Influence of Hospital Transfer Status on Surgical Outcomes for Traumatic Thoracolumbar Spine Fractures: Insights from a Multicenter Investigation.

Objective: Surgical intervention for unstable thoracolumbar spine fractures is common, but delayed management and complications can impact outcomes. This study compares perioperative outcomes between patients directly admitted and those transferred from another facility for thoracolumbar spine surgery, aiming to identify predictors of complications and mortality.

Methods: A multicenter retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2021 identified 61,626 patients undergoing fusion surgeries for thoracolumbar spine fractures, excluding spinal cord injury or pathological fractures.

Transabdominal motor evoked potential neuromonitoring of lumbosacral spine surgery.

Background Context: Transcranial Motor Evoked Potentials (TcMEPs) can improve intraoperative detection of femoral plexus and nerve root injury during lumbosacral spine surgery. However, even under ideal conditions, TcMEPs are not completely free of false-positive alerts due to the immobilizing effect of general anesthetics, especially in the proximal musculature. The application of transcutaneous stimulation to activate ventral nerve roots directly at the level of the conus medularis (bypassing the brain and spinal cord) has emerged as a method to potentially monitor the motor component of the femoral plexus and lumbosacral nerves free from the blunting effects of general anesthesia.

An Integrated 3-Dimentional Navigation System Increases the Accuracy, Efficiency, and Safety of Percutaneous Thoracolumbar Pedicle Screw Placement in Minimally Invasive Approaches: A Randomized Cadaveric Study.

Study Design: Cadaveric study.

Objectives: The purpose of this study was to compare a novel, integrated 3D navigational system (NAV) and conventional fluoroscopy in the accuracy, efficiency, and radiation exposure of thoracolumbar percutaneous pedicle screw (PPS) placement.

Methods: Twelve skeletally mature cadaveric specimens were obtained for twelve individual surgeons.

A Lateral Expandable Cage with Independently Adjustable Anterior and Posterior Heights Can Improve the Pressure Distribution at the Cage-Endplate Interface: A Biomechanics Study.

Objective: To investigate how the expansion trajectory of a lateral expandable cage affects pressure distribution at the cage-endplate interface under well-controlled biomechanical loading conditions.

Methods: Three unique vertical height expansion trajectories used by clinically relevant lateral expandable cages were evaluated: craniocaudal, fixed-arc, and independently adjustable anterior and posterior height expansion. Two biomechanical loading scenarios were performed.

Fractured Lumbar Drain Catheter Retrieval Using an Endoscopic Transforaminal Approach to the Lumbar Spine.

Background And Importance: Lumbar drain placement is a common neurosurgical procedure, with several surgical and medical indications extending even beyond the specialty. One complication of placement is a fractured catheter fragment. In some circumstances, catheter retrieval is necessary which is classically performed through an open approach.

The utility of intraoperative neuromonitoring on simple posterior lumbar fusions-analysis of the National Inpatient Sample.

Background: Several studies have demonstrated the utility of intraoperative neuromonitoring (IOM) including somatosensory evoked potentials (SSEPs), motor-evoked potentials (MEPs), and electromyography (EMG), in decreasing the risk of neurologic injury in spinal deformity procedures. However, there is limited evidence supporting the routine use of IOM in elective posterolateral lumbar fusion (PLF).

Methods: The National Inpatient Sample (NIS) was analyzed for the years 2012-2015 to identify patients undergoing elective PLF with (n=22,404) or without (n=111,168) IOM use.

Hybrid Anterior Column Realignment-Pedicle Subtraction Osteotomy for Severe Rigid Sagittal Deformity.

Objective: Recently, a hybrid anterior column realignment-pedicle subtraction osteotomy (ACR-PSO) approach has been conceived for patients with severe rigid sagittal deformity, the clinical and radiographic outcomes of which require further investigation compared with ACR only.

Methods: A single-center, retrospective chart review identified patients undergoing a combination of hyperlordotic lateral lumbar interbody grafting (ACR) and concurrent Schwab grade 3 three-column osteotomy and propensity-matched patients undergoing ACR only in the same time frame. Anterior longitudinal ligament was directly released or partially sectioned in all patients.

Complications associated with L4-5 anterior retroperitoneal trans-psoas interbody fusion: a single institution series.

Background: Lateral lumbar interbody fusion (LLIF), first described in the literature in 2006 by Ozgur ., involves direct access to the lateral disc space via a retroperitoneal trans-psoas tubular approach. Neuromonitoring is vital during this approach since the surgical corridor traverses the psoas muscle where the lumbar plexus lies, risking injury to the lumbosacral plexus that could result in sensory or motor deficits.

Utility of Patient-Specific Rod Instrumentation in Deformity Correction: Single Institution Experience.

Introduction: Patient-specific instrumentation is an emerging technology with the promise of a better fit to patient anatomy. With the advent of deformity correction planning software, prefabricated rods can mitigate the need to bend rods in the operating room. Prefabricated rods allow the surgeon to provide a deformity correction closely in line with the surgical plan.

Resection of Spinal Meningioma Using Ultrasonic BoneScalpel Microshaver: Cases, Technique, and Review of the Literature.

Background: Meningiomas of the spinal canal comprise up to 40% of all spinal tumors. The standard management of these tumors is gross total resection. The outcome and extent of resection depends on location, size, patient's neurologic status, and experience of the surgeon.

Variability in the size of the retroperitoneal oblique corridor: A magnetic resonance imaging-based analysis.

Background: A minimally invasive approach to the L2-S1 disc spaces through a single, left-sided, retroperitoneal oblique corridor has been previously described. However, the size of this corridor varies, limiting access to the disc space in certain patients. Here, the authors retrospectively reviewed lumbar spine magnetic resonance imaging (MRI) in 300 patients to better define the size and variability of the retroperitoneal oblique corridor.

Minimally Invasive, Stereotactic, Wireless, Percutaneous Pedicle Screw Placement in the Lumbar Spine: Accuracy Rates With 182 Consecutive Screws.

Background: Standard fluoroscopic navigation and stereotactic computed tomography-guided lumbar pedicle screw instrumentation traditionally relied on the placement of Kirshner wires (K-wires) to ensure accurate screw placement. The use of K-wires, however, is associated with a risk of morbidity due to potential ventral displacement into the retroperitoneum. We report our experience using a computer image-guided, wireless method for pedicle screw placement.

Stormy weather: a retrospective analysis of demand for emergency medical services during epidemic thunderstorm asthma.

Objectives: To describe the demand for emergency medical assistance during the largest outbreak of thunderstorm asthma reported globally, which occurred on 21 November 2016.

Design: A time series analysis was conducted of emergency medical service caseload between 1 January 2015 and 31 December 2016. Demand during the thunderstorm asthma event was compared to historical trends for the overall population and across specific subgroups.

Variation in Psoas Muscle Location Relative to the Safe Working Zone for L4/5 Lateral Transpsoas Interbody Fusion: A Morphometric Analysis.

Background: The safe working zone for lateral access to the L4/5 disc space has been said to lie in the anteroposterior (AP) midpoint of the disc space due to the location of the femoral nerve at that level. However, the AP location of the psoas muscle (and thus the lumbosacral plexus within) at L4/5 is variable. A psoas muscle lying excessively anteriorly at the L4/5 disc space may preclude safe access to the L4/5 disc space from a lateral transpsoas approach.

Videoexoscopic real-time intraoperative navigation for spinal neurosurgery: a novel co-adaptation of two existing technology platforms, technical note.

Image-guided approaches to spinal instrumentation and interbody fusion have been widely popularized in the last decade [1-5]. Navigated pedicle screws are significantly less likely to breach [2, 3, 5, 6]. Navigation otherwise remains a point reference tool because the projection is off-axis to the surgeon's inline loupe or microscope view.

Sagittal plane lumbar intervertebral motion during seated flexion-extension radiographs of 658 asymptomatic nondegenerated levels.

Object: Evaluation of lumbar stability is fundamentally dependent on a clear understanding of normal lumbar motion. There are inconsistencies in reported lumbar motion across previously published studies, and it is unclear which provide the most reliable reference data. New technology now allows valid and reliable determination of normal lumbar intervertebral motion (IVM).

Acute Onset of Guillain-Barré Syndrome After Elective Spinal Surgery.

Background: Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy caused by an autoimmune response against myelin of peripheral nerves. GBS has been reported after surgery, in general, and after spinal surgery, in particular. In most cases, GBS developed 1-3 weeks after surgery.

Lateral retroperitoneal transpsoas interbody fusion in a patient with achondroplastic dwarfism.

The authors present the first reported use of the lateral retroperitoneal transpsoas approach for interbody arthrodesis in a patient with achondroplastic dwarfism. The inherent anatomical abnormalities of the spine present in achondroplastic dwarfism predispose these patients to an increased incidence of spinal deformity as well as neurogenic claudication and potential radicular symptoms. The risks associated with prolonged general anesthesia and intolerance of significant blood loss in these patients makes them ideal candidates for minimally invasive spinal surgery.

Spinal extradural arteriovenous fistulas: a clinical and radiological description of different types and their novel treatment with Onyx.

Object: Spinal extradural (epidural) arteriovenous fistulas (AVFs) are uncommon vascular lesions of the spine with arteriovenous shunting located primarily in the epidural venous plexus. Understanding the complex anatomical variations of these uncommon lesions is important for management. The authors describe the different types of spinal extradural AVFs and their endovascular management using Onyx.

Lessons from the front lines: the prehospital experience of the 2009 novel H1N1 outbreak in Victoria, Australia.

The H1N1 (swine influenza) 2009 outbreak in Victoria, Australia, provided a unique opportunity to review the prehospital response to a public health emergency. As part of Ambulance Victoria's response to the outbreak, relevant emergency response plans and pandemic plans were instigated, focused efforts were aimed at encouraging the use of personal protective equipment (PPE), and additional questions were included in the call-taking script for telephone triage of emergency calls to identify potential cases of H1N1 from the point of call. As a result, paramedics were alerted to all potential cases of H1N1 influenza or any patient who met the current case definition before their arrival on the scene and were advised to use appropriate PPE.

Black Saturday: the immediate impact of the February 2009 bushfires in Victoria, Australia.

Objective: To examine the response of the Victorian State Trauma System to the February 2009 bushfires.

Design And Setting: A retrospective review of the strategic response required to treat patients with bushfire-related injury in the first 72 hours of the Victorian bushfires that began on 7 February 2009. Emergency department (ED) presentations and initial management of patients presenting to the state's adult burns centre (The Alfred Hospital [The Alfred]) were analysed, as well as injuries and deaths associated with the fires.

Iatrogenic pyogenic osteomyelitis of C-1 and C-2 treated with transoral decompression and delayed posterior occipitocervical arthrodesis. Case report.

The authors describe a case of osteomyelitis of the craniocervical junction caused by iatrogenic infection of the spine during corticosteroid injection therapy. This 58-year-old diabetic man presented with acute exacerbation of neck pain that had began 4 months prior to admission. He did not experience the associated fever, chills, or sweats, but he did notice transient weakness in the right upper extremity.

Surgical management of metastatic disease of the lumbar spine: experience with 139 patients.

Object: The surgical treatment of metastatic spinal tumors is an essential component of the comprehensive care of cancer patients. In most large series investigators have focused on the treatment of thoracic lesions because 70% of cases involve this region. The lumbar spine is less frequently involved (20% cases), and it is unclear whether its unique anatomical and biomechanical features affect surgery-related outcomes.