World Neurosurg
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Over the past decade, the surgical treatment of adolescent idiopathic scoliosis (AIS) has established new techniques to reduce curve severity and shifted to include the regular use of pedicle screws. Few studies have focused on this evolving trend in AIS correction surgery. In this study, we investigated how the operative approach, instrumentation, and surgical techniques have changed over the past 15 years and to quantify the related improvements in AIS surgical treatment. ⋯ Consistent improvement of major curve correction has been achieved by the spine community over 15 years. After stabilized coronal correction and fewer fusion levels, the next steps in this evolution are the restoration of sagittal profiles, especially the hypokyphosis seen in patients with Lenke 1, the posterior minimally invasive approach, and a fast-track return to activity.
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Total en bloc spondylectomy (TES) significantly decreases the rate of local recurrence and provides long-term survival in patients with malignant tumor of the spine. This procedure can be performed through a posterior-only approach. However, TES for lower lumbar spine through a posterior-only approach is technically challenging. ⋯ TES for the fourth lumbar spine in a posterior-only approach is feasible. Although the surgery is challenging, long-term oncologic and neurologic outcomes are satisfying.
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Bloodless dry fields are indispensable for successful and safe neurosurgical operations using microscopes. Appropriate irrigation and suction systems are needed to obtain clear surgical fields. We invented a novel malleable continuous suction tube to address this need. ⋯ The newly developed malleable suction tube is effective for microsurgery.
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A vertebral artery arteriovenous fistula is rare and usually due to trauma. Atraumatic cases are quite rare. We reported 2 cases and a review of other reported studies. ⋯ Vascular changes are known in patients with neurofibromatosis. A proposed pathogenesis of fistula is that the fragility and defective nature of the arterial wall could be a predisposing factor or it might be congenital. Understanding the clinical symptoms, diagnosis, and effective management strategies are important for physicians treating patients with a vertebral artery arteriovenous fistula.
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Fluoroscopy use in spine surgery is increasing owing to the increasing popularity of minimally invasive techniques. The effectiveness and safe distance for protective barriers might have been commonly misrepresented. The present study evaluated x-ray propagation and the efficacy of protective barriers in the setting of spine surgery. ⋯ Spine surgeons who wear lead gowns during fluoroscopy could still be exposed to <80% of the radiation produced. Safe distances from fluoroscopy machines might be much farther than commonly believed. Alternatives to reduce the use of fluoroscopy for intraoperative imaging should be explored.