World Neurosurg
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In the setting of a previous proximal fusion, an asymmetric 3-column osteotomy (3CO) can provide tremendous deformity correction. Our goal was to evaluate outcomes and complications of asymmetric 3CO through the proximal fusion mass, for coronal malalignment in patients with previous long thoracic fusion for adolescent idiopathic scoliosis. ⋯ Patients with a history of previous thoracic fusion for adolescent idiopathic scoliosis and coronal malalignment may develop painful degeneration of the segments caudal to the fusion as adults. In this setting, extension of fusion to the sacropelvis alone may worsen the patient's coronal alignment. An asymmetric 3CO may be considered at the proximal fusion mass to achieve realignment objectives, with an acceptable complication rate and an expected improvement in outcomes.
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Observational Study
Navigated 3-dimensional intraoperative ultrasound for spine surgery.
To integrate 3-dimensional (3D) intraoperative ultrasound (iUS) data in spinal navigation. ⋯ Using 3D-iUS can be successfully integrated in spinal navigation. Automatic registration applying low-dose iCT and non-linear image registration offers displaying preoperative images in the same orientation as the 3D-iUS scan, as well as visualizing segmented structures in the navigated 3D-iUS data. This greatly facilitates image interpretation. Navigated 3D-iUS provides a possibility for navigation updating and immediate online quality control.
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To evaluate the surgical outcome of using a trepan to treat single-segment ossification of ligamentum flavum under endoscopy and the clinical value of the new surgical treatment. ⋯ The visual trepan technique using a spinal endoscope can be used to treat single-segment ossification of ligamentum flavum. Advantages include less trauma, faster recovery, and lower cost. However, more cases and long-term follow-up are required to further evaluate the clinical effectiveness and safety of this surgical method.
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Deep-seated cerebral lesions have fascinated and frustrated countless surgical innovators since the dawn of the microneurosurgical era. To determine the optimal approach, the microneurosurgeon must take into account the characteristics and location of the pathological lesion as well as the operator's range of technical expertise. ⋯ In this article, we highlight 4 innovative surgical corridors and compare their strengths and weaknesses against those of more conventional approaches. Our goal is to use these examples to illustrate the following principles of microneurosurgical innovation: (1) discover more efficient and flexible exposures with superior working angles; (2) ensure maximal early protection of critical neurovascular structures; and (3) effectively handle target pathology with minimal disruption of normal tissues.
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Surgical site infection (SSI) in spine surgery remains a significant cause of morbidity and prolonged hospitalization. We intended to document our experience in our center and to highlight possible factors influencing SSI in posterior lumbar fusion surgery. ⋯ The risk factors for SSI after lumbar fusion surgery are multifactorial. These data should provide a step toward the development of quality improvement measures aimed at reducing complications in high-risk patients. These factors may prove useful for patient counseling and for surgical planning.