World Neurosurg
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To compare patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) achievement following anterior or transforaminal lumbar interbody fusion for isthmic spondylolisthesis in patients presenting with predominant back pain versus predominant leg pain symptoms. ⋯ Compared with patients presenting for surgery with predominant leg pain symptoms, patients undergoing lumbar fusion at L4-L5 and L5-S1 for isthmic spondylolisthesis with predominant back pain symptoms may demonstrate improved long-term clinical outcomes for reported back pain, leg pain, and disability and reduced postoperative length of stay and narcotic consumption.
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Review Case Reports
Anterior Thoracic Discectomy and Fusion: Surgical Technique and Anatomical Considerations.
Ossification of the posterior longitudinal ligament (OPLL) is a rare condition that can lead to progressive spinal cord compression.1 Currently, surgical decompression remains the optimal treatment in symptomatic patients.2,3 In cases with significant thoracic stenosis and concern for ventral erosion of the dura, an anterior approach may be necessary for direct decompression.4 In Video 1, we demonstrate the successful application of a multidisciplinary approach for surgical resection of a large OPLL lesion located at the T2-3 disk space. A 37-year-old female with medical history significant for rickets presented a year after a fall with bilateral lower extremity paraparesis and saddle anesthesia. Exposure consisted of a manubrial window, followed by thoracic diskectomy and fusion with drilling of the calcified posterior longitudinal ligament. ⋯ The patient tolerated the procedure well with immediate relief of symptoms and was subsequently discharged on postoperative day 1 with no complications. This operative video illustrates the technical steps and capabilities of an anterior approach, achieving near-complete gross total resection of an OPLL lesion using a multidisciplinary approach. The patient consented to this procedure.
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Because of the challenging anatomic location, corpectomies are performed less often at the fourth lumbar vertebral body than at other levels. Our objective was to review the literature of L4 corpectomy and anterior column reconstruction. ⋯ Corpectomies of the L4 vertebral body are challenging. None of the various approaches described clearly demonstrates any superiority in mitigating the risk of neural complications. Decision making about which surgical approach to use should be based on patient-specific characteristics.
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Cerebrospinal fluid tap test is a common procedure to predict the efficacy of ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus. Objective tests after cerebrospinal fluid tap test are used to establish the surgical indication, but subjective improvements may also be important in selection of surgical candidates. The aim of this study was to evaluate surgical outcomes of patients with ventriculoperitoneal shunt for idiopathic normal pressure hydrocephalus, comparing patients showing objective improvement with patients improving only on subjective assessments. ⋯ Surgical outcomes after ventriculoperitoneal shunt were similar between the 2 groups, with a more favorable trend in terms of symptom improvement for subjective responders. Subjective assessment seems to be an important factor to consider in preoperative evaluation.
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Traumatic brain injuries (TBIs) in pediatrics are the most common cause of long-term morbidity and mortality, generating a considerable burden on the health care system. In the current retrospective study, we aimed to identify the predictors that contribute to prolonged hospital stays in pediatric TBI. ⋯ The current study identified motor vehicle collision and pedestrian injuries, as well as initial Glasgow Coma Scale score of <9 as independent predictors of prolonged hospitalization in pediatrics TBI.