Evaluation of the Rotational Stability of Directional Deep Brain Stimulation Leads: A Case Series and Systematic Review.

Background: The rotational stability of directional deep brain stimulation leads is a major prerequisite for sustained clinical effects. Data on directional lead stability are limited and controversial.

Methods:  We aimed to evaluate the long-term rotational stability of directional leads and define confounding factors in our own population and the current literature.

Patient radiation exposure from intraoperative computed tomography in spinal surgery.

Intraoperative CT imaging is becoming increasingly used, but often little attention is paid to the underlying radiation exposure to the patient. This work showed that the dosimetrically assessed radiation exposure for cervical and lumbar 3D scans with an intraoperative CT is considerably higher than with a 3D C-arm. Therefore, proper selection of the intraoperative 3D imaging system is essential, and further technological developments and dose-saving protocols are warranted to further reduce patient radiation exposure.

Laminectomy and fusion in multilevel degenerative cervical myelopathy - Correlation between objective and subjective postoperative restriction of cervical spine mobility.

For patients with multilevel degenerative cervical myelopathy (DCM), laminectomy and fusion is an established technique. A concomitant effect of multilevel fusion is a restriction of cervical spine mobility. This retrospective study on DCM-patients with at least 4 laminectomy and fusion levels, compares data between objective and subjective restriction of the postoperative cervical spine mobility.

Does the postoperative cervical lordosis angle affect the cervical rotational range of motion after cervicothoracic multilevel fusion?

Background: Laminectomy and multilevel fusion in patients with degenerative cervical myelopathy lead to severe restriction in cervical spine mobility. Since fusions from C to the thoracic spine result in a permanently stiff subaxial cervical spine, it seems obvious to restore physiological cervical lordosis, especially with regard to sagittal balance. However, there are reports that a fusion in a more lordotic position leads to a reduction of rotational cervical range of motion in the still mobile segments C-C.

The Impact of Implementing a Radiation-Sparing Protocol for Percutaneous Kyphoplasty-A Prospective Dosemetric Study.

Study Design: Prospective cohort study.

Objectives: The purpose of this prospective study was to evaluate a protocol for radiation-sparing kyphoplasty by assessing dosemetrically recorded radiation exposures to both patient and surgeon.

Methods: This prospective clinical study examines the radiation exposure to patient and surgeon during single-level kyphoplasty in 32 thoracolumbar osteoporotic vertebral body fractures (12 OF 2, 9 OF 3, 11 OF 4 types) using a radiation aware surgical protocol between May 2017 and November 2019.

Subjective and Objective Change in Cervical Spine Mobility After Single-level Anterior Cervical Decompression and Fusion.

Study Design: Prospective, observational study.

Objective: The aim of this study was to collect objective and especially subjective data on changes in cervical spine mobility after single-level anterior cervical decompression and fusion (ACDF) and to investigate the impact on quality of life and activities of daily living (ADLs).

Summary Of Background Data: Although there are several studies dealing with the objective change in mobility after single-level ACDF, there are few data on how spondylodesis of a motion segment affects subjective restriction of cervical spine mobility.

Directional Deep Brain Stimulation Can Target the Thalamic "Sweet Spot" for Improving Neuropathic Dental Pain.

Background: Neuropathic dental pain (NDP) is a chronic pain condition that is notoriously difficult to treat. To date, there are no deep brain stimulation (DBS) studies on this specific pain condition and no optimal target or "sweet spot" has ever been defined.

Objective: To determine the optimal thalamic target for improving this condition by utilizing the steering abilities of a directional DBS electrode (Vercise CartesiaTM Model DB-2202-45, Boston Scientific).

Radiation protection measures to reduce the eye lens dose in spinal surgery.

The annual limit value for the eye lens dose for occupationally exposed personnel has recently been considerably reduced from 150mSv to 20mSv. We have therefore re-evaluated the effectiveness of radiation protection measures (lead glass goggles, mobile radiation shielding wall and distance to the radiation source) in an experimental setting to provide spinal surgeons with clearly understandable radiation dose data for their daily work.

Pterional Orbit Decompression in Grave Disease with Dysthyroid Optic Neuropathy.

Objective: The choice of surgical technique in sight-threatening Grave orbitopathy remains controversial. Available data are mostly derived from mixed cohorts with multiple surgical indications and techniques. The authors assessed predictors for visual outcome after standardized pterional orbital decompression for dysthyroid optic neuropathy.

Radiation Exposure to Scrub Nurse, Assistant Surgeon, and Anesthetist in Minimally Invasive Spinal Fusion Surgery Comparing 2D Conventional Fluoroscopy With 3D Fluoroscopy-based Navigation: A Randomized Controlled Trial.

Study Design: A randomized controlled trial.

Objective: To compare the radiation exposure with the scrub nurse, assistant surgeon, and anesthetist during minimally invasive transforaminal lumbar interbody fusion using conventional 2-dimensional (2D) fluoroscopy or 3D fluoroscopy-based navigation.

Summary Of Background Data: Minimally invasive spinal fusion techniques are related to higher radiation exposures compared with open techniques.

Evaluation of Automatic Segmentation of Thalamic Nuclei through Clinical Effects Using Directional Deep Brain Stimulation Leads: A Technical Note.

Automatic anatomical segmentation of patients' anatomical structures and modeling of the volume of tissue activated (VTA) can potentially facilitate trajectory planning and post-operative programming in deep brain stimulation (DBS). We demonstrate an approach to evaluate the accuracy of such software for the ventral intermediate nucleus (VIM) using directional leads. In an essential tremor patient with asymmetrical brain anatomy, lead placement was adjusted according to the suggested segmentation made by the software (Brainlab).

Laminectomy and fusion in multilevel degenerative cervical myelopathy -How severely do patients feel restricted by a postoperatively reduced mobility of the cervical spine?

Objective: Laminectomy and fusion is a standard technique in patients with multilevel degenerative cervical myelopathy (DCM). However, this procedure is associated with a reduction of cervical range of motion. This study examines how patients are subjectively restricted in cervical spine mobility, how they are impaired in activities of daily living (ADLs) and how this affects their quality of life.

Radiation Exposure in Minimally Invasive Lumbar Fusion Surgery: A Randomized Controlled Trial Comparing Conventional Fluoroscopy and 3D Fluoroscopy-based Navigation.

Study Design: Randomized controlled trial.

Objective: The aim of this study was to compare the dosemetrically determined radiation exposure of surgeon and patient during minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using conventional 2D fluoroscopy (FLUORO) or 3D fluoroscopy-based navigation (NAV).

Summary Of Background Data: MIS TLIF was shown to exhibit higher radiation exposures compared to open techniques.

Do directional deep brain stimulation leads rotate after implantation?

Background: The two middle contacts of directional leads (d-leads) for deep brain stimulation are split into three segments, allowing current steering toward desired axial directions. To facilitate programming, their final orientation needs to be reliably determined. However, it is currently unclear whether d-leads rotate after implantation.

Noninvasive patient tracker mask for spinal 3D navigation: does the required large-volume 3D scan involve a considerably increased radiation exposure?

Objective: Intraoperative 3D imaging and navigation is increasingly used for minimally invasive spine surgery. A novel, noninvasive patient tracker that is adhered as a mask on the skin for 3D navigation necessitates a larger intraoperative 3D image set for appropriate referencing. This enlarged 3D image data set can be acquired by a state-of-the-art 3D C-arm device that is equipped with a large flat-panel detector.

Radiation exposure of a mobile 3D C-arm with large flat-panel detector for intraoperative imaging and navigation - an experimental study using an anthropomorphic Alderson phantom.

Background: Intraoperative 3-dimensional (3D) navigation is increasingly being used for pedicle screw placement. For this purpose, dedicated mobile 3D C-arms are capable of providing intraoperative fluoroscopy-based 3D image data sets. Modern 3D C-arms have a large field of view, which suggests a higher radiation exposure.

Long-term results after surgical treatment of diffuse idiopathic skeletal hyperostosis (DISH) causing dysphagia.

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory, systemic skeletal disease. The associated formation of anterior cervical osteophytes can cause severe dysphagia, so the osteophytes have to be surgically removed. Because the clinical syndrome is rare, long-term outcome after surgical therapy is likewise scarce.

Impact of morbid obesity (BMI > 40 kg/m) on complication rate and outcome following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Objectives: The negative effects of obesity on the health and quality of life of those afflicted has become an important public concern. Previous studies have shown an association between obesity and higher rates of complications and unfavorable outcomes following spine surgery. This study is to identify peri- and postoperative complication rates as well as short-term and long-term outcomes in morbidly obese patients who underwent minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in comparison to age-matched normal-weight patients.

Atlantoaxial Instability in Patients Older Than 70 Years: What Is the Outcome When Further Conservative Treatment Is Not an Option?

Objective:  We report on our experiences of navigated posterior C1-C2 spondylodesis in the elderly (≥ 70 years of age).

Patients:  This retrospective cohort study evaluated all patients ≥ 70 years of age treated with navigated posterior spondylodesis C1-C2 (at the most to C3) from 2008 to 2015 with a minimum follow-up of 1 year. Minor and major complications within 30 days after surgery, patient outcome, and the rate of solid fusion in computed tomography were recorded.