Comparison of Fusion versus Nonunion After 4-Level and 5-Level Anterior Cervical Diskectomy and Fusion With Anterior Plate Fixation.

Background: Nonunion remains a concern in multilevel anterior cervical discectomy and fusion (ACDF), yet there are limited data on nonunion after 4 to 5-level ACDF. In fact, the largest series on 4-level or 5-level ACDF focused specifically on the swallowing outcomes.

Objective: To assess nonunion after 4 to 5-level ACDF.

Clinical Outcomes After 4- and 5-Level Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Multilevel Cervical Spondylosis.

Objective: There are limited patient-reported outcome measure (PROM) data on 4-level and 5-level anterior cervical discectomy and fusion (ACDF). The largest series to date solely focused on complications. This retrospective series evaluates PROMs after 4-level and 5-level ACDF.

Conductive and injectable hyaluronic acid/gelatin/gold nanorod hydrogels for enhanced surgical translation and bioprinting.

There is growing evidence indicating the need to combine the rehabilitation and regenerative medicine fields to maximize functional recovery after spinal cord injury (SCI), but there are limited methods to synergistically combine the fields. Conductive biomaterials may enable synergistic combination of biomaterials with electric stimulation (ES), which may enable direct ES of neurons to enhance axon regeneration and reorganization for better functional recovery; however, there are three major challenges in developing conductive biomaterials: (1) low conductivity of conductive composites, (2) many conductive components are cytotoxic, and (3) many conductive biomaterials are pre-formed scaffolds and are not injectable. Pre-formed, noninjectable scaffolds may hinder clinical translation in a surgical context for the most common contusion-type of SCI.

Solitary osteochondroma of the cervical spine presenting with quadriparesis and hand contracture.

Background: Spinal osteochondromas are rare, benign tumors arising from the cartilaginous elements of the spine that may appear as solitary lesions versus multiple lesions in patients with hereditary multiple exostoses. Here, we present a 15-year-old female with a solitary C3-C4 osteochondroma who presented with a progressive quadriparesis and hand contracture successfully managed with a laminectomy/posterior spinal fusion.

Case Description: A 15-year-old female presented with a 3-month history of progressive quadriparesis and hand contracture secondary to a magnetic resonance (MR) documented C3-C4 cervical spine osteochondroma.

The V-Sign: A Simple Radiographic Sign of Shoulder Subluxation.

Introduction Shoulder subluxation is a common finding associated with orthopedic pathology. This study assesses the inter- and intra-observer reliability of a new radiographic sign used to identify glenohumeral subluxation. Methods Shoulders of 55 consecutive patients presenting with shoulder pain were reviewed for the presence of a "V-sign".

Surgical Treatment of Tethered Cord Syndrome in Adults: A Systematic Review and Meta-Analysis.

Objective: In the healthy spine, the spinal cord moves unimpeded with spinal fluid pulsation in the rostral and caudal directions. When a portion of the spinal cord becomes attached to lesions within the spinal column, excess strain can cause signs and symptoms such as pain, motor deficits, sensory deficits, bladder dysfunction, and bowel dysfunction. This condition is termed tethered cord syndrome.

Anterior cervical discectomy and fusion requiring resection of the superior horn of thyroid cartilage: case report.

Anterior cervical discectomy and fusion (ACDF) is the most common surgical procedure utilized for degenerative diseases of the cervical spine. The authors present the case of a 64-year-old man who underwent an ACDF for degenerative changes causing cervical stenosis with myelopathy. The patient's symptoms consisted of pain and weakness of the bilateral upper extremities that slowly progressed over 1.

An Awake Contralateral, Transcallosal Approach for Deep-Seated Gliomas of the Basal Ganglia.

Background: The basal ganglia and thalamus are uncommon locations for infiltrating gliomas. Tumors here are usually managed with biopsy and adjuvant therapy, with relatively poor results. Rarely do patients undergo extensive surgical intervention.

Blunt vertebral artery injury in occipital condyle fractures.

OBJECTIVEA shifting emphasis on efficient utilization of hospital resources has been seen in recent years. However, reduced screening for blunt vertebral artery injury (BVAI) may result in missed diagnoses if risk factors are not fully understood. The authors examined the records of blunt trauma patients with fractures near the craniocervical junction who underwent CTA at a single institution to better understand the risk of BVAI imposed by occipital condyle fractures (OCFs).

An Examination of the Role of Supramaximal Resection of Temporal Lobe Glioblastoma Multiforme.

Background: Resection of the T1 contrast-enhancing portion of glioblastoma multiforme (GBM) has been shown to increase patient survival, although whether GBM resection beyond these boundaries has an additional survival benefit is not clear. In this study, we examined the effect of resecting the enhancement and a margin of brain tissue surrounding the enhancement in patients with GBM of the temporal lobe.

Methods: We identified 32 consecutive patients with temporal lobe GBM who underwent initial resection between 2012 and 2015.

The crossed frontal aslant tract: A possible pathway involved in the recovery of supplementary motor area syndrome.

Introduction: Supplementary motor area (SMA) syndrome is a constellation of temporary symptoms that may occur following tumors of the frontal lobe. Affected patients develop akinesia and mutism but often recover within weeks to months. With our own case examples and with correlations to fiber tracking validated by gross anatomical dissection as ground truth, we describe a white matter pathway through which recovery may occur.

Dural Closure in Confined Spaces of the Skull Base with Nonpenetrating Titanium Clips.

Background: Dural repair in areas with limited operative maneuverability has long been a challenge in skull base surgery. Without adequate dural closure, postoperative complications, including cerebrospinal fluid (CSF) leak and infection, can occur.

Objective: To show a novel method by which nonpenetrating, nonmagnetic titanium microclips can be used to repair dural defects in areas with limited operative access along the skull base.

A Simplified Method of Accurate Postprocessing of Diffusion Tensor Imaging for Use in Brain Tumor Resection.

Background: Use of diffusion tensor imaging (DTI) in brain tumor resection has been limited in part by a perceived difficulty in implementing the techniques into neurosurgical practice.

Objective: To demonstrate a simple DTI postprocessing method performed without a neuroscientist and to share results in preserving patient function while aggressively resecting tumors.

Methods: DTI data are obtained in all patients with tumors located within presumed eloquent cortices.

A Technique for Resecting Occipital Pole Gliomas Using a Keyhole Lobectomy.

Objective: Our purpose is to describe a method of resecting occipital pole gliomas through a keyhole lobectomy and share the patient outcomes of this technique.

Methods: We performed a retrospective review of data obtained on all patients who underwent resection of occipital pole gliomas by the senior author between 2012 and 2016. We describe our technique for resecting these tumors using a keyhole lobectomy and share the patient outcomes of this operation.

Method for temporal keyhole lobectomies in resection of low- and high-grade gliomas.

OBJECTIVE The purpose of this study was to describe a method of resecting temporal gliomas through a keyhole lobectomy and to share the results of using this technique. METHODS The authors performed a retrospective review of data obtained in all patients in whom the senior author performed resection of temporal gliomas between 2012 and 2015. The authors describe their technique for resecting dominant and nondominant gliomas, using both awake and asleep keyhole craniotomy techniques.

Simultaneous Resection of Multiple Metastatic Brain Tumors with Multiple Keyhole Craniotomies.

Background: The proper management of symptomatic patients with 2 or more brain metastases is not entirely clear, and the surgical outcomes of these patients undergoing multiple simultaneous craniotomies have not been well described. In this article, we describe patient outcomes after simultaneously resecting metastatic lesions through multiple keyhole craniotomies.

Methods: We conducted a retrospective review of data obtained for all patients undergoing resection of multiple brain metastases in one operation between 2014 and 2016.

Frontal Keyhole Craniotomy for Resection of Low- and High-Grade Gliomas.

Background: Minimally invasive techniques are increasingly being used to access intra-axial brain lesions.

Objective: To describe a method of resecting frontal gliomas through a keyhole craniotomy and share the results with these techniques.

Methods: We performed a retrospective review of data obtained on all patients undergoing resection of frontal gliomas by the senior author between 2012 and 2015.

Utilization of the O-arm after Ommaya reservoir placement.

The authors demonstrate the utility of portable intraoperative CT scans for the rapid identification of ventricular catheter tip location after Ommaya reservoir placement. The O-arm (Medtronic Sofamor Danek, Memphis, TN, USA) was utilized to confirm ventricular catheter placement intraoperatively. Conventionally, a postoperative CT scan is obtained prior to Ommaya reservoir use to ensure proper catheter placement.

Intradural, extramedullary amyloidoma involving cervical and thoracic spine.

We present the case of a 46-year-old woman with insidious lower extremity paralysis and bowel and bladder disruption found to have an intradural, extramedullary amyloidoma from the levels of C4-T4. To our knowledge, this is the first known reported case of amyloidoma occurring in this location. Solitary amyloidoma of the spine is a rare entity typically manifesting as an extradural tumor with bony involvement.

Open surgical management of a ruptured intracranial aneurysm in Klippel-Trenaunay-Weber (KTW) syndrome.

A 24-year-old man with a history of Klippel-Trenaunay-Weber syndrome presented with severe headache and neck pain. Work-up revealed subarachnoid hemorrhage and evidence of multiple intracranial aneurysms. The patient was treated with open surgical clipping of his ruptured aneurysm and is currently doing well.

Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion.

Purpose: The lateral transpsoas interbody fusion (LTIF) is an increasingly popular minimally invasive technique for lumbar interbody fusion. Although a posterior approach to the lumbar spine has traditionally been favored for the treatment of canal stenosis and neural foraminal stenosis, a growing body of evidence suggests that indirect decompression of the spinal canal and neural foramen can be achieved using a lateral transpsoas approach to the lumbar spine. We present 2 cases that may suggest a role for spontaneous electromyography (s-EMG) monitoring in assessing the adequacy of decompression during LTIF.

Functional outcomes following single-event multilevel surgery of the upper extremity for children with hemiplegic cerebral palsy.

Background: Outcomes following single-event multilevel surgery of the upper extremity for children with cerebral palsy have not been well described in the literature. Since 1996, all children with hemiplegic cerebral palsy at our institution thought to be candidates for upper extremity surgery have had serial Shriners Hospital for Children Upper Extremity Evaluation performed for both clinical decision making and outcome assessment. The goal of the current study was to determine the functional outcomes, as described by the Shriners Hospital for Children Upper Extremity Evaluation, following single-event multilevel surgery of the upper extremity in children with hemiplegic cerebral palsy.