Neurosurgery
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Review Case Reports
Biportal Versus Uniportal Lumbar Decompression-Indications and Efficacy: A Review With Case Examples.
Minimally invasive lumbar decompression surgery offers many advantages including reduced patient morbidity and quicker return to normal life. Endoscopic lumbar spine surgery, sometimes termed "ultra" minimally invasive, further pushes the envelope on reducing operative time, blood loss, and recovery time. ⋯ Biportal approach involves two incisions, one for the endoscope and one for the instruments. In what follows we review the indications and efficacy of these procedures with case examples.
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Minimally invasive spine surgery (MISS) has transformed spinal surgery by minimizing tissue disruption, reducing recovery times, and lowering complication rates compared with traditional open procedures. MISS uses smaller incisions, specialized tools, and advanced imaging to treat conditions such as degenerative disk disease, trauma, and tumors. Techniques such as endoscopic spine surgery and tubular retractors have expanded its applications, enabling effective treatment with less postoperative pain and faster mobilization. ⋯ Enhanced recovery after surgery protocols, when combined with MISS, improve outcomes by reducing hospital stays and postoperative pain. Complications such as dural tears and hardware misplacement, although less common than in open surgery, require careful management, with techniques such as intraoperative imaging and robotic navigation aiding in complication prevention. Continued innovation in MISS will broaden its application and improve safety and patient outcomes across various spinal pathologies.
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Neuromonitoring in minimally invasive spine surgery (MISS) provides real-time feedback to surgeons and enhances surgical precision for improved patient safety. Since the 1970s, established techniques like somatosensory evoked potentials, motor evoked potentials, and electromyography have been integrated into spine surgeries, significantly reducing the risk of neurological complications. These neuromonitoring modalities have been crucial, particularly in complex procedures with limited direct visualization. ⋯ This review explores the historical development, current techniques, clinical outcomes, and future directions of neuromonitoring in MISS. It emphasizes the critical role of these technologies in enhancing surgical outcomes and patient care. As MISS continues to evolve, adopting next-generation neuromonitoring systems, including artificial intelligence and machine learning, will play a pivotal role in advancing the efficacy and safety of spine surgeries.
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Augmented reality (AR) is a technology that allows digital information to be superimposed onto a user's view of the real world, thereby enhancing the user's experience of a given real-world scenario. As recent advances in AR technology have made it more available for a variety of applications, hospitals and doctors have begun to test its utility in the operating room. AR technology allows surgeons to supplement their view of the operative field with useful patient-specific information for which they might otherwise need to turn their attention away from the task at hand. ⋯ The field of spine surgery is uniquely positioned to benefit from AR, given the extent to which many spine surgeons already rely on intraoperative navigation techniques for certain surgical tasks, including pedicle screw and interbody device placement. In this review, we outline the origins and history of AR in spine surgery and cover the current state of the literature regarding the applications, benefits, and drawbacks of its use within the field. Lastly, we speculate as to the future of AR in spine surgery and propose which gaps in knowledge must be addressed before the technology enjoys a degree of adoption on par with currently available intraoperative navigation techniques.
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Meta Analysis Comparative Study
A Meta-Analysis of Medication Reduction and Motor Outcomes After Awake Versus Asleep Deep Brain Stimulation for Parkinson Disease.
There remains significant debate regarding the performance of deep brain stimulation (DBS) procedures for Parkinson disease (PD) under local or general anesthesia. The aim of this meta-analysis was to compare the clinical outcomes between "asleep" DBS (general anesthesia) and "awake" DBS (local anesthesia) for PD. ⋯ There was no significant difference in the primary motor outcomes and LEDD improvement between asleep vs awake DBS. The variables of target selection and MER use had no statistically significant impact on outcome. We find that asleep techniques are both safe and effective compared with the awake technique.