World Neurosurg
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The prevalence of physicians experiencing work-related musculoskeletal disorders is high. Traditionally, minimally invasive surgery (MIS) sacroiliac joint (SIJ) fusions are performed with the patient oriented in the prone position, with an incision made inferior to the iliac crest. However, a novel technique that orients the patient in the lateral decubitus position has the potential of significantly enhancing ergonomics and ease of approach. The primary objectives of this study were to quantify surgical parameters, describe this 'lateral-decubitus MIS' technique, and identify imaging angle parameters that predict feasibility. ⋯ The aim was to provide an insight into outcomes and metrics observed from pioneering this style of procedure. A future study comparing traditional perioperative parameters together with surgical ergonomics is needed.
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The treatment strategy for thoracolumbar burst fractures is still debated. The aim of this study is to evaluate clinical and radiologic outcomes of a 2-stage strategy with immediate posterior percutaneous instrumentation and delayed anterolateral fusion (group A) versus a single-stage open posterior instrumented fusion (group B). ⋯ Our study indicates that percutaneous instrumentation and anterior fusion or an expandable cage lead to excellent long-term clinical and radiologic outcomes with a lower complication rate and higher fusion rate than those of open posterior approaches.
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Comparative Study
Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional vs General Anesthesia.
This study compares the postsurgical course of frontotemporal craniotomies conducted "awake" under regional anesthesia (RA) versus "asleep" under general anesthesia (GA) to investigate postoperative recovery, pain, opioid use, and anesthesia-related side effects. ⋯ Frontotemporal craniotomy under RA during awake craniotomies provides better pain control, a reduction in opioid use, and less somnolence in the early postoperative period.
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Surgical treatment is widely used to treat patients with Hirayama disease (HD). However, postoperative follow-up with abundant samples is still scarce. This study investigated short-term to midterm clinical outcomes after anterior cervical discectomy and fusion (ACDF) among patients with HD. ⋯ This study showed favorable radiologic, electrophysiologic, and clinical outcomes after ACDF among patients with HD.
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Pathologies of the ventral thoracic spine represent a challenge, igniting arguments about which should be the ideal surgical approach to access this area. Anterior transthoracic thoracotomy and a number of posterolateral routes have been developed. Among the latter, costotransversectomy has demonstrated to provide good ventral exposure with a lower, but not negligible, morbidity. The optimal approach should be the one minimizing surgical morbidity on both neural and extraneural structures while optimizing exposure. ⋯ CRBA represents a safe and effective option to access the ventral mid/low thoracic spine. It provides great exposure and bimanual manipulation of the surgical target, minimizes potential morbidity, and avoids entrance into the thoracic cavity and paraspinal muscle splitting.