Pedicle Screw Placement in the Thoracolumbar Spine Using a Novel, Simple, Safe, and Effective Guide-Pin : A Computerized Tomography Analysis.

Objective: To improve pedicle screw placement accuracy with minimal radiation and low cost, we developed specially designed K-wire with a marker. To evaluate the accuracy of thoracolumbar pedicle screws placed using the novel guide-pin and portable X-rays.

Methods: Observational cohort study with computerized tomography (CT) analysis of in vivo and in vitro pedicle screw placement.

Epidural Steroids After a Percutaneous Endoscopic Lumbar Discectomy.

Study Design: Randomized controlled study from a single surgeon.

Objective: The objective of the present study is to assess the effectiveness of the administration of epidural steroids in patients who undergo a percutaneous endoscopic lumbar discectomy (PELD) because of a herniated lumbar disc.

Summary Of Background Data: Steroids are drugs that show strong anti-inflammatory effects; in specific, the effects of epidural steroid application after an open lumbar discectomy have been studied extensively.

Does pre-existing L5-S1 degeneration affect outcomes after isolated L4-5 fusion for spondylolisthesis?

Background: Concerns have been raised regarding residual symptoms of caudal segment (L5-S1) degeneration that may affect clinical outcomes or require additional surgery after isolated L4-5 fusion, especially if there is pre-existing L5-S1 degeneration. This study aimed to evaluate the L5-S1 segment after minimally invasive lumbar interbody fusion at the L4-5 segment, as well as the influence of pre-existing L5-S1 degeneration on radiologic and clinical outcomes.

Methods: This retrospective study evaluated patients with isthmic spondylolisthesis and degenerative spondylolisthesis who underwent mini-open anterior lumbar interbody fusion with percutaneous pedicle screw fixation (PSF) or minimally invasive transforaminal interbody fusion with PSF at the L4-5 segment.

Clinical significance of achieving a flexion limitation with a tension band system in grade 1 degenerative spondylolisthesis: a minimum 5-year follow-up.

Study Design: Retrospective clinical study.

Objective: To evaluate the effect of the limitation of flexion rotation clinically and radiologically after interspinous soft stabilization using a tension band system in grade 1 degenerative spondylolisthesis.

Summary Of Background Data: Although several studies have been published on the clinical effects of limiting rotatory motion using tension band systems, which mainly targets the limitation of flexion rather than that of extension, they were confined to the category of pedicle screw-based systems, revealing inconsistent long-term outcomes.

Usefulness of Noninvasive Positive-pressure Ventilation During Surgery of Flaccid Neuromuscular Scoliosis.

Study Design: This is a retrospective study.

Objective: To assess the effects of noninvasive positive-pressure ventilation (NIPPV) through evaluations of outcomes and incidences of postoperative pulmonary complications among patients with flaccid neuromuscular scoliosis for pulmonary support in the perioperative periods.

Background Data: There is no report on the effects of NIPPV on neuromuscular scoliosis patient during the perioperative periods.

Postoperative expansion of dural sac cross-sectional area after unilateral laminotomy for bilateral decompression: correlation with clinical symptoms.

Objective: Dural sac cross-sectional area (DSCSA) is a way to measure the degree of central spinal canal compression. The objective was to investigate the correlation between the expansion ratio of DSCSA after unilateral laminotomy for bilateral decompression (ULBD) and the clinical results for lumbar spinal stenosis.

Methods: We retrospectively reviewed the clinical data and radiographs of 103 patients who underwent ULBD for symptomatic spinal stenosis in one year.

Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases.

Background: Percutaneous endoscopic lumbar discectomy (PELD) has remarkably evolved with successful results. Although PELD has gained popularity for the treatment of herniated disc (HD), the risk of surgical failure may be a major obstacle to performing PELD. We analyzed unsuccessful cases requiring reoperation.

Direct bursoscopic ossicle resection in young and active patients with unresolved Osgood-Schlatter disease.

Purpose: The aim of this study was to determine the outcomes of bursoscopic ossicle excision in young and active patients with unresolved Osgood-Schlatter disease.

Methods: This retrospective study included 18 male military recruits. A direct bursoscopic ossicle excision was performed using low anterolateral and low anteromedial portals.

Contrast dispersion pattern and efficacy of computed tomography-guided cervical transforaminal epidural steroid injection.

Background: The causes of upper extremity radicular pain or neck pain are varied, often involving disc herniation, spinal stenosis, or spondylosis. Cervical transformaminal epidural steroid injection (C-TFESI) is a common treatment for such pain. However, its efficacy conceivably may depend on needle-tip placement, linking the degree of pain reduction achieved to the pattern of contrast dispersion.

Clinical and radiographic changes after percutaneous endoscopic cervical discectomy: a long-term follow-up.

Objective: Results following anterior cervical discectomy (ACD) without fusion are not well reported because of skepticism that the disturbed cervical spine anatomy after ACD might compromise clinical outcome. The purpose of this study was to determine whether ACD without fusion prompts the degenerative process significantly, and whether it is necessary to preserve disc height and cervical alignment for the sake of better clinical outcome following cervical spine surgery.

Background Data: Out of 56 consecutive patients, 37 patients who replied and consequently underwent postoperative MRI from April to June 2009 were included in this study.

Lateral antebrachial cutaneous neuropathy after steroid injection at lateral epicondyle.

Background And Objectives: This report aimed to present a case of lateral antebrachial cutaneous neuropathy (LACNP) that occurred after a steroid injection in the lateral epicondyle to treat lateral epicondylitis in a 40-year-old woman.

Material And Method: A 40-year-old woman presented with decreased sensation and paresthesia over her right lateral forearm; the paresthesia had occurred after a steroid injection in the right lateral epicondyle 3 months before. Her sensation of light touch and pain was diminished over the lateral side of the right forearm and wrist area.

Clinical usefulness of electrodiagnostic study to predict surgical outcomes in lumbosacral disc herniation or spinal stenosis.

Purpose: Although surgeries have been performed for the treatment of lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS), not all patients who undergo surgery are satisfied with the outcome. Electrodiagnostic study (EDX) can assess the physiological functions of nerve roots with higher specificity and relate better with clinical manifestations. The purpose of this study was to examine how EDX can predict surgical outcomes in patients with LDH and LSS and to compare the predicted values of EDX with other clinical factors and MRI findings.

Percutaneous endoscopic decompression for lumbar spinal stenosis.

Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis.

Twist technique for removal of spinal extradural arachnoid cyst: technical note.

Study Design: We document a spinal extradual arachnoid cyst treated by twist technique. The cyst is tightly adherent to the neural tissue or the dura, and the communication stalk is little or short.

Objective: To demonstrate the effectiveness of twist technique of closure of the communication stalk for the removal of spinal extradural arachnoid cyst.

Abdominal aortic aneurysm presenting as a claudication.

Back pain and radiating pain to the legs are the most common symptoms encountered in routine neurosurgical practice and usually originates from neurogenic causes including spinal stenosis. The clinial symptoms are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and vascular disease in elderly patients. Because it is not easy to distinguish out the cause of symptoms by only physical examination, routine spinal MRI is checked first to rule out the spinal diseases in most outpatient clinics.

Working channel endoscope in lumbar spine surgery.

Percutaneous endoscopic lumbar discectomy (PELD) is a well established modality in the treatment of patients with herniated lumbar discs. Since the time of its inception towards the end of 20th century, this technique has undergone significant modifications. With better understanding of the patho-anatomy and development of instrumentation the indications for PELD are on the rise.

Analysis on bilateral hindlimb mapping in motor cortex of the rat by an intracortical microstimulation method.

Intracortical microstimulation (ICMS) is a technique that was developed to derive movement representation of the motor cortex. Although rats are now commonly used in motor mapping studies, the precise characteristics of rat motor map, including symmetry and consistency across animals, and the possibility of repeated stimulation have not yet been established. We performed bilateral hindlimb mapping of motor cortex in six Sprague-Dawley rats using ICMS.

Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes.

Background: Although several authors have reported the use of endoscopic techniques to treat lumbar foraminal stenosis, the practical application of these techniques has been limited to soft disc herniation.

Objective: To describe the details of the percutaneous endoscopic lumbar foraminotomy (ELF) technique for bony foraminal stenosis and to demonstrate the clinical outcomes.

Methods: Two years of prospective data were collected from 33 consecutive patients with lumbar foraminal stenosis who underwent ELF.

Clinical effectiveness of percutaneous adhesiolysis versus transforaminal epidural steroid injection in patients with postlumbar surgery syndrome.

Background And Objectives: A number of patients with postlumbar surgery syndrome (PLSS) do not experience satisfactory results after epidural injection. A main reason for failure is surgically induced perineural fibrosis impeding injected material from spreading effectively into the target area. Percutaneous adhesiolysis (PA) has the ability to eliminate the deleterious effects of such adhesions.

Video-assisted thoracoscopic surgery under O-arm navigation system guidance for the treatment of thoracic disk herniations: surgical techniques and early clinical results.

This study describes the surgical technique and clinical results of video-assisted thoracoscopic surgery (VATS) assisted by an O-arm-based navigation system, used for the treatment of thoracic disk herniation (TDH). The trend toward the use of minimally invasive procedures with endoscopic visualization of the thoracic cavity in thoracic spine surgery has evolved. It is difficult to develop a new set of visuomotor skills unique to endoscopic procedures and understand the three-dimensional (3D) anatomy while performing a two-dimensional (2D) imaging procedure.

Percutaneous endoscopic intra-annular subligamentous herniotomy for large central disc herniation: a technical case report.

Study Design: Technical case report.

Objective: To describe the novel technique of percutaneous endoscopic herniotomy using a unilateral intra-annular subligamentous approach for the treatment of large centrally herniated discs.

Summary Of Background Data: Open discectomy for large central disc herniations may have poor long-term prognosis due to heavy loss of intervertebral disc tissue, segmental instability, and recurrence of pain.

Correlation between severity of lumbar spinal stenosis and lumbar epidural steroid injection.

Objective: Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal that causes mechanical compression of the spinal nerve roots. The compression of these nerve roots can cause leg pain, as well as neurogenic claudication. Lumbar epidural steroid injections have commonly been used in patients with LSS.

Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach.

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive spinal technique. The unique anatomic features of the L5-S1 space include a large facet joint, narrow foramen, small disc space, and a wide interlaminar space. PELD can be performed via 2 routes, transforaminal (TF-PELD) or interlaminar (IL-PELD).

The efficacy of hydroxyapatite for screw augmentation in osteoporotic patients.

The stability of screw constructs is of considerable importance in determining the outcome, especially in spinal osteoporosis. Polymethylmethacrylate (PMMA) has been proven as an effective material for increasing the pullout strength of pedicle screws inserted into the osteoporotic bones. However, PMMA has several disadvantages, such as its exothermic properties, the risk of neural injury in the event of extravasation, and difficulties in performing revision surgery.