Halo traction evaluation of craniocervical instability in hereditary connective tissue disorder patients: Case series.

Introduction: Craniocervical instability (CCI) is a condition commonly found in patients with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS), leading to various symptoms. Assessing patients for surgical fusion as a treatment for CCI is challenging due to the complex nature of EDS-related symptoms. This study aimed to evaluate the role of pre-fusion halo-vest traction in alleviating symptoms and determining suitable candidates for fusion surgeries.

A biomechanical study shows the direction of compression influences the amount of lordosis gained in lumbar fusion.

Study Design: Biomechanical model study.

Background: Lumbar lordosis is usually lost in the degenerative process, and when lumbar fusion is required, its restoration is one of the modern metrics of a successful operation. We sought to investigate the hypothesis that changing direction of compression during surgical fusion, would gain more lordosis.

Consent for spine surgery: an observational study.

Background: The tension between the ideal of informed consent and the reality of the process is under-investigated in spine surgery. Guidelines around consent imply a logical, plain-speaking process with a clear endpoint, agreement and signature yet surgeons' surveys and patient interviews suggest that surgeons' explanation is anecdotally variable and patient understanding remains poor. To obtain a more authentic reflection of practice, spine surgeons obtaining 'informed consent' for non-instrumented spine surgery were studied via video recording and risk/benefit discussions were analysed.

Morphometric anatomy of the lumbar sympathetic trunk with respect to the anterolateral approach to lumbar interbody fusion: a cadaver study.

Background: An approach to lateral lumbar interbody fusion (LLIF) utilizing an oblique corridor anterior to the psoas muscle was first described by Mayer in 1997 and subsequently by other authors. The only consistent structure of note in this corridor is the lumbar sympathetic trunk (LST), which at times must be mobilized in order to perform a discectomy and interbody fusion, thereby placing the LST at risk. This study was designed to describe the morphometric anatomy of the LST in relation to surgically relevant landmarks for the anterolateral approach to the lumbar spine at L3/L4 to L5/S1.

Maintenance of Segmental Lordosis and Disk Height in Stand-alone and Instrumented Extreme Lateral Interbody Fusion (XLIF).

Study Design: A prospective single-surgeon nonrandomized clinical study.

Objective: To evaluate the radiographic and clinical outcomes, by fixation type, in extreme lateral interbody fusion (XLIF) patients and provide an algorithm for determining patients suitable for stand-alone XLIF.

Summary Of Background Data: XLIF may be supplemented with pedicle screw fixation, however, since stabilizing structures remain intact, it is suggested that stand-alone XLIF can be used for certain indications.

Anterior to psoas (ATP) fusion of the lumbar spine: evolution of a technique facilitated by changes in equipment.

Background: Lateral interbody cages have been proven useful in spinal fusions. Spanning both lateral cortical rims while sparing the Anterior Longitudinal Ligament, the lateral interbody cages restore and maintain disc height while adding stability prior to supplemental fixation. The standard approach for their insertion is by a 90-degree lateral transpsoas method.

Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF.

Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity.

Choice of Approach Does Not Affect Clinical and Radiologic Outcomes: A Comparative Cohort of Patients Having Anterior Lumbar Interbody Fusion and Patients Having Lateral Lumbar Interbody Fusion at 24 Months.

Study Design: Retrospective analysis of prospectively collected registry data.

Objective: This study aimed to compare the clinical and radiologic outcomes between comparative cohorts of patients having anterior lumbar interbody fusion (ALIF) and patients having lateral lumbar interbody fusion (LLIF).

Methods: Ninety consecutive patients were treated by a single surgeon with either ALIF (n = 50) or LLIF (n = 40).

Complex Spine Pathology Simulator: An Innovative Tool for Advanced Spine Surgery Training.

 Technical advancements in spine surgery have made possible the treatment of increasingly complex pathologies with less morbidity. Time constraints in surgeons' training have made it necessary to develop new training models for spine pathology.  To describe the application of a novel compound, Stratathane resin ST-504 derived polymer (SRSDP), that can be injected at different spinal target locations to mimic spinal epidural, subdural extra-axial, and intra-axial pathologies for the use in advanced surgical training.

Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography.

OBJECT Intervertebral cage settling during bone remodeling after lumbar lateral interbody fusion (LIF) is a common occurrence during the normal healing process. Progression of this settling with endplate collapse is defined as subsidence. The purposes of this study were to 1) assess the rate of subsidence after minimally invasive (MIS) LIF by CT, 2) distinguish between early cage subsidence (ECS) and delayed cage subsidence (DCS), 3) propose a descriptive method for classifying the types of subsidence, and 4) discuss techniques for mitigating the risk of subsidence after MIS LIF.

Intracranial injectable tumor model: technical advancements.

Background and Objectives Few simulation models are available that provide neurosurgical trainees with the challenge of distorted skull base anatomy despite increasing importance in the acquisition of safe microsurgical and endoscopic techniques. We have previously reported a unique training model for skull base neurosurgery where a polymer is injected into a cadaveric head where it solidifies to mimic a skull base tumor for resection. This model, however, required injection of the polymer under direct surgical vision via a complicated alternative approach to that being studied, prohibiting its uptake in many neurosurgical laboratories.

Intraosseous hibernoma: characterization of five cases and literature review.

Objective: To describe the imaging and histopathological findings and provide an overview of a recently described and rare cause of bone sclerosis.

Materials And Methods: Five cases of intra-osseous hibernoma of bone that presented over the last year. The imaging and histopathology is reviewed.

Lateral extent and ventral laminar attachments of the lumbar ligamentum flavum: cadaveric study.

Background Context: Cadaveric descriptions of the deep layer of the lumbar ligamentum flavum (LF), extending between contiguous borders of adjacent laminae and into the lateral spinal canal region are limited.

Purpose: To provide detailed descriptions of the lumbar LF.

Study Design: Cadaveric dissection.

Anterior to psoas fusion of the lumbar spine.

Lateral interbody cages have proven useful in lumbar fusion surgery. Spanning both lateral cortical rims while sparing the anterior longitudinal ligament, they restore disc height, improve coronal balance and add stability. The standard approach to their insertion is 90 degrees lateral transpsoas which is bloodless compared to other techniques of interbody cage insertion but requires neuro-monitoring and at L4/5 can be difficult because of iliac crest obstruction or an anterior plexus position.

Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis: report of 2 cases.

The authors report on 2 cases of anterior dislocation of the Maverick lumbar disc prosthesis, both occurring in the early postoperative period. These cases developed after experience with more than 50 uneventful cases and were therefore thought to be unrelated to the surgeon's learning curve. No similar complications have been previously reported.

Clinical outcome and fusion rates after the first 30 extreme lateral interbody fusions.

Introduction: The lateral transpsoas approach for lumbar interbody fusion (XLIF) is gaining popularity. Studies examining a surgeon's early experience are rare. We aim to report treatment, complication, clinical, and radiographic outcomes in an early series of patients.

Results of a prospective randomized study comparing a novel retractor with a Caspar retractor in anterior cervical surgery.

Background: Retraction injury might explain the soft tissue complications seen after anterior cervical surgery. A novel retractor system (Seex retractor system [SRS]) that uses a principle of bone fixation with rotation has been shown to reduce retraction pressure in a cadaveric model of anterior cervical decompression and fusion.

Objective: To compare the conventional Cloward-style retractor (CRS) with the SRS in a prospective randomized clinical trial.

Comparison of retraction pressure between novel and conventional retractor systems--a cadaver study.

Object: Sore throat, dysphagia, and dysphonia are very common after anterior cervical surgery; clinical studies show an incidence of up to 60% or more. Neural, mucosal, or muscular injuries during dissection or retraction are regularly discussed, but investigations are few. Retraction pressure causing ischemia might explain these complications.

An anterior cervical retractor utilizing a novel principle.

The alarmingly high soft-tissue complication rates after anterior cervical surgery suggests that the design of current retractors is inadequate. A review of retractor design and consideration of new designs is worthwhile. The author reviewed the literature and the 7 described devices (Cloward, Caspar, Thompson-Farley, Tresserras, Ozer, Takayasu, and Oh devices).

Spinal epidural lipomatosis--a brief review.

Spinal epidural lipomatosis (SEL) is a rare disorder characterized by overgrowth of fat in the extradural space, causing compression of the neural elements. It is frequently associated with the administration of exogenous steroids or elevation of endogenous steroids. We present two patients, both with epidural lipamotosis of idiopathic origin.

Intracerebral hemorrhage after thrombolytic therapy managed with ventricular drainage.

Intracerebral hemorrhage (ICH) after thrombolytic treatment for acute myocardial infarction (AMI) is a serious complication causing significant morbidity and mortality. Drainage of the haematoma by craniotomy is associated with poor outcome. We present a patient who received tissue plasminogen activator (t-PA) for acute myocardial infarction; he subsequently developed an ICH with ventricular system extension.

Magnetic resonance imaging clarity of the Bryan, Prodisc-C, Prestige LP, and PCM cervical arthroplasty devices.

Study Design: Prospective, randomized, controlled and double-blinded study on imaging of artificial discs.

Objective: The purpose of this study is to compare postoperative imaging characteristics of the 4 currently available cervical arthroplasty devices at the level of implantation and at adjacent levels.

Summary Of Background Data: Cervical arthroplasty is being performed increasingly frequently for degenerative disc disease and, in most cases, with frank neural compression.