ABSTRACT
Objective@#In oblique lateral interbody fusion (OLIF) surgery at the L5-S1 level (OLIF51), anatomical complexity and the possibility of vascular injury during retraction of the common iliac vein (CIV) make the surgery challenging. We radiologically evaluated patients who underwent OLIF surgery to determine approaches that can make OLIF51 surgery easier during multilevel OLIF. @*Methods@#We retrospectively analyzed 275 consecutive patients who underwent OLIF surgery between September 2014 and December 2019. The distance between the left and right CIVs (dCIV) was measured using an axial image at the L5 lower endplate level, and the height of the iliocaval junction (hCIV) was measured from the L5 lower endplate to the iliocaval junction in the sagittal image. The sum of anterior disc height of each level (sADH) was calculated. @*Results@#Eighty-two patients (33 males and 49 females) were enrolled. The number of three- (L2-3-4-5), two- (L3-4-5), and one-level (L4-5) fusions was 13, 21, and 48, respectively. Changes between the pre- and postoperative sADH, dCIV, and hCIV values were 17.1±4.7, 7.7±3.5, and 13.1±4.7 mm in three-level fusion; 10.6±4.1, 5.6±3.7, and 7.0±3.1 in two-level fusion; and 4.3±2.5, 3.3±2.7, and 3.0±2.0 mm in one-level fusion, respectively. As the number of surgical levels increased, the changes in sADH, dCIV, and hCIV significantly increased. @*Conclusions@#The dCIV and hCIV values increased when the upper segment underwent surgery before OLIF51 during multilevel OLIF.
ABSTRACT
Background@#One of the challenges neurosurgeons are facing in the global public health crisis caused by the coronavirus disease 2019 (COVID-19) pandemic is to balance COVID-19 screening with timely surgery. We described a clinical pathway for patients who needed emergency brain surgery and determined whether differences in the surgery preparation process caused by COVID-19 screening affected clinical outcomes. @*Methods@#During the COVID-19 period, patients in need of emergency brain surgery in our institution were managed using a novel standardized pathway designed for COVID-19 screening. We conducted a retrospective review of patients who were hospitalized through the emergency room and underwent emergency brain surgery. A total of 32 patients who underwent emergency brain surgery from February 1 to June 30, 2020 were included in the COVID-19 group, and 65 patients who underwent surgery from February 1 to June 30, 2019 were included in the pre-COVID-19 group. The baseline characteristics, disease severity indicators, time intervals of emergency processes, and clinical outcomes of the two groups were compared. Subgroup analysis was performed between the immediate surgery group and the semi-elective surgery group during the COVID-19 period. @*Results@#There were no significant differences in baseline characteristics and severity indicators between the pre-COVID-19 group and COVID-19 group. The time interval to skin incision was significantly increased in the COVID-19 group (P = 0.027). However, there were no significant differences in the clinical outcomes between the two groups. In subgroup comparison, the time interval to skin incision was shorter in the immediate surgery group during the COVID-19 period compared with the pre-COVID-19 group (P = 0.040). The screening process did not significantly increase the time interval to classification and admission for immediate surgery.The time interval to surgery initiation was longer in the COVID-19 period due to the increased time interval in the semi-elective surgery group (P < 0.001). @*Conclusion@#We proposed a clinical pathway for the preoperative screening of COVID-19 in patients requiring emergency brain surgery. No significant differences were observed in the clinical outcomes before and after the COVID-19 pandemic. The protocol we described showed acceptable results during this pandemic.