World Neurosurg
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Surgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the fragility of the thoracic spinal cord. Posterior approach with long instrumentation has been predominantly performed. However, this procedure includes the risk of neurologic deterioration caused by the progression of OPLL during long-term follow-up and the need for long instrumentation to achieve dekyphosis, even for so-called beaked-type OPLL between 1 vertebra. ⋯ Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. Relatively narrow and little resection of the vertebral body under the presently demonstrated microsurgical procedures might negate the need for bone grafting or spinal instrumentation. The patient gave informed consent for surgery and video recording (Video 1).
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Three-dimensional (3D) printing has emerged as a visualization tool for clinicians and patients. We sought to use patient-specific 3D-printed anatomic modeling for preoperative planning and live intraoperative guidance in a series of complex primary spine tumors. ⋯ We present the largest case series of 3D-printed spine tumor models reported to date. 3D-printed models are broadly useful for operative planning and intraoperative guidance in spinal oncology surgery.
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Case Reports
Transpedicular Approach for Ventral Epidural Abscess Evacuation in the Cervical Spine - A Technical Note.
Spinal epidural abscess may require prompt surgical intervention. Ventral cervical abscesses pose a particular challenge regarding the approach for surgical evacuation. The aim of this article was to describe the technical nuances of a posterior transpedicular cervical approach for evacuation of a ventral epidural abscess. ⋯ Access to the ventral epidural space is feasible using a transpedicular approach in the cervical spine for evacuation of an epidural abscess.
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Minimally invasive techniques in spine surgery have continued to advance as robotic technology has evolved over several generations. Although traditional techniques for placing pedicle screws are still widespread in practice, newer technology has increased the reliability of accurately placing instrumentation with smaller incisions and subsequent decreased length of stay. Additionally, advancements in planning software have improved the ability to align posterior instrumentation to assist with rod placement on multilevel constructs. ⋯ In our experience, this robotic technology has the potential to improve patient outcomes and is associated with advanced surgical planning compared with more traditional techniques.