ABSTRACT
Background Minimally invasive lateral lumbar interbody fusion (LLIF) offers advantages over traditional approaches, providing indirect decompression of neural elements and deformity correction while avoiding many challenges and risks of anterior and posterior approaches. Mastering this technique requires a specialized team, advanced equipment, and sufficient case exposure. Current training is limited to the classic educational model, and alternative training methods such as cadaver labs can be inconvenient, inaccessible, expensive, and incompatible with intraoperative neuromonitoring (IONM) systems. Objective The aim of this study was to create a proof-of-concept, low-cost, fully synthetic lateral lumbar surgical simulator and to increase awareness of the lack of current training alternatives. Methods Standard engineering design and expert interviews of attending neurosurgeons, nurses, engineers, and medical device representatives (n=20) were utilized to determine key elements for the simulator, physical characteristics of the components, and translational strategy. Physical and radiographic testing was performed on multiple thermoplastics to determine appropriateness for inclusion in the simulator. For evaluation of the concept, a descriptive slide deck and questionnaire were sent to 15 U.S. and 15 international surgeons who perform LLIF. Results The lateral access training model (LATM) features the following three components: torso casing, spine module, and IONM feature. This model utilizes operable ABS (acrylonitrile butadiene styrene) 3D-printed lumbar vertebrae, verified for anatomical accuracy and compatibility with fluoroscopy. Additionally, a novel neuromonitoring simulation algorithm was developed to train junior residents on neurological complications. To further highlight the need for lateral training models, 30/30 polled surgeons felt that this simulator has value for the field, 29/30 noted that they would have used the LATM if they had access during training, and 30/30 responded that they would encourage trainees to practice on the LATM. Conclusion The LATM is a first step to provide reliable and inexpensive basic lateral lumbar spine training. While this model is lacking some anatomical features, our simulator offers novel training elements for lateral lumbar transpsoas approaches, which lay the foundation for future models to be built. The need for this training exists, and current gaps in the approach to learning these complex techniques need to be filled due to the inconvenience, cost, and impracticability of standard cadaveric models.
ABSTRACT
OBJECTIVE: To describe the clinical characteristics and outcomes of CVT in patients with history of recent COVID-19 infection or vaccination. METHODS: We reviewed demographic, clinical, and radiographic characteristics of non-pyrogenic, non-traumatic CVT cases at our multi-center institution between March 2020 and December 2021. Patients were grouped according to their history of recent COVID-19 infection or vaccination into group-I (+COVID-19 association) and group-II (-COVID-19 association). RESULTS: Fifty-one patients with CVT were included, of which 14 (27.4%) had a positive COVID-19 association: 10 with infection and 4 with mRNA-COVID-vaccine. Nine patients in group-I had COVID-19 infection or vaccine within 30 days of CVT diagnosis, including 3 patients with active infection at the time of CVT diagnosis. Half of the patients in group-I (n = 7,50.0%) and 32.4% (n = 12) of group-II were male, and mean age was 52.6 years in group-I and 51.4 years in group-II. Fever at presentation was noted in one patient who had active COVID infection (I=1 (7.1%), II= 0 (0%)). Higher rates of comorbidities were observed in group-II: hypertension (I= 2 (14.3%), II= 13 (35.1%)), deep venous thrombosis(I=1(7.1%), II= 10 (27.0%)), pulmonary emboli (I=1(7.1%), II= 8(21.6%)), or stroke(I=0(0%), II= 6(16.4%)). Three patients had thrombocytopenia at the time of CVT diagnosis (5.4%) and most patients (n = 37, 72.5%) were treated medically with anticoagulation. Complication rate during hospitalization was 17.6% (n = 6), and no mortality was noted. CONCLUSION: Twenty-seven percent of CVT patients were associated with COVID-19 infection or vaccination, and the majority presented within 30 days of infection/vaccination.