Safety and Efficacy of Osteotomy for Congenital Spinal Deformity Associated with Split Spinal Cord Malformation

Intracranial endoscopy in the treatment of hydrocephalus, arachnoid cysts, or brain tumors has gained wide acceptance, but the use of endoscopy for intradural navigation in the pediatric spine has received much less attention. The aim of the authors' present study was to analyze their experience in using spinal endoscopy to treat various pathologies of the spinal canal. The authors performed a retrospective review of intradural spinal endoscopic cases at their institution. They describe 4 representative cases, including an arachnoid cyst, intrinsic spinal cord tumor, holocord syrinx, and split cord malformation. Intradural spinal endoscopy was useful in treating the aforementioned lesions. It resulted in a more limited laminectomy and myelotomy, and it assisted in identifying a residual spinal cord tumor. It was also useful in the fenestration of a multilevel arachnoid cyst and in confirming communication of fluid spaces in the setting of a complex holocord syrinx. Endoscopy aided in the visualization of the spinal cord to ensure the absence of tethering in the case of a long-length Type II split spinal cord malformation. Conclusions Based on their experience, the authors found intradural endoscopy to be a useful surgical adjunct and one that helped to decrease morbidity through reduced laminectomy and myelotomy. With advances in technology, the authors believe that intradural endoscopy will begin to be used by more neurosurgeons for treating diseases of this anatomical region.

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Fluctuations in Spinal Cord Perfusion During Adult Spinal Deformity Correction Identify Neurologic Changes: Proof of Concept

World Neurosurgery ◽

10.1016/j.wneu.2015.08.067 ◽

2016 ◽

Vol 85 ◽

pp. 365.e1-365.e6 ◽

Cited By ~ 5

Author(s):

Jay D. Turner ◽

Robert K. Eastlack ◽

Zaman Mirzadeh ◽

Stacie Nguyen ◽

Jeff Pawelek ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Proof Of Concept

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Ligamentum flavum hypertrophy in a patient with Pott’s disease

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh191201077a ◽

2020 ◽

pp. 77-77

Author(s):

Vuk Aleksic ◽

Rosanda Ilic ◽

Mihailo Milicevic ◽

Filip Milisavljevic ◽

Milos Jokovic

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Neurological Deficit ◽

Ligamentum Flavum ◽

Late Onset ◽

Spinal Canal Stenosis ◽

Pott’S Disease ◽

Canal Stenosis ◽

Common Causes ◽

Angular Kyphosis

Introduction. The spine is involved in less than 1% of all tuberculosis (TB) cases, and it is a very dangerous type of skeletal TB as it can be associated with neurologic deficit and even paraplegia due to compression of adjacent neural structures and significant spinal deformity. The spine TB is one of the most common causes for an angular kyphotic deformity of spine. Patients with 60 or more degree kyphosis at dorsolumbar spine are at great risk to develop late onset neurological deficit and paraplegia due to chronic compression and stretching of the spinal cord over bonny ridges. In small portion of cases other conditions may lead to neurological deficit in patients with long standing angular kyphosis which also alters the treatment strategy that otherwise involves prolonged and mutilant surgery. Case outline. We present a case of a 61-year-old male patient with concomitant 90-degree dorsolumbar spine kyphosis due to spinal TB and ligamentum flavum hypertrophy, which led to spinal canal stenosis with myelopathy and consequent paraplegia. The patient undergoes dorsal decompression with removal of the hypertrophic yellow ligament after which he recovered to the level of walking. Conclusion. Many authors propose guidelines for treatment of spinal TB taking into account the stage of the disease, the age of the patient, the angle of kyphosis, and other factors. We find that the best approach for each patient is personalized medical approach.

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The Safety and Efficacy of CT-Guided, Fluoroscopy-Free Vertebroplasty in Adult Spinal Deformity Surgery

World Neurosurgery ◽

10.1016/j.wneu.2018.05.139 ◽

2018 ◽

Vol 116 ◽

pp. e944-e950 ◽

Cited By ~ 1

Author(s):

Corinna C. Zygourakis ◽

Anthony M. DiGiorgio ◽

Clifford L. Crutcher ◽

Michael Safaee ◽

Fred H. Nicholls ◽

...

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Ct Guided ◽

Safety And Efficacy ◽

Spinal Deformity Surgery

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Safety and Efficacy of Rose Bengal Derivatives for Glial Scar Ablation in Chronic Spinal Cord Injury

Journal of Neurotrauma ◽

10.1089/neu.2017.5398 ◽

2018 ◽

Vol 35 (15) ◽

pp. 1745-1754 ◽

Cited By ~ 5

Author(s):

Nandadevi Patil ◽

Vincent Truong ◽

Mackenzie H. Holmberg ◽

Nicolas S. Lavoie ◽

Mark R. McCoy ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Rose Bengal ◽

Glial Scar ◽

Chronic Spinal Cord Injury ◽

Safety And Efficacy ◽

Cord Injury

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Surgeon-directed transcranial motor evoked potential spinal cord monitoring in spinal deformity surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1278.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 547-552

Author(s):

Ramanare Sibusiso Magampa ◽

Robert Dunn

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Early Identification ◽

Evoked Potential ◽

Motor Evoked Potential ◽

Congenital Scoliosis ◽

Spinal Cord Monitoring ◽

Cord Injury ◽

Spinal Deformity Surgery ◽

Transcranial Motor Evoked Potential

Aims Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy. Methods We carried out a retrospective review of a single surgeon’s prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed. Results Of the 299 cases reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No patient with normal traces had a postoperative clinical neurological deficit. True alerts occurred in 20 cases (6.7%). The diagnoses of the alert group included nine cases of adolescent idiopathic scoliosis (AIS) (45%) and six of congenital scoliosis (30%). The incidence of deterioration based on diagnosis was 9/153 (6%) for AIS, 6/30 (20%) for congenital scoliosis, and 2/16 (12.5%) for spinal tuberculosis. Deterioration was much more common in congenital scoliosis than in AIS (p = 0.020). Overall, 65% of alerts occurred during rod instrumentation: 15% occurred during decompression of the internal apex in vertebral column resection surgery. Four alert cases (20%) awoke with clinically detectable neurological compromise. Conclusion Surgeon-directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress, thereby enabling immediate intervention. In resource constrained environments, surgeon-directed TcMEP is a viable and effective method of intraoperative spinal cord monitoring. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(3):547–552.

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