Failure of Surgery in Idiopathic Spinal Cord Herniation: Case Report and Review of the Literature.

Background: Idiopathic spinal cord herniation is a disorder in which the spinal cord herniates through a dural defect. We present a case in which both the standard surgical method and a salvage method failed.

Case Description: A 36-year-old man presented with 2 years of progressive numbness and proximal hip flexion weakness of both lower extremities.

Lateral access to paravertebral tumors.

Traditional transabdominal and retroperitoneal approaches for paravertebral tumors can be associated with injury to the viscera and lumbar plexus. The authors provide a technical description of a known approach with a new application for the resection of paraspinal tumors using both open and minimally invasive transpsoas techniques and report on 2 illustrative cases. In both cases, gross-total resection of the tumor was achieved and the patients experienced resolution of their presenting neurological symptoms, although one of the patients required 2 extra days of hospitalization due to an asymptomatic retroperitoneal hematoma, which was conservatively managed.

Technical modifications and decision-making to reduce morbidity in thoracic disc surgery: An institutional experience and treatment algorithm.

Background: Symptomatic thoracic disc herniation (TDH) is an uncommon condition with significant treatment risks.

Objective: To evaluate strategies to avoid and manage complications from thoracic disc surgery.

Methods: All TDH cases by the senior author were retrospectively reviewed from 2000 to 2012.

Video-assisted thoracoscopic surgery combined with a tubular retractor system for minimally invasive thoracic discectomy.

Background: Several approaches have been proposed for the treatment of thoracic disc herniations. Posterior approaches include transpedicular, costotransversectomy, and lateral extracavitary; anterior approaches include retropleural and transpleural thoracotomy and thoracoscopy.

Objective: We present a novel minimally invasive approach to thoracic discectomies, combining thoracoscopy and a tubular retractor system.

Utility of neurophysiological monitoring using dorsal column mapping in intramedullary spinal cord surgery.

Object: Intramedullary spinal cord tumors can displace the surrounding neural tissue, causing enlargement and distortion of the normal cord anatomy. Resection requires a midline myelotomy to avoid injury to the posterior columns. Locating the midline for myelotomy is often difficult because of the distorted anatomy.

Revision of Chiari decompression for patients with recurrent syrinx.

The management of adult patients with Chiari malformation associated with syrinx remains controversial. Although an abundance of literature exists for the pediatric population, there is an absence of guidelines for the adult population. It is unclear which of the different surgical approaches is appropriate in patients with Chiari I malformations and syringomyelia.

Fixation of the axis.

Objective: To review and compare the techniques of fixation of the axis vertebral segment. Also, to review the anatomy of the axis vertebrae, ligamentous attachments, and unique biomechanics of this segment.

Methods: The use of wire, cable, screw, and plate fixation techniques are reviewed and discussed in the treatment of fractures of C1 and C2 along with utilization of the halo vest and cervical collar during the postoperative period.

Impact of compensatory hyperhidrosis on patient satisfaction after endoscopic thoracic sympathectomy.

Objective: Endoscopic thoracic sympathectomy (ETS) remains the definitive treatment for primary focal hyperhidrosis. Compensatory hyperhidrosis (CH) is a significant drawback of ETS. We sought to identify the predictors for the development of severe CH after ETS, its anatomic locations, and its frequency of occurrence, and we analyzed the impact of CH on patient satisfaction with ETS.

Surgical management of chordomas of the cervical spine.

Object: Chordomas of the cervical spine are rare tumors. Although en bloc resection has proven to be the ideal procedure in other areas, there is controversy regarding this approach in the cervical spine. The goal in this study was to determine whether piecemeal tumor resection was efficient in the management of chordomas that arise in this location.

Endoscopic resection of thoracic paravertebral and dumbbell tumors.

Objective: Neurogenic paravertebral tumors are uncommon neoplasms arising from neurogenic elements within the thorax. These tumors may be dumbbell shaped, extending into the spinal canal or exclusively paraspinal. Generally encapsulated, they are located in the posterior mediastinum.

Diagnosis and treatment of spinal cord herniation: a combined experience.

Object: Idiopathic spinal cord herniation (ISCH) is an uncommon clinical entity typically presenting with lower-extremity myelopathy. Despite the existence of 85 ISCH cases in the literature, misdiagnosis and delayed diagnosis remain a major concern.

Methods: The authors conducted a retrospective review of patients who underwent surgery for ISCH at their institutions between 1993 and 2004.

Occipitocervical fusion after resection of craniovertebral junction tumors.

Object: Surgical access to tumors at the craniovertebral junction (CVJ) requires extensive bone removal. Guidelines for the use of occipitocervical fusion (OCF) after resection of CVJ tumors have been based on anecdotal evidence. The authors performed a retrospective study of factors associated with the use of OCF in 46 patients with CVJ tumors.

Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis.

Object: Intramedullary spinal cord tumors (IMSCTs) in the older-age adult population pose complex management issues regarding the extent of resection and functional outcome, especially in terms of quality of life. Historically, IMSCTs in the older adult population were treated with irradiation alone because it was assumed that functional recovery would be poor. The authors examined their IMSCT database and report the first large series of IMSCTs in patients older than 50 years of age.

Review: complications of minimally invasive spinal surgery.

Complications of minimally invasive spinal surgery can be related to anesthesia, patient positioning, and surgical technique. The performance of successful minimally invasive spinal surgery is beset with several technical challenges, including the limited tactile feedback, two-dimensional video image quality of three-dimensional anatomy, and the manual dexterity needed to manipulate instruments through small working channels, which all account for a very steep learning curve. Knowledge of possible complications associated with particular minimally invasive spinal procedures can aid in their avoidance.