Management of autonomic dysreflexia associated with Charcot spinal arthropathy in a patient with complete spinal cord injury: Case report and review of the literature.

Background: Charcot spinal arthropathy (CSA) clearly represents a challenge in long-term spinal cord injury patients, one that can have extremely uncomfortable and potentially lethal outcomes if not managed properly.

Case Description: A 66-year-old man with a history of complete C7 quadriplegia presented with new-onset autonomic dysreflexia that resulted from Charcot spinal arthropathy (CSA). Pathologic instability, in the atypical site of the mid-thoracic spine, spanning from the T8-T9 vertebral levels was appreciated on physical exam as an audible, palpable, and visible dynamic kyphosis; kyphosis was later confirmed on neuroimaging.

Best Practices for Outpatient Anterior Cervical Surgery: Results From a Delphi Panel.

Study Design: Delphi Panel expert panel consensus and narrative literature review.

Objective: To obtain expert consensus on best practices for patient selection and perioperative decision making for outpatient anterior cervical surgery (anterior cervical disc fusion (ACDF) and cervical total disc replacement (CTDR)).

Summary Of Background Data: Spine surgery in ambulatory settings is becoming a preferred option for both patients and providers.

Lumbar ligamentum flavum: spatial relationships to surrounding anatomical structures and technical description of en bloc resection.

Background: One structure, the ligamentum flavum, nearly always encountered in lumbar spinal operations, has not been examined as an important anatomical landmark. In this context, we describe its relevance in corridors of small surgical exposures created by minimally invasive spinal approaches.

Material And Methods: In cadaveric and intraoperative dissections, we introduce a systematic technique for resection of this ligament and clarify its anatomical relationships with the exiting nerve roots, pedicles, facet capsule, and midline epidural fat.

Conus medullaris syndrome after epidural steroid injection: Case report.

Background: Given the risk of paralysis associated with cervical transforaminal injection, is it time to reconsider transforaminal injections of the lumbar spine? Arguments for discontinuing lumbar injections have been discussed in the anesthesia literature, raising concern about the risks of epidural steroid injections (ESIs).

Methods: In a 47-year-old man, paraplegia of the lower extremities developed, specifically conus medullaris syndrome, after he underwent an ESI for recurrent pain. Correct needle placement was verified with epidurography.

Presacral retroperitoneal approach to axial lumbar interbody fusion: a new, minimally invasive technique at L5-S1: Clinical outcomes, complications, and fusion rates in 50 patients at 1-year follow-up.

Background: The presacral retroperitoneal approach to an axial lumbar interbody fusion (ALIF) is a percutaneous, minimally invasive technique for interbody fusion at L5-S1 that has not been extensively studied, particularly with respect to long-term outcomes.

Objective: The authors describe clinical and radiographic outcomes at 1-year follow-up for 50 consecutive patients who underwent the presacral ALIF.

Methods: Our patients included 24 males and 26 females who underwent the presacral ALIF procedure for interbody fusion at L5-S1.

Vertebral osteomyelitis.

Vertebral osteomyelitis (VO) is an infectious disease of the vertebral body that requires early diagnosis with identification of the infecting organism to direct antibiotic therapy. Most VO can be treated nonsurgically, but 10% to 20% of cases require open surgical treatment. Excellent clinical outcomes can be achieved with appropriate medical and surgical treatment.

Video-assisted thoracoscopic dissection of the brachial plexus: cadaveric study and illustrative case.

Objective: Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus.

Methods: VATS was used in cadaveric dissections to study the anatomic details of the brachial plexus at the thoracic apex.

Novel use of a threadwire saw for high sacral amputation. Technical note and description of operative technique.

The authors describe and demonstrate an innovative modification of the osteotomy procedure required to achieve a supraforaminal high sacral amputation in a patient harboring a large sacral chordoma. Via a combined anterior-posterior approach, three carefully placed threadwire saws were used to create releasing osteotomies through specific portions of the dorsal iliac crests and through the axial midportion of the S-1 vertebral body. The threadwire saws are pulled away from neurovascular and visceral structures, ensuring greater protection.

Adaptation of a standard low-field (0.3-T) system to the operating room: focus on pituitary adenomas.

iMRI is a reliable and safe tool to monitor the extent of resection and to avoid complications in the transsphenoidal surgical approach for pituitary tumors. The best indication for its application in transsphenoidal surgery is for patients with pituitary macroadenomas with suprasellar extension. The low-field 0.

Principles and techniques of en bloc vertebrectomy for bone tumors of the thoracolumbar spine: an overview.

Oncological principles for en bloc resection of bone tumors were initially developed for tumors of the long bone by orthopedic surgical oncologists. Recently, spine surgeons have adopted these principles for the treatment of vertebral column tumors. The goal of en bloc resection is to establish a surgical margin that can be designated marginal or wide.

Intramedullary and extramedullary solitary fibrous tumor of the cervical spine. Case report and review of the literature.

Solitary fibrous tumor is a spindle cell tumor deriving from mesenchymal cells that arises most commonly in the pleura. Only very recently has this tumor been reported in the spine. A solitary fibrous tumor strongly resembles other spindle cell neoplasms of the spine and may be an unrecognized entity if not routinely considered in the differential diagnosis of spinal neoplasms.

Antitumor effect of secreted Flt3-ligand can act at distant tumor sites in a murine model of head and neck cancer.

The Flt3 ligand (Flt3-L) manifests antitumor activity, presumably due to its capacity to recruit dendritic cells and cause their proliferation. To assess whether local production of Flt3-L can mediate a "distant bystander" effect, murine B4B8 squamous cell carcinoma cells were transfected with a plasmid encoding a secretory form of Flt3-L to produce B4B8FL cells. Similarly, B4B8FL and B4B8 cells were transfected with herpes simplex virus thymidine kinase (HSVTK) to produce B4B8TK and B4B8FL/TK cells, which should be sensitive to ganciclovir (GCV), to know whether the effects of Flt3-L and HSVTK/GCV would be synergistic.