World Neurosurg
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Pedicle screw loosening is a common postoperative complication for osteoporotic patients, and several studies have identified the important role of fusion length in internal fixation failure, but the relationship between the number of fusion segments and the potential risks remains unclear. This study aimed to investigate the rate and risk factors of screw loosening in osteoporotic patients with different levels of degenerative lumbar disease. ⋯ Owing to the high rate of screw loosening in cranial and caudal vertebra, osteoporotic patients with double-level or multilevel pedicle screw fixation benefited less than those with single-level pedicle screw fixation. Larger PI-LL, larger PT, and lumbosacral fixation are other risk factors for screw loosening. An instrument with stronger holding strength at cranial and caudal pedicle screws is recommended for those high-risk patients.
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Intraventricular metastatic brain tumors account for a small, but challenging, fraction of metastatic brain tumors (0.9%-4.5%). Metastases from renal cell carcinoma (RCC) account for a large portion of these intraventricular tumors. Although patient outcomes have been assumed to be poor, these have not been reported in a modern series with a multimodality treatment paradigm of radiotherapy (RT), resection, and cerebrospinal fluid (CSF) diversion. We have presented the first case series of patients with intraventricular metastatic tumors from RCC. ⋯ Despite the relatively limited overall survival for this population with metastatic cancer, comparable to contemporary parenchymal brain metastasis cohorts, reasonable local central nervous system control was achieved in most patients using a paradigm of focal RT and resection, where indicated. Finally, CSF diversion was not required even in patients presenting with hydrocephalus.
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To explore 1) whether the degree of facet joint distraction during single-segment anterior cervical discectomy and fusion for cervical spondylotic radiculopathy affects functional outcome and 2) whether the degree of facet joint distraction is related to cervical sagittal parameters. ⋯ After undergoing single-segment ACDF for the treatment of cervical spondylotic radiculopathy, patients with an interfacet distance of 0.7 mm or more had worse VAS pain scores. However, this was not related to the improvement in postoperative Neck Disability Index scores; changes in the interfacet distance were not associated with changes in the cervical sagittal parameters.
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Case Reports
Sympathetic outflow disturbance following posterior deformity correction: A rare complication.
Sympathetic system injury is a known but rare complication in scoliosis deformity correction. It is not common following posterior correction. We report a case of diastematomyelia with neuromuscular scoliosis with unusual complication of sympathetic outflow disturbance, after posterior instrumented correction. ⋯ Sympathetic chain disturbances after surgery recover with time. The exact time duration needed for recovery is not yet defined, however. Spine surgeons should be aware of this postsurgical complication and identify it so that management can be initiated. The symptoms may be long and drawn out, thus the roles of communication with and counseling of the patient as cannot be underemphasized.
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Before the COVID-19 pandemic, telemedicine utilization was mostly used for postoperative visits only in neurosurgery. Shelter-in-place measures led the rapid expansion of telemedicine to address the needs of the neurosurgical patient population. Our goal is to determine the extent of adoption of telemedicine across tumor, vascular, spine, and function neurosurgery and utilization for new patient visits. ⋯ Use of telemedicine drastically increased across all 4 divisions within neurosurgery with a significant increase in online-first encounters in order to meet the needs of our patients once the shelter-in-place measures were implemented. We provide a detailed account of the lessons learned and discuss the anticipated role of telemedicine in surgical practices once the shelter-in-place measures are lifted.