade was D (62.7%); 69% (35) improved postoperatively. The patients were divided as follows: subgroup A (15 patients = 29.4%), B (19 patients = 37.3%), and C (17 patients = 33.3%). The length of hospitalization was similar (~5.4 days) for all groups. The overall complication rate was 31%, while blood loss was lower in Subgroups A and B versus C. Conclusion: Different MIS surgical techniques were utilized in patients with thoracic and/or lumbar MESCC. Interestingly, clinical outcomes were similar between MIS subgroups, in this study, with a trend toward higher complications and greater blood loss associated with those undergoing more aggressive MIS procedures (e.g., full corpectomy and fusion).
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Moore, Robert D., and John R. Miklos. "Vaginal Repair of Cystocele with Anterior Wall Mesh via Transobturator Route: Efficacy and Complications with Up to 3-Year Followup." Advances in Urology 2009 (2009): 1–8. http://dx.doi.org/10.1155/2009/743831.
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Study Objective. The objective of this study was to report on the safety and efficacy of cystocele repair with anterior wall mesh placed via a transobturator route (Perigee system, AMS, Minnetonka, MN).Design. Single center retrospective study.Setting. Single center hospital setting and Urogynecology practice in the United States.Patients. 77 women presenting with symptomatic anterior wall prolapse.Intervention. Repair of cystocele with an anterior wall Type I soft-polypropylene mesh placed via a transobturator approach. Concomitant procedures in other compartment were also completed as indicated.Measurements and Main Results. 77 women underwent the Perigee procedure at our institution over a 2-year period. The mesh was attached to the pelvic sidewalls at the level of the bladder neck and near the ischial spine apically with needles passed through the groins and obturator space. Mean follow-up was 18.2 months (range 3–36 months). Objective cure rate was 93%. Subjectively only two patients have had recurrent symptoms of prolapse, and only 1 of these has required repeat surgery for cystocele. Mesh exposure vaginally occurred in 5 patients (6.5%); however all were treated with estrogen and/or local excision of exposed mesh and had no further sequelae. There were no incidences of chronic pain, infection, or abscess, and no patient required complete mesh removal for infection, pain, or extrusion.Conclusion. In select patients with anterior wall prolapse, repair with mesh augmentation via the transobturator route is a safe and effective procedure with up to 3 years of follow-up.
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Sheperd, Courtney S., and William F. Young. "Instrumented Outpatient Anterior Cervical Discectomy and Fusion: Is it Safe?" International Surgery 97, no. 1 (January 1, 2012): 86–89. http://dx.doi.org/10.9738/cc35.1.
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Abstract Anterior cervical discectomy and fusion procedures are one of the most common procedures performed in spinal surgery. Increasingly they are being performed on an outpatient basis. The primary impetus for performing procedures as an outpatient is potential cost savings. However, there are few studies discussing the safety of performing the procedure in an ambulatory setting. This is a retrospective review of our initial experience in performing anterior cervical discectomy and fusion procedures with instrumentation (ACDFI) in an ambulatory surgery center dedicated to spine surgery. Patients were selected for outpatient surgery if they had limited co-morbidities and the surgery involved only 1 or 2 levels. One hundred fifty-two patients underwent outpatient ACDFI during the study period (2007–2009). Six patients returned to the hospital emergency room after discharge. The reasons for evaluation included 2 for neck pain, 1 for dysphagia, 1 for vocal cord paralysis and dysphagia, 1 for nausea, and 1 for cervical swelling. Only 1 of the 6 patients required admission to the hospital. None of the 6 suffered any long-term sequelae. The overall complication rate was 3.9%. A self-reported survey was completed by 75 patients within 6 months of surgery, and there was a 100% satisfaction rate among responders. ACDFI can be performed safely on an outpatient in selected patients with a high degree of patient satisfaction. Our experience is consistent with those of previous investigators.
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Niu, Tianyi, Derek S. Lu, Andrew Yew, Darryl Lau, Haydn Hoffman, David McArthur, Dean Chou, and Daniel C. Lu. "Postoperative Cerebrospinal Fluid Leak Rates with Subfascial Epidural Drain Placement after Intentional Durotomy in Spine Surgery." Global Spine Journal 6, no. 8 (April 13, 2016): 780–85. http://dx.doi.org/10.1055/s-0036-1582392.
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Study Design Retrospective chart review. Objective Postoperative cerebrospinal fluid (CSF) leak is a known complication of intraoperative durotomy. Intraoperative placement of subfascial epidural drains following primary dural repair has been proposed as a potential management strategy to prevent formation of CSF cutaneous fistula and symptomatic pseudomeningocele. Here we describe our experience with subfascial drain after intentional durotomy. Methods Medical records of patients who underwent placement of subfascial epidural drains during spinal procedures with intentional intraoperative durotomies over a 4-year period at two institutions were retrospectively reviewed. Primary outcomes of interest were postoperative CSF cutaneous fistula or symptomatic pseudomeningocele formation. Results Twenty-five patients were included. Mean length of follow-up was 9.5 months. Twelve patients (48%) underwent simultaneous arthrodesis. The average duration of the drain was 5.3 days with average daily output of 126.5 mL. Subgroup analyses revealed that average drain duration for the arthrodesis group was 6.33 days, which is significantly greater than that of the nonfused group, which was 3.7 days ( p = 0.016). Similarly, the average daily drain output for the arthrodesis subgroup at 153.1 mL was significantly higher than that of the nonfused subgroup (86.8 mL, p = 0.04). No patient developed postoperative CSF cutaneous fistula or symptomatic pseudomeningocele or had negative sequelae associated with overdrainage of CSF. One patient had a delayed wound infection. Conclusions The intraoperative placement of subfascial epidural drains was not associated with postoperative development of CSF cutaneous fistula, symptomatic pseudomeningocele, overdrainage, or subdural hematoma in the cases reviewed. Subfascial closed wound drain placement is a safe and efficacious management method after intentional spinal durotomies. It is particularly helpful in those who undergo simultaneous arthrodesis, as those patients have statistically higher daily drain output and longer drain durations.
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Panico, Caroline Thomaz, Priscila Rosalba Domingos de Oliveira, Vladimir Cordeiro de Carvalho, Angélica Makio dos Anjos, Vanessa Ferreira Amorim de Melo, and Ana Lucia Lei Munhoz Lima. "Clinical–epidemiological profile of confirmed cases of osteoarticular tuberculosis." Journal of Bone and Joint Infection 8, no. 1 (January 5, 2023): 11–17. http://dx.doi.org/10.5194/jbji-8-11-2023.
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Abstract. Introduction: tuberculosis (TB) remains a major cause of morbidity and mortality worldwide. The incidence of TB has increased since the 1980s. Given the increasing prevalence of TB worldwide, osteoarticular TB (OATB) is a significant health problem. Methods: retrospective study of a case series of hospitalized patients with confirmed OATB by culture or histopathological examination who were seen at a reference orthopedic hospital in São Paulo, Brazil, from 2014 to 2019. Results: thirty patients with confirmed bone and joint TB were seen from 2014 to 2019. The main sites of OATB were the spine (83.3 %) and the appendicular skeleton (26.7 %). Indication of surgical treatment was significantly related to the need for hospitalization (p=0.009) and the increased length of hospital stay (p=0.005). Presence of sequelae at the end of treatment was correlated with the presence of motor deficit at the time of OATB diagnosis (p=0.035) as well as with initial presence of functional limitation (p=0.025) and with high value of C-reactive protein at the end of treatment (p=0.037). Conclusions: the delay in the onset of clinical and laboratory signs of cases of osteoarticular infections hinders the early diagnosis and treatment of the disease, resulting in major complications sometimes requiring surgical treatment and consequently leading to a prolonged hospital stay, evidence of high inflammatory activities, and the presence of neurological deficits.
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Scheufler, Kai-Michael, Joerg Franke, Anke Eckardt, and Hildegard Dohmen. "Accuracy of Image-Guided Pedicle Screw Placement Using Intraoperative Computed Tomography-Based Navigation With Automated Referencing. Part II: Thoracolumbar Spine." Neurosurgery 69, no. 6 (June 30, 2011): 1307–16. http://dx.doi.org/10.1227/neu.0b013e31822ba190.
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Abstract BACKGROUND Image-guided spinal instrumentation may reduce complications in spinal instrumentation. OBJECTIVE To assess accuracy, time efficiency, and staff radiation exposure during thoracolumbar screw instrumentation guided by intraoperative computed tomography (iCT)-based neuronavigation (iCT-N). METHODS In 55 patients treated for idiopathic and degenerative deformities, 826 screws were inserted in the thoracic (T2–T12; n = 243) and lumbosacral (L1–S1; n = 545) spine, as well as ilium (n = 38) guided by iCT-N. Up to 17 segments were instrumented following a single automated registration sequence with the dynamic reference arc (DRA) uniformly attached to L5. Accuracy of iCT-N was assessed by calculating angular deviations between individual navigated tool trajectories and final implant positions. Final screw positions were also graded according to established classification systems. Clinical and radiological outcome was assessed at 12 to 14 months. RESULTS Additional intraoperative fluoroscopy was unnecessary, eliminating staff radiation exposure. Unisegmental K-wire insertion required 4.6 ± 2.9 minutes. Of the thoracic pedicle screws 98.4% were assigned grades I to III according to the Heary classification, with 1.6% grade IV placement. In the lumbar spine, 94.4% of screws were completely contained (Gertzbein classification grade 0), 4.6% displayed minor pedicle breaches <2 mm (grade 1), and 1% of lumbar screws deviated by >2 to <4 mm (grade 2). The accuracy of iCT-N progressively deteriorates with increasing distance from the DRA, but allows safe instrumentation of up to 12 segments. CONCLUSION iCT-N using automated referencing allows for safe, highly accurate multilevel instrumentation of the entire thoracolumbosacral spine and ilium, rendering additional intraoperative imaging dispensable. In addition, automated registration is time-efficient and significantly reduces the need for re-registration in multilevel surgery.
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Fehlings, Michael G., Paul R. Cooper, and Thomas J. Errico. "Posterior plates in the management of cervical instability: long-term results in 44 patients." Journal of Neurosurgery 81, no. 3 (September 1994): 341–49. http://dx.doi.org/10.3171/jns.1994.81.3.0341.
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✓ Although posterior plates are increasingly used to manage cervical spinal instability, long-term follow-up evaluation of patients with a critical analysis of efficacy and complications has not been reported. The authors have retrospectively analyzed the outcome in 44 consecutive patients (37 males and seven females, age range 16 to 80 years) treated with posterior cervical plates. The indications for instrumentation were instability due to trauma in 42 cases, tumor in one, and infection in one. In four patients the follow-up period was limited to 3, 5, 11, and 16 months. Two patients died of chronic medical problems 4 and 9 months after treatment. The remaining 38 patients were followed from 2 to 6 years (mean 46 months). One motion segment was stabilized in 23 patients using two-hole plates; two motion segments were stabilized in the other 21 patients using three-hole plates. In the majority of patients (37 cases), supplemental bone grafting was not used. Patients were immobilized postoperatively in a Philadelphia collar. Solid arthrodesis was achieved in 39 (93%) of 42 patients. Three patients required revision of the cervical plating: in one patient with a C-5 burst fracture, two-hole plates were applied at C5–6 and progressive kyphosis mandated anterior fusion; the second patient required posterior wiring due to screw pull-out resulting from a technical error in screw insertion; the third patient, who refused to wear an orthosis postoperatively, also developed screw pull-out. In two patients who went on to spinal fusion, there was an increase in sagittal kyphosis (6° and 8°) without clinical sequelae. Screw loosening was noted in five patients, involving eight (3.8%) of the 210 lateral mass screws; this complication resulted in instrumentation failure or increased kyphosis in three cases. There were two superficial infections. This analysis indicates that posterior cervical plating is highly effective; at long-term follow-up review the cervical spine was successfully stabilized in 93% of cases. Plate failure was related to faulty screw placement, failure to include sufficient motion segments, and noncompliance with postoperative orthoses. Halo vest immobilization was unnecessary and supplemental bone grafting was generally not required for recent trauma.
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Black, Perry. "Laminotomy/medial facet approach in the excision of thoracic disc herniation." Neurosurgical Focus 9, no. 4 (October 2000): 1–3. http://dx.doi.org/10.3171/foc.2000.9.4.6.
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Object The author describes a technique of thoracic discectomy that has evolved from the posterolateral transfacet and the transpedicular approaches but that spares the pedicle and most of the facet joint. Methods This approach was used to remove a total of 11 discs (T6–12) in seven patients. The follow-up period ranged from 8 months to 3 years. In four patients with axial and/or girdle pain significant improvement was demonstrated. The paraparesis in one patient with myelopathy improved postoperatively; that in another patient improved but recurred 8 months postoperatively. In one patient who experienced preoperative leg weakness, the weakness was slightly increased postoperatively, but this sequela was only transient. There were no other complications, and there were no deaths. Conclusions This technique appears safe and effective. It can be adapted to the conventional laminectomy known to spine surgeons and requires no specialized instruments. Further trials appear warranted.
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Eleraky, Mohammed A., Carlos Llanos, and Volker K. H. Sonntag. "Cervical corpectomy: report of 185 cases and review of the literature." Journal of Neurosurgery: Spine 90, no. 1 (January 1999): 35–41. http://dx.doi.org/10.3171/spi.1999.90.1.0035.
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Object. This study was conducted to determine the indications, safety, efficacy, and complication rate associated with performing corpectomy to achieve anterior decompression of neural elements or for removing anterior lesions. Methods. Between 1987 and 1998, 185 patients underwent cervical corpectomy for the treatment of degenerative spondylitic disease (81 cases), ossification of posterior longitudinal ligament (16 cases), correction of postoperative kyphosis (31 cases), trauma (39 cases), tumor (10 cases), and infection (eight cases). Ninety-nine patients presented with myelopathy, 48 with radiculomyelopathy, 24 with radicular pain, and 14 with neck muscle pain. Eighty-seven patients underwent a one-level corpectomy; 45 of these patients underwent a discectomy at a different level. Seventy patients underwent a two-level corpectomy; 27 of these patients underwent a discectomy at a different level. Twenty-eight patients underwent a three-level corpectomy. Autograft (iliac crest) was used in 141 cases and allograft (fibula) in 44 cases. All but six patients underwent fixation with an anterior plate-screw system. There were no operative deaths. During the procedure the vertebral artery was injured in four patients and preserved in two of them. No neurological sequelae were encountered. Postoperative hoarseness, transient dysphagia, and pain at the graft site were transitory and successfully managed. The fusion rate was 98.8%. Six patients experienced transient deterioration after surgery but they improved. No patient experienced permanent neurological deterioration and 160 (86.5%) improved. Conclusions. Corpectomy has an important role in the management of various degenerative, traumatic, neoplastic, or infectious disorders of cervical spine. Following treatment in this series, radiculopathy always improved and myelopathy was reversed in most patients.
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Nasser, Rani, Sanjay Yadla, Mitchell G. Maltenfort, James S. Harrop, D. Greg Anderson, Alexander R. Vaccaro, Ashwini D. Sharan, and John K. Ratliff. "Complications in spine surgery." Journal of Neurosurgery: Spine 13, no. 2 (August 2010): 144–57. http://dx.doi.org/10.3171/2010.3.spine09369.
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Object The overall incidence of complications or adverse events in spinal surgery is unknown. Both prospective and retrospective analyses have been performed, but the results have not been critically assessed. Procedures for different regions of the spine (cervical and thoracolumbar) and the incidence of complications for each have been reported but not compared. Authors of previous reports have concentrated on complications in terms of their incidence relevant to healthcare providers: medical versus surgical etiology and the relevance of perioperative complications to perioperative events. Few authors have assessed complication incidence from the patient's perspective. In this report the authors summarize the spine surgery complications literature and address the effect of study design on reported complication incidence. Methods A systematic evidence-based review was completed to identify within the published literature complication rates in spinal surgery. The MEDLINE database was queried using the key words “spine surgery” and “complications.” This initial search revealed more than 700 articles, which were further limited through an exclusion process. Each abstract was reviewed and papers were obtained. The authors gathered 105 relevant articles detailing 80 thoracolumbar and 25 cervical studies. Among the 105 articles were 84 retrospective studies and 21 prospective studies. The authors evaluated the study designs and compared cervical, thoracolumbar, prospective, and retrospective studies as well as the durations of follow-up for each study. Results In the 105 articles reviewed, there were 79,471 patients with 13,067 reported complications for an overall complication incidence of 16.4% per patient. Complications were more common in thoracolumbar (17.8%) than cervical procedures (8.9%; p < 0.0001, OR 2.23). Prospective studies yielded a higher incidence of complications (19.9%) than retrospective studies (16.1%; p < 0.0001, OR 1.3). The complication incidence for prospective thoracolumbar studies (20.4%) was greater than that for retrospective series (17.5%; p < 0.0001). This difference between prospective and retrospective reviews was not found in the cervical studies. The year of study publication did not correlate with the complication incidence, although the duration of follow-up did correlate with the complication incidence (p = 0.001). Conclusions Retrospective reviews significantly underestimate the overall incidence of complications in spine surgery. This analysis is the first to critically assess differing complication incidences reported in prospective and retrospective cervical and thoracolumbar spine surgery studies.
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Hsieh, Patrick C., and Ziya L. Gokaslan. "Complications of spine surgery." Neurosurgical Focus 31, no. 4 (October 2011): Introduction. http://dx.doi.org/10.3171/2011.8.focus11204.
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Chambers, Henry G. "Complications of Spine Surgery." Journal of Pediatric Orthopaedics 10, no. 5 (September 1990): 675. http://dx.doi.org/10.1097/01241398-199009000-00023.
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Ebersold, Michael J. "Complications of Spine Surgery." Mayo Clinic Proceedings 65, no. 4 (April 1990): 610–11. http://dx.doi.org/10.1016/s0025-6196(12)60965-3.
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Pulliam, Morris W. "COMPLICATIONS OF SPINE SURGERY." Military Medicine 156, no. 2 (February 1, 1991): A12. http://dx.doi.org/10.1093/milmed/156.2.a12b.
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Sypert, George W. "Complications of spine surgery." Surgical Neurology 33, no. 4 (April 1990): 298–99. http://dx.doi.org/10.1016/0090-3019(90)90059-x.
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Batniji, Rami K. "Complications/Sequelae of Neck Rejuvenation." Facial Plastic Surgery Clinics of North America 22, no. 2 (May 2014): 317–20. http://dx.doi.org/10.1016/j.fsc.2014.01.007.
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Stundner, Ottokar. "Pulmonary complications after spine surgery." World Journal of Orthopedics 3, no. 10 (2012): 156. http://dx.doi.org/10.5312/wjo.v3.i10.156.
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Lebude, Bryan, Sanjay Yadla, Todd Albert, David G. Anderson, James S. Harrop, Alan Hilibrand, Mitchel Maltenfort, Ashwini Sharan, Alexander R. Vaccaro, and John K. Ratliff. "Defining “Complications” in Spine Surgery." Journal of Spinal Disorders & Techniques 23, no. 8 (December 2010): 493–500. http://dx.doi.org/10.1097/bsd.0b013e3181c11f89.
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Pelton, Miguel, Steven J. Fineberg, Matthew Oglesby, Richa Singh, and Kern Singh. "Ocular Complications of Spine Surgery." Contemporary Spine Surgery 14, no. 6 (June 2013): 1–7. http://dx.doi.org/10.1097/01.css.0000430686.61633.cb.
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&NA;. "Ocular Complications of Spine Surgery." Contemporary Spine Surgery 14, no. 6 (June 2013): 8. http://dx.doi.org/10.1097/01.css.0000430687.38762.55.
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Salcman, Michael. "Complications of cervical spine surgery." Critical Care Medicine 29, no. 10 (October 2001): 2027–28. http://dx.doi.org/10.1097/00003246-200110000-00032.
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Peris, Marshal D., Thomas S. Muzzonigro, and William F. Donaldson. "Complications of cervical spine surgery." Current Opinion in Orthopaedics 9, no. 2 (April 1998): 12–15. http://dx.doi.org/10.1097/00001433-199804000-00003.
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Reid, Daniel B. C., Shyam A. Patel, Alan H. Daniels, and Jeffrey A. Rihn. "Vascular complications in spine surgery." Seminars in Spine Surgery 31, no. 4 (December 2019): 100756. http://dx.doi.org/10.1016/j.semss.2019.100756.
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Feingold, Deborah J., Sharon A. Peck, Ellen J. Reinsma, and Susan C. Ruda. "Complications of Lumbar Spine Surgery." Orthopaedic Nursing 10, no. 4 (July 1991): 39–58. http://dx.doi.org/10.1097/00006416-199107000-00007.
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Swann, Matthew C., Kathryn S. Hoes, Salah G. Aoun, and David L. McDonagh. "Postoperative complications of spine surgery." Best Practice & Research Clinical Anaesthesiology 30, no. 1 (March 2016): 103–20. http://dx.doi.org/10.1016/j.bpa.2016.01.002.
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Jules-Elysse, K., M. K. Urban, B. Urquhart, M. H. Susman, and A. Brown. "PULMONARY COMPLICATIONS POST SPINE SURGERY." Anesthesia & Analgesia 88, Supplement (February 1999): 119S. http://dx.doi.org/10.1097/00000539-199902001-00119.
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