Journal of neurosurgery. Spine
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The thoracolumbar junction (T11-L2) poses an anatomical dilemma, given the presence of the lower rib cage and the diaphragm when performing anterolateral approaches. To circumvent dealing with the diaphragm, a minimally invasive lateral extracoelomic approach has been used to approach the thoracolumbar junction by mobilizing the diaphragm anteriorly. No anatomical studies have described the attachments of the diaphragm and their surgical significance during the lateral approach to the thoracolumbar spine. The objective of this study is to describe the anatomical relationship of the diaphragm in reference to the minimally invasive lateral approach to the thoracolumbar spine and its surgical significance. ⋯ The diaphragm has multiple attachments that can be categorized as anterior, lateral, and posterior. In reference to the minimally invasive lateral extracoelomic approach to the thoracolumbar junction, the surgically significant attachments are primarily to the 12th rib and transverse process of L-1.
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The object of this study was to compare the clinical and radiographic outcomes of 36 patients with posttuberculosis kyphosis who underwent one of two types of osteotomy. ⋯ Posterior tubercular kyphosis can be effectively improved through corrective surgery, and deformity correction can be accompanied by improvement in clinical symptoms. When appropriately selected, both the mPSO and the VCR can be expected to yield satisfactory reduction of post-tuberculosis kyphotic deformities. Differences in radiographic and clinical outcomes should be anticipated, however, when treating such deformities in different regions of the spine.
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Unilateral contusions represent an increasingly popular model for studying the pathways and recovery mechanisms of spinal cord injury (SCI). Current studies rely heavily on motor behavior scoring and histological evidence to make assessments. Electrophysiology represents one way to reliably quantify the functionality of motor pathways. The authors sought to quantify the functional integrity of the bilateral motor and sensory pathways following unilateral SCI by using measurements of motor and somatosensory evoked potentials (MEPs and SSEPs, respectively). ⋯ Motor evoked potential recovery corresponded to the amount of spared CST in unilateral and midline injuries, but motor behavior consistently recovered independent of MEPs. These data support the idea that spared contralateral pathways aid in reducing the functional deficits of injured ipsilateral pathways and further support the idea of CNS plasticity.
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Placement of transarticular facet screws is one option for stabilization of the subaxial cervical spine. Small clinical series and biomechanical data support their role as a substitute for other posterior stabilization techniques; however, the application of transarticular facet screws in the subaxial cervical spine has not been widely adopted, possibly because of surgeon unfamiliarity with the trajectory. In this study, the authors' objective is to define insertion points and angles of safe trajectory for transarticular facet screw placement in the subaxial cervical spine. ⋯ The calculated optimal insertion angles and lengths for each level may guide the safe placement of subaxial cervical transfacet screws.
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Revision lumbar fusion procedures are technically challenging and can be associated with tremendous health care resource utilization and cost. There is a paucity of data regarding specific factors that significantly contribute to increased cost of care. In light of this, the authors set out to identify independent risk factors predictive of increasing 2-year direct health care costs after revision lumbar fusion. ⋯ Revision lumbar fusion can be associated with considerable 2-year health care costs. These costs can also vary widely among patients, as evidenced by the 2.6-fold overall cost range in this series. Although comorbidities and preoperative severity of disease states contribute to cost of care, the primary drivers of increased cost include perioperative complications such as surgical site infection, return to the operating room, and readmission during the global health period. Measures focused on health service improvement will be most successful in reducing the cost of care for patients undergoing revision lumbar fusion.