Radiographic Robustness of Lumbar Interbody Fusion Techniques.

Study Design: Retrospective chart review.

Objectives: Lumbar interbody fusion (LIF) can be achieved with various techniques. Evidence supporting the long-term clinical advantages of one technique over another are inconclusive.

Posterior Dynamic Stabilization of the Lumbar Spine Review of Biomechanical and Clinical Studies.

Fusion and rigid instrumentation have been the mainstay for the surgical treatment of degenerative diseases of the spine for many years. Dynamic stabilization provides a theoretical advantage of decreased biomechanical stress on adjacent spinal segments and decreased fatigue failure of implants. Artificial discs provide an alternative treatment and have been well-studied in the literature.

How Cervical Reconstruction Surgery Affects Global Spinal Alignment.

Background: There have been no reports describing how cervical reconstruction surgery affects global spinal alignment (GSA).

Objective: To elucidate the effects of cervical reconstruction for GSA through a retrospective multicenter study.

Methods: Seventy-eight patients who underwent cervical reconstruction surgery for cervical kyphosis were divided into a Head-balanced group (n = 42) and a Trunk-balanced group (n = 36) according to the values of the C7 plumb line (PL).

Comparative analysis of 3 surgical strategies for adult spinal deformity with mild to moderate sagittal imbalance.

OBJECTIVE Surgical treatment of adult spinal deformity (ASD) is an effective endeavor that can be accomplished using a variety of surgical strategies. Here, the authors assess and compare radiographic data, complications, and health-related quality-of-life (HRQoL) outcome scores among patients with ASD who underwent a posterior spinal fixation (PSF)-only approach, a posterior approach combined with lateral lumbar interbody fusion (LLIF+PSF), or a posterior approach combined with anterior lumbar interbody fusion (ALIF+PSF). METHODS The medical records of consecutive adults who underwent thoracolumbar fusion for ASD between 2003 and 2013 at a single institution were reviewed.

Lateral interbody fusion combined with open posterior surgery for adult spinal deformity.

OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone.

Preoperative Predictors of Spinal Infection within the National Surgical Quality Inpatient Database.

Background: Surgical-site infections (SSIs) are a major cause of morbidity and mortality, increasing the length and cost of hospitalization. In patients undergoing spine surgery, there are limited large-scale data on patient-specific risk factors for SSIs.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for all spinal operations between 2006 and 2012.

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.

Intravenous tissue-type plasminogen activator therapy is an independent risk factor for symptomatic intracerebral hemorrhage after carotid endarterectomy.

Background: Carotid endarterectomy (CEA) for symptomatic carotid artery stenosis and intravenous tissue-type plasminogen activator (IV-tPA) for acute ischemic stroke are proven therapies; however, the safety of CEA in stroke patients who recently received IV-tPA has not been established.

Objective: To evaluate the safety of CEA in stroke patients who recently received IV-tPA.

Methods: A retrospective review of patients who underwent CEA for symptomatic carotid artery stenosis was performed.

Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery: risk of hemorrhage and venous thromboembolism.

Study Design: Retrospective review.

Objective: To assess the safety and efficacy of prophylactic low-molecular-weight heparin (LMWH) started 24 to 36 hours after degenerative spine surgery.

Summary Of Background Data: Venous thromboembolism (VTE) is a significant postoperative complication best averted with dual mechanical/pharmacological prophylaxis.

Lumbar laminectomy and fusion with routine local application of vancomycin powder: decreased infection rate in instrumented and non-instrumented cases.

Objective: Wound infections are one of the most common and potentially devastating complications of spinal surgery. Intra-wound application of vancomycin powder has been shown to lower the infection risk following posterior instrumented fusion, but little evidence supports use in other spinal operations. The goal of this study is to assess the efficacy of vancomycin powder for lumbar laminectomy and fusion, both instrumented and non-instrumented.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome secondary to an epidermoid tumor in the cerebellopontine angle.

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is classified under trigeminal autonomic cephalalgias. This rare headache syndrome is infrequently associated with secondary pathologies. In this paper the authors report on a patient with paroxysmal left retroorbital pain with associated autonomic symptoms of ipsilateral conjunctival injection and lacrimation, suggestive of SUNCT syndrome.

Malignant meningiomas with epithelial (adenocarcinoma-like) metaplasia: a study of 3 cases.

Background: Meningiomas exhibit a wide range of histomorphologic features, including variable mesenchymal and epithelioid phenotypes. Meningiomas also represent the most common host tumors for systemic metastases, particularly carcinomas. Recently, however, 3 unique dural-based neoplasms were encountered, wherein malignant-appearing gland-like structures were intermixed with meningothelial elements, yet genetic data suggested epithelial metaplasia rather than metastatic carcinoma.

Clinical outcomes after selective dorsal rhizotomy in an adult population.

Object: Selective dorsal rhizotomy (SDR) is a highly effective and well-established surgical tool for correction of lower-extremity spasticity in children with spastic diplegia caused by cerebral palsy (CP). Although the literature demonstrates considerable immediate and long-term functional benefits in children treated with SDR, the effects of SDR on adults with spastic diplegia have not been thoroughly investigated. The purpose of this retrospective study was to examine the objective and subjective clinical outcomes of SDR on an adult population.

Idiopathic bilateral stenosis of the foramina of Monro treated using endoscopic foraminoplasty and septostomy.

Hydrocephalus caused by stenosis of the foramen of Monro is rare. The authors describe a 28-year-old female patient with bilateral foraminal stenosis treated using endoscopic septostomy and unilateral foraminal balloon plasty (foraminoplasty). The patient's hydrocephalus and symptoms resolved postoperatively.

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome.

Object: Controversy persists concerning the optimal treatment of craniopharyngiomas in children, and no standard outcome metric exists for comparison across treatment modalities, nor is there one that adequately reflects the multisystem dysfunction that may arise.

Methods: The authors retrospectively analyzed the records of 86 consecutive children who underwent a uniform treatment paradigm of attempted radical resection performed by a single surgeon. Excluding 3 perioperative deaths and 3 patients with inadequate follow-up, 80 children (34 girls and 46 boys; mean age 9.

Cranial dural arteriovenous fistulae: asymptomatic cortical venous drainage portends less aggressive clinical course.

Objective: Cranial dural arteriovenous fistulae (dAVF) with cortical venous drainage (CVD) (Borden Types 2 and 3) are reported to carry a 15% annual risk of intracranial hemorrhage (ICH) or nonhemorrhagic neurological deficit (NHND). The purpose of this study was to compare the clinical course of Type 2 and 3 dAVFs that present with ICH or NHND with those that do not.

Methods: Twenty-eight patients with Type 2 or 3 dAVFs were retrospectively evaluated.

Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course.

Object: The clinical characteristics and overall outcome in patients with spontaneous isolated convexity subarachnoid hemorrhage (SAH) are not well described in the literature. The purpose of this study was to examine the mode of presentation, common origins, radiographic findings, and clinical course in a large case series of such patients.

Methods: A retrospective single-center chart review of all patients in whom nontraumatic primary convexity SAH was diagnosed between 2002 and 2007 was performed.