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Steven M Falowski, Ashwini Sharan, James McInerney, Darren Jacobs, Lalit Venkatesan, Filippo Agnesi
BACKGROUND: Spinal cord stimulation (SCS) is a common intervention for managing intractable pain. Generally, leads are implanted in a minimally invasive procedure with verbal feedback regarding the location and nature of generated paresthesias by active stimulation; in this way their optimal location can be confirmed. However, lead placement under general anesthesia can have additional benefits. OBJECTIVE: To investigate the outcomes of awake vs asleep lead placement procedures...
March 14, 2018: Neurosurgery
Rafet Ozay, Torel Ogur, Hasan Ali Durmaz, Erhan Turkoglu, Yusuf Sukru Caglar, Zeki Sekerci, Mehmet Sorar, Sahin Hanalioglu
OBJECTIVE: Preserving the ligamentum flavum (LF) during lumbar spine surgery may help limit the extent of postoperative epidural fibrosis (EF), a potential cause of persistent leg pain. We present a retrospective analysis of microdiscectomy with preservation of the LF in order to evaluate the effects of the two LF mobilizing techniques (reflecting inferiorly or medially vs. removing completely) on EF and clinical outcomes. METHODS: Microdiscectomy was performed through a unilateral laminotomy in 93 patients (52 male, 41 female; mean age 46; range 25-65 years) with L3-L4 (n=3), L4-L5 (n=40), and L5-S1 (n=50) lumbar disc herniation...
March 9, 2018: World Neurosurgery
Jae-Kwang Kim, Bong Ju Moon, Sang-Deok Kim, Jung-Kil Lee
RATIONALE: In the treatment of noncontiguous lumbar burst fractures, there still remains controversy over proper surgical procedures. PATIENT CONCERNS: A 19-year-old female patient visited our hospital after fall down from 3 m high. DIAGNOSES: Initial neurologic examination revealed an incomplete spinal cord injury characterized by hypoesthesia and motor grade of 2 below the L2 segment. Lumbar computed tomography and magnetic resonance imaging demonstrated L2 and L5 burst fractures severely obliterating the spinal canal...
March 2018: Medicine (Baltimore)
Yong-Peng Lin, Yong-Jin Li, Bo-Lai Chen, Yu-Hai Guo
RATIONALE: Adult spinal epidermoid cyst (SEC) is a rare tumor. Lumbar laminectomy and tumor removal was a routine surgical procedure for adult spinal epidermoid cyst according to the literature, but postoperative lumbar instability and intractable low back pain may occur. In this study, we presented a brief report of an adult lumbar epidermoid cyst and introduced another surgical approach. PATIENT CONCERNS: This 28-year-old woman has been complaining of the severe right buttock pain and right thigh radiating pain for half a year...
January 2018: Medicine (Baltimore)
Maria Isabel Bento Ayres Pereira Harry Leite, Sérgio Azevedo Ferreira Alves, Rui Paulo Vicente Reinas, Marta Gomes Rodrigues, Ana Sofia Martins das Neves Garrido, Otília Peixoto da Cunha, Joana Sofia Oliveira Rodrigues, Maria de Fátima Oliveira Santos Poças, Mário António Leite Resende Martins
A previously healthy 13-year-old girl presented with a 9-day history of acute onset severe neck pain associated with limited range of movement. Medical evaluation at day 2 was suggestive of muscle contracture, and she was discharged home with diazepam, antiinflammatory agents, and rest; however, she returned because of progressive clinical worsening with left arm distal paresthesia and paralysis since day 3. There was no history of trauma or other systemic complaints, and her familial medical history was unremarkable...
February 28, 2018: Pediatric Emergency Care
Gorka Zabalo, Daniel de Frutos, Juan Carlos García, Rodrigo Ortega, Juan José Guelbenzu, Idoya Zazpe
We report a case of a 41 years old patient complaining of chronic dorsalgia. MRI showed a well defined intradural extramedular dumbbell-shaped lesion, associated to a left paravertebral tumor at D5-D6 level. The tumor was embolizated prior to surgery. Following she underwent a D4-D6 laminotomy, left D5-D6 costotransversectomy and resection of the intracanal extradural part of the lesion with section of the left D5 nerve. Posteriorly, complete resection of the extracanal portion of the tumor was performed by a postero-lateral approach...
February 19, 2018: Neurocirugía
Chul-Woo Lee, Kang-Jun Yoon, Ji-Ho Jun
OBJECTIVE: The objective of this retrospective study was to evaluate the clinical feasibility and safety of percutaneous endoscopic decompression by uniportal, unilateral approach for the lumbar canal or lateral recess stenosis. METHODS: The procedure was performed with endoscopic instruments in the same way as with conventional microscopic laminotomy and flavectomy. Clinical outcomes (VAS, ODI, modified MacNab criteria) were evaluated. Surgical outcomes including operative time, hospital stay and complications were also investigated...
February 6, 2018: World Neurosurgery
Homa Sadeghian, Rouzbeh Motiei-Langroudi
Oedema refers to the excessive accumulation of fluid within intercellular tissues as a result of disequilibrium between the capillary hydrostatic and oncotic pressure gradients. Lumbar disc herniation (LDH) commonly causes lower back pain and radicular leg pain. We report a 57-year-old female who presented to the neurosurgery clinic of the Bam University of Medical Sciences, Bam, Iran, in 2015 with pain and pitting oedema in the bilateral lower extremities. Magnetic resonance imaging confirmed a diagnosis of LDH of the L3-L4 and L4-L5 vertebrae...
November 2017: Sultan Qaboos University Medical Journal
Toshiaki Hayashi, Tomomi Kimiwada, Misaki Kohama, Reizo Shirane, Teiji Tominaga
Filum terminale lipoma (FTL) causes various spinal symptoms known as tethered cord syndrome. The treatment for FTL is surgical untethering by sectioning the FTL, which can prevent symptom progression and often results in improvement of symptoms. This report describes a minimally invasive surgical strategy that we have introduced for FTL sectioning. The pediatric patients with FTL since 2007 were treated using this minimally invasive surgical strategy, which we refer to as an interlaminar approach (ILA). In summary, the surgical technique involves: minimal skin incision to expose the unilateral ligamentum flavum in the lower lumbar region; ligamentum flavum incision to expose the dural sac, and dural incision followed by identification and sectioning of the filum...
January 23, 2018: Neurologia Medico-chirurgica
Sheng-Hua Tsai, Hsuan-Han Wu, Chun-Yuan Cheng, Chien-Min Chen
BACKGROUND: Endoscopic surgery has been successfully applied in the treatment of degenerative spinal disease, but few studies have assessed its use in treating sacral metastasis. Herein, a successful full endoscopic interlaminar approach for sacral nerve root decompression of a sacral metastatic tumor was presented. CASE DESCRIPTION: An 80-year-old man with history of hepatocellular carcinoma suffered from buttock pain with radiation to the right lower leg for one week...
January 17, 2018: World Neurosurgery
Mark G Williams, Ahmad M Wafai, Malcolm D Podmore
Background: This clinical descriptive study aims to establish if differences exist in functional outcomes, to include both leg and lower back pain (LBP) as well as disability, in patients undergoing laminectomy or laminotomy surgery for lumbar spinal stenosis (LSS). Methods: We conducted a single centre, prospective study of 119 patients undergoing laminectomy or laminotomy surgery for LSS, from 2006 and 2012. Clinical outcomes for back and leg pain were analyses using Oswestry Disability Index (ODI) questionnaires and visual analogue scale (VAS) scores collected preoperatively, at 6 weeks and 1 year...
December 2017: Journal of Spine Surgery (Hong Kong)
Ivan Cheng, Don Y Park, Robert E Mayle, Michael Githens, Robert L Smith, Howard Y Park, Serena S Hu, Todd F Alamin, Kirkham B Wood, Alexander I Kharazi
Background: We previously reported that functional recovery of rats with spinal cord contusions can occur after acute transplantation of neural stem cells distal to the site of injury. To investigate the effects of timing of administration of human neural stem cell (hNSC) distal to the site of spinal cord injury on functional outcomes in an animal model. Methods: Thirty-six adult female Long-Evans hooded rats were randomized into three experimental and three control groups with six animals in each group...
December 2017: Journal of Spine Surgery (Hong Kong)
S Raju, P O Champagne, L Walsh, Daniel J Denis
Background: Shearing of an intrathecal catheter during implantation of a drug delivery system is an underreported complication that can be challenging to manage. Case Description: A 53-year-old man with refractory cancer pain had an intrathecal pump system implanted. The procedure was complicated with catheter shear and retention in the intrathecal space. A second catheter was successfully placed but formation of a painful pseudomeningocele and ineffective pain relief complicated the outcome...
2017: Surgical Neurology International
Wolfgang Senker, Harald Stefanits, Matthias Gmeiner, Wolfgang Trutschnig, Ingo Weinfurter, Andreas Gruber
OBJECTIVE: The impact of obesity on spine surgery has been studied extensively, but just a few investigations have been focused on minimally invasive spinal fusion techniques and complication rates in normal-weight, preobese, or obese patients. Obesity was found to be a risk factor for intraoperative complications. Published data tend to favor minimal access surgery techniques (MAST) for obese patients. In a prospective study, we assessed the perioperative and postoperative complications of MAST in a large population of 187 patients...
December 20, 2017: World Neurosurgery
Nicolò Marchesini, Christian Soda, Umberto Maria Ricci, Mattia Sedia, Francesco Sala, Giampietro Pinna
A case of delayed spinal adamantinomatous craniopharyngioma recurrence is presented. A 54-year-old male patient was admitted in our Emergency Department complaining of urinary disorders and leg pains. He underwent surgical removal of intraventricular craniopharyngioma 12 years previously. On MR imaging a well-circumscribed intradural cistyc mass at the T12 level was reavealed. A T11 and T12 laminotomy was performed and total removal of the tumour was achieved. Histology examination showed adamantinous craniopharyngioma...
December 4, 2017: British Journal of Neurosurgery
Prasoon Kumar, Vishal Kumar, Rakesh John, Rajbahadur Sharma
Introduction: Unilateral pedicle screw fixation and transforaminal cage for interbody fusion are well-established form of treatment for lumbar spondylolisthesis. It is cost effective and has shown to have a comparable outcome to bilateral pedicle screw fixation. We present a case of unilateral pedicle screw fixation and transforaminal cage for interbody fusion in a patient of Grade 1 Degenerative spondylolisthesis who had an early implant failure, and try to assess the possible events leading to it...
July 2017: Journal of Orthopaedic Case Reports
Tarush Rustagi, Fernando Alonso, Cameron Schmidt, Rod Oskouian, Jens R Chapman, R Shane Tubbs, Christian Fisahn
BACKGROUND: Ossification of the posterior longitudinal ligament (OPLL) has a reported incidence of 1.9 - 4.3%. Disease progression is associated with surgery, with most studies focusing on OPLL progression following laminoplasty. It is believed the continued range of motion following surgery places strain on adjacent levels, driving calcification of the ligament. We present a case of marked progression of OPLL at levels adjacent to a previous anterior cervical discectomy and fusion (ACDF)...
October 28, 2017: World Neurosurgery
Mark D Unger, Timothy P Maus, Ross C Puffer, Laura K Newman, Bradford L Currier, Andreas S Beutler
Dorsal root ganglia (DRG) are anatomically well defined structures that contain all primary sensory neurons below the head. This fact makes DRG attractive targets for injection of novel therapeutics aimed at treating chronic pain. In small animal models, laminectomy has been used to facilitate DRG injection because it involves surgical removal of the vertebral bone surrounding each DRG. We demonstrate a technique for intraganglionic injection of lumbar DRG in a large animal species, namely, swine. Laminotomy is performed to allow direct access to DRG using standard neurosurgical techniques, instruments, and materials...
October 10, 2017: Journal of Visualized Experiments: JoVE
Anthony F DiMarco, Robert T Geertman, Kutaiba Tabbaa, Rebecca R Polito, Krzysztof E Kowalski
CONTEXT: Spinal cord stimulation (SCS) via disc electrodes surgically placed via laminotomy incisions has been shown to restore an effective cough in subjects with spinal cord injury (SCI). The purpose of this study was to evaluate a new method of expiratory muscle activation utilizing spinal cord wire leads, which can be implanted with minimally invasive techniques. METHODS: In a subject with SCI, parallel wire leads with two electrode contacts were inserted percutaneously through a needle, advanced to the T9, T11 spinal levels and connected to an implanted radiofrequency receiver...
October 11, 2017: Journal of Spinal Cord Medicine
Arvind G Kulkarni, Shumayou Dutta, Abhilash Dhruv, Anupreet Bassi
STUDY DESIGN: Retrospective study. OBJECTIVE: To analyze the various anatomical parameters that influence segmental stability in patients suffering from lumbar intra spinal cysts (LISCs) and to determine the outcome of microscopic unilateral laminotomy and cystectomy. METHODS: All patients that were surgically managed for a LISC between 2007 and 2013 with more than 3 years of follow-up were reviewed. Those without associated instability were evaluated for segmental mobility, segmental angulation, facet inclination, stage of disc degeneration, and level of involvement on MRI and dynamic radiographs...
October 2017: Global Spine Journal
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