World Neurosurg
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Esophageal injury following anterior cervical spine surgery is a rare complication. In this interesting report, we present a 60-year-old male who presented with delayed dysphagia and intermittent breathing difficulty 20 months after multilevel anterior cervical diskectomy and fusion. ⋯ The patient is recovering well at last follow-up. This is the first report of delayed mediastinal migration of standalone cage-plate construct, to the best of our knowledge.
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Increased posterior cervical decompression and fusion (PCDF) procedures over the past decade have raised the prospect of bundled payment plans. The American Society of Anesthesiologists (ASA) Physical Status Classification system may enable accurate estimation of health care costs, length of stay (LOS), and other postoperative outcomes in patients undergoing PCDF. ⋯ High ASA class is strongly associated with increased costs, LOS, and adverse outcomes following PCDF and could be useful for preoperative prediction of these outcomes.
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Unilateral biportal endoscopic (UBE) laminotomy with bilateral decompression is a high-risk operation when performed in the cervical spine. In this study, we aimed to design an auxiliary portal for treatment of cervical spondylotic myelopathy using a percutaneous biportal endoscopic approach. ⋯ Zhang's portal can allow for safe, flexible, and convenient contralateral decompression without the need to remove excessive portions of bone from the spinous process. Our results suggest that applying Zhang's portal in unilateral biportal endoscopy surgery represents an alternative when aiming to decompress the contralateral canal in patients with cervical spondylotic myelopathy caused by hypertrophy of the ligamentum flavum.
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The natural history of asymptomatic adult moyamoya disease (MMD) is unclear, and the benefit of treatment remains controversial. This study aimed to investigate the natural history of asymptomatic MMD in a North American cohort and to evaluate risk factors associated with and the effects of treatment on disease progression. ⋯ We found an overall 1.7% annual rate of radiographic infarction or hemorrhage in asymptomatic MMD hemispheres. Although we did not find a benefit to surgical treatment within the study period, asymptomatic patients with expected long-term survival may benefit from surgery given the sustained long-term benefits after surgery despite an initial postoperative risk.
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Metastatic glioblastoma to the vertebral spine is rarely encountered. The decision to intervene surgically must consider the poor prognosis in these patients. ⋯ She initially underwent vertebroplasty with symptomatic improvement, but the progression of disease precluded further surgical interventions, and the patient was referred for chemotherapy and radiotherapy. The case illustrates that the choice of treatment modality varies throughout the time course of the disease-patients with spinal instability or few solitary metastases may benefit from intervention, but as the disease burden increases, palliative radiotherapy and chemotherapy may offer greater benefit.