Total uncinectomy of the cervical spine with an osteotome: technical note and intraoperative video

2019 ◽  
Vol 31 (6) ◽  
pp. 831-834 ◽  
Author(s):  
Anand H. Segar ◽  
Alexander Riccio ◽  
Michael Smith ◽  
Themistocles S. Protopsaltis
Keyword(s):  
Vertebral Artery ◽  
High Speed ◽  
Thermal Injury ◽  
Technical Note ◽  
Uncinate Process ◽  
Foraminal Stenosis ◽  
Cervical Kyphosis ◽  
Kyphosis Correction ◽  
Direct Injury ◽  
High Speed Burr

Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.

Ultrasonic Total Uncinectomy: A Novel Technique for Complete Anterior Decompression of Cervical Nerve Roots

2014 ◽  
Vol 10 (4) ◽  
pp. 535-541 ◽  
Author(s):  
Peyman Pakzaban
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Uncinate Process ◽  
Foraminal Stenosis ◽  
Anterior Decompression ◽  
Nerve Roots ◽  
Cervical Nerve ◽  
Arm Pain ◽  
Nerve Root Injury ◽  
Cervical Nerve Roots

Abstract BACKGROUND: In standard anterior cervical diskectomy, complete resection of the uncinate process is not commonly attempted because of the risk of injury to the vertebral artery. This may result in incomplete decompression of the nerve root when there is severe osseous foraminal stenosis. OBJECTIVE: To demonstrate the feasibility of total uncinectomy with an ultrasonic bone dissector in patients with concomitant central and foraminal stenosis requiring anterior decompression and fusion. METHODS: A case series of patients with cervical radiculopathy or myeloradiculopathy who underwent single-level or multilevel ultrasonic total uncinectomy (UTU) in combination with anterior cervical diskectomy and fusion is presented. The uncinate process was amputated along its base with an ultrasonic bone dissector and removed en bloc to expose the cervical root and the vertebral artery. Data gathered in accordance with routine practice were analyzed retrospectively. RESULTS: Forty-four uncinate processes were resected in 38 patients. No UTU procedures were aborted because of technical difficulties, and no vertebral artery or nerve root injury occurred. Mean follow-up was 28 weeks (range, 14-37 weeks). Mean Neck Disability Index and Visual Analog Scale scores for neck and arm pain improved from 42%, 4.9%, and 6.8% to 23%, 2.6%, and 2.1%, respectively. Postoperative computed tomography and oblique radiographs revealed complete decompression of the neural foramen after UTU. CONCLUSION: UTU is a safe and effective technique for complete decompression of cervical nerve roots when the coexistence of central and foraminal pathology dictates an anterior approach. The surgical technique is described in detail.

Transforaminal 360° lumbar endoscopic foraminotomy in postfusion patients: technical note and case series

2021 ◽  
pp. 1-7
Author(s):  
Albert E. Telfeian ◽  
Ashwin Veeramani ◽  
Andrew S Zhang ◽  
Matthew S. Quinn ◽  
Alan H. Daniels
Keyword(s):  
Minimally Invasive ◽  
High Speed ◽  
Lumbar Fusion ◽  
Case Series ◽  
Visual Analog Scale Score ◽  
Technical Note ◽  
Leg Pain ◽  
Decompression Surgery ◽  
Foraminal Stenosis

OBJECTIVE This report describes a minimally invasive lumbar foraminotomy technique that can be applied in patients who underwent complex spine decompression procedures or in patients with severe foraminal stenosis. METHODS Awake, endoscopic decompression surgery was performed in 538 patients over a 5-year period between 2014 and 2019. Transforaminal endoscopic foraminal decompression surgery using a high-speed endoscopic drill was performed in 34 patients who had previously undergone fusions at the treated level. RESULTS At 2-year follow-up, the mean (± SD) preoperative visual analog scale score for leg pain and the Oswestry Disability Index improved from 7.1 (± 1.5) and 40.1% (± 12.1%) to 2.1 (± 1.9) and 13.6% (± 11.1%). CONCLUSIONS A minimally invasive, awake procedure is presented for the treatment of severe lumbar foraminal stenosis in patients with lumbar radiculopathy after lumbar fusion.

Anchoring Method for Hemifacial Spasm Associated with Vertebral Artery: Technical Note

Neurosurgery ◽  
1999 ◽  
Vol 45 (6) ◽  
pp. 1487-1491 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Atsushi Watanabe ◽  
Yasuyuki Toba ◽  
Junpei Nitta ◽  
Shinsuke Muraoka ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Technical Note

Microvascular Compressicaude by Slinging a Tortuous Vertebrobasilar Artery to the Petrous Dura in Hemifacial Spasm: Technical Note

2018 ◽  
Vol 37 (04) ◽  
pp. 352-361
Author(s):  
Forhad Chowdhury ◽  
Mohammod Haque ◽  
Jalal Rumi ◽  
Monir Reza
Keyword(s):  
Vertebral Artery ◽  
Free Flap ◽  
Hemifacial Spasm ◽  
Technical Note ◽  
Taxi Driver ◽  
Treatment Technique ◽  
Entry Zone ◽  
Temporal Fascia ◽  
Vertebrobasilar Artery ◽  
The Brain

Objective In cases of hemifacial spasm caused by a tortuous vertebrobasilar artery (TVBA), the traditional treatment technique involves Teflon (polytetrafluoroethylene), which can be ineffective and fraught with recurrence and neurological complications. In such cases, there are various techniques of arteriopexy using adhesive compositions, ‘suspending loops’ made of synthetic materials, dural or fascial flaps, surgical sutures passed around or through the vascular adventitia, as well as fenestrated aneurysmal clips. In the present paper, we describe a new technique of slinging the vertebral artery (VA) to the petrous dura for microvascular decompression (MVD) in a patient with hemifacial spasm caused by a TVBA. Method A 50-year-old taxi driver presented with a left-sided severe hemifacial spasm. A magnetic resonance imaging (MRI) scan of the brain showed a large tortuous left-sided vertebral artery impinging and compressing the exit/entry zone of the 7th and 8th nerve complex. After a craniotomy, a TVBA was found impinging and compressing the entry zone of the 7th and 8th nerve complex. Arachnoid bands attaching the artery to the nerve complex and the pons were released by sharp microdissection. Through the upper part of the incision, a 2.5 × 1 cm temporal fascia free flap was harvested. After the fixation of the free flap, a 6–0 prolene suture was passed through its length several times using the traditional Bengali sewing and stitching techniques to make embroidered quilts called Nakshi katha. The ‘prolenated’ fascia was passed around the compressing portion of the VA. Both ends of the fascia were brought together and stitched to the posterior petrous dura to keep the TVBA away from the 7th and 8th nerves and the pons. Result The patient had no hemifacial spasm immediately after the recovery from the anesthesia. A postoperative MRI of the brain showed that the VA was away from the entry zone of the 7th and 8th nerves. Conclusion The ‘prolenated’ temporal fascia slinging technique may be a very good option of MVD in cases in which the causative vessel is a TVBA.

Extensive curettage using a high-speed burr versus dehydrated alcohol instillation for the treatment of enchondroma of the hand

2013 ◽  
Vol 40 (4) ◽  
pp. 384-391 ◽  
Author(s):  
S. M. Cha ◽  
H. D. Shin ◽  
K. C. Kim ◽  
I. Y. Park
Keyword(s):  
Analogue Scale ◽  
High Speed ◽  
Proximal Phalanx ◽  
Healing Time ◽  
Complete Healing ◽  
Pathological Fractures ◽  
Active Motion ◽  
The Mean ◽  
High Speed Burr

The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients treated with different adjuvant methods after curettage for enchondromas of the hand. Sixty-two patients with enchondroma were treated with high-speed burring (29 patients) or alcohol instillation (33 patients) after curettage. The mean follow-up was 40.8 months. No significant differences in the visual analogue scale, Disabilities of the Arm, Shoulder, and Hand scores, total range of active motion, grip strength, and complete healing time were observed between the groups. The distribution of the results of the formula by Wilhelm and Feldmeier were not significantly different between the groups. No surgery-related complications, postoperative pathological fractures, or recurrence was found in either group. For the treatment of enchondroma in the metacarpal and proximal phalanx, alcohol instillation immediately after curettage was as effective as extensive curettage using a high-speed burr.

scholarly journals Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion

2020 ◽  
Author(s):  
Sung Hyun Noh ◽  
Jeong Yoon Park ◽  
Sung Uk Kuh ◽  
Dong Kyu Chin ◽  
Keun Su Kim ◽  
...  
Keyword(s):  
Sella Turcica ◽  
Uncinate Process ◽  
Disc Height ◽  
Foraminal Stenosis ◽  
Sagittal Vertical Axis ◽  
Arm Pain ◽  
T1 Slope ◽  
Cervical Sagittal Alignment ◽  
Post Operation

Abstract Background: Many patients with cervical radiculopathy experience stenosis of the neural foramens due to cumulative osteophyte or uncovertebral joint hypertrophy. For cervical foraminal stenosis, complete uncinate process resection (UPR) is often conducted concurrently with anterior discectomy and fusion (ACDF). The aim of this study was to assess the clinical and radiological outcomes of ACDF with complete UPR versus ACDF without UPR. Methods: In total, 105 patients who performed one-level ACDF with a cage-and-plate construct between 2011 and 2015 were retrospectively reviewed. Among them, 37 patients had ACDF with complete UPR, and 68 patients had ACDF without UPR. Radiologic outcomes of disc height, C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis (SVA), center of the sella turcica–C7 SVA (St-SVA), spino-cranial angle (SCA), and fusion rate were evaluated on plain X-ray at pre-operation, immediately post-operation, and at 2-year follow-up. For statistically matched pairs analysis, ACDF with UPR group (24 patients) and ACDF without UPR (24 patients) were compared.Results: All of the clinical parameters improved at the 2-year follow up (P<0.0001). Improvement in visual analogue scale (VAS) scores for arm pain was significantly improved in the ACDF with complete UPR group immediately post-operation. All cervical sagittal parameters, including cervical lordosis, segmental angle, disc height, C2-C7 SVA, St-SVA, T1 slope, and SCA, except for preoperative St-SVA, SCA, and disc height of 2 years follow-up, were similar between the ACDF with complete UPR and ACDF without UPR groups. Differences in disc height, C2-C7 SVA, and SCA at 2-year follow up after preoperative examination, however, were statistically significant (p<0.05). Subsidence occurred in 9 patients (ACDF with complete UPR: 8 cases [33%] versus ACDF without UPR: 1 cases [4%]; p < 0.05). Conclusions: Cervical sagittal alignment after ACDF with complete UPR is not significantly different from that achieved with ACDF without UPR. However, subsidence appears to occur more often after ACDF with complete UPR than after ACDF without UPR, although with little to no clinical impact. More precise and careful selection of patients is needed when deciding on additional complete UPR.

scholarly journals THORACIC AND LUMBAR HEMIVERTEBRA EXCISION IN PEDIATRIC PATIENTS: HOW DOES THE OPERATION TECHNIQUE INFLUENCE ON OUTCOMES? (СOHORT ANALYSIS AND LITERATURE REVIEW)

2018 ◽  
Vol 24 (3) ◽  
pp. 83-90 ◽  
Author(s):  
A. Yu. Mushkin ◽  
D. G. Naumov ◽  
E. Yu. Umenushkina
Keyword(s):  
Blood Loss ◽  
Surgical Approach ◽  
High Speed ◽  
Operation Technique ◽  
Posterior Fixation ◽  
Surgical Trauma ◽  
Dorsal Approach ◽  
Total Blood ◽  
High Speed Burr ◽  
The Moment

Purpose of the study— to study impact of hemi-vertebrae extirpation technique in mono-segmental reconstructionon the surgical trauma.Material and Methods.34 patients underwent 36 mono-segmental extirpations of hemi-vertebrae followed by aposterior fixation during a single center four years cohort study. Mean age of children at the moment of procedure was 4 years and 3 months (min — 1 year, max — 14 years). The authors studied impact of pathology level, surgical approach, type of bony structures removal technique and age of the patients on the time of procedure and volume of blood loss. Results.Extirpation of thoracic hemi-vertebrae was characterized by a lengthier procedure and greater blood lossin contrast to lumbar hemi-vertebrae. Patients were divided into three groups depending on extirpation technique: 1)  extirpation from two approaches using a high-speed burr; 2) from a single dorsal approach using the same extirpation technique; 3) from dorsal approach using ultrasonic bone scalpel. Surgery time was 208±72 min in the first group, 187±54 min in the second group, and 170±30 min in the third group; blood loss volume was 181±39, 181±53, 132±73 ml respectively in the groups, or 11.5±4.3%, 9.4±2.8% and 9.6±5.2% of total blood volume, respectively.Conclusion.Surgical approach and hemi-vertebrae extirpation technique in children have a varying impact onsurgery time and intraoperative blood loss, and the least values were reported for posterior approach using ultrasonic bone scalpel.

In Vivo Retrieval of a Trapped Merci Embolectomy Device: Technical Case Report

2010 ◽  
Vol 67 (3) ◽  
pp. onsE304-onsE304 ◽  
Author(s):  
Ajeet Gordhan ◽  
John Soliman
Keyword(s):  
Vertebral Artery ◽  
Conformational Changes ◽  
Basilar Artery ◽  
Technical Note ◽  
Vessel Injury ◽  
Artery Segment ◽  
In Vitro Assessment ◽  
Artery Flow

Abstract BACKGROUND AND IMPORTANCE: This technical note describes a complication related to the use of the Merci embolectomy device not previously reported. The device can induce critical flow limitation within an accessed vessel because of a combination of vasospasm and anatomic conformational changes. Furthermore, this can limit the safe removal of the device from intracranial vasculature. We present a novel rescue technique that can be used to safely retrieve the entrapped Merci device without inciting localized vessel injury. CLINICAL PRESENTATION: A 51-year-old male with embolic occlusion of the distal basilar artery and dissection-related occlusion of the left cervical vertebral underwent mechanical thrombolysis. Flow-limiting vasospasm and/or anatomic conformational changes/ telescoping of the intracranial right vertebral artery segment was induced during deployment with subsequent entrapment of the device. Reclamation of the entrapped device was performed by initially removing the Merci microcatheter. The entrapped and fixated device was then resheathed into a 4F slip catheter within the intracranial vertebral artery. The Merci device and the slip catheter were then removed. Right vertebral and proximal basilar artery flow was reestablished after removal of the Merci device. Successful clot extraction was thereafter performed using a microsnare. CONCLUSION: In vitro assessment of the device has demonstrated its propensity to induce vasospasm. In vivo entrapment of the device has not been previously reported. Successful retrieval can be achieved if the Merci device becomes entrapped and fixated. This may be an important consideration as increased utilization of the device occurs.

Selective angiography of the vertebral artery in the rabbit: Technical note

1996 ◽  
Vol 46 (1) ◽  
pp. 84-86
Author(s):  
Hajime Touho ◽  
Jun Karasawa ◽  
Hideyuki Ohnishi ◽  
Satoshi Ueda
Keyword(s):  
Vertebral Artery ◽  
Technical Note ◽  
Selective Angiography
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