A history of Colombian neurosurgery: events, persons, and outcomes that have shaped the specialty in the country.

The history of Colombian neurosurgery is a collective legacy of neurosurgeon-scientists, scholars, teachers, innovators, and researchers. Anchored in the country's foundational values of self-determination and adaptability, these pioneers emerged from the Spanish colonial medical tradition and forged surgical alliances abroad. From the time of Colombian independence until the end of World War I, exchanges with the French medical tradition produced an emphasis on anatomical and systematic approaches to the emerging field of neurosurgery. The onset of American neurosurgical expertise in the 1930s led to a new period of exchange, wherein technological innovations were added to the Colombian neurosurgical repertoire. This diversity of influences culminated in the 1950s with the establishment of Colombia's first in-country neurosurgery residency program. A select group of avant-garde neurosurgeons from this period expanded the domestic opportunities for patients and practitioners alike. Today, the system counts 10 recognized neurosurgery residency programs and over 500 neurosurgeons within Colombia. Although the successes of specific individuals and innovations were considered, the primary purpose of this historical survey was to glean relevant lessons from the past that can inform present challenges, inspire new opportunities, and identify professional and societal goals for the future of neurosurgical practice and specialization.

Intraoperative Complications of Anterior Lumbar Interbody Fusion: A 5-Year Experience of a Group of Spine Surgeons Performing Their Own Approaches.

BACKGROUND: Spine surgery has evolved at an accelerated pace, allowing the development of more efficient surgical techniques while providing a decreasing rate of morbimortality. One example of these approaches is the anterior lumbar interbody fusion (ALIF). The aim of this study was to evaluate the surgical complication rate when performing ALIF without the help of a vascular "access" surgeon. METHODS: A retrospective descriptive study was conducted at the Hospital Universitario San Ignacio between 2014 and 2018 and included all patients who underwent ALIF during this time. A nonsystematic review was performed assessing approach-related complications in ALIF and the impact of "access" surgeons in surgical outcomes. RESULTS: A total of 337 patients were included and 508 levels were fused. ALIF was performed as ALIF-360° (27%), ALIF-lateral lumbar interbody fusion (LLIF) (8.9%), and stand-alone ALIF (62%). Most procedures were single-level fusions (51.9%), 45.4% involved 2 levels, and 2.6% were 3-level fusions. The mortality rate was 0%, and only 9 cases of vascular injury were observed and described. Left and common iliac veins were the predominant affected structures. Only a single case required blood transfusion without any other treatment or intensive care unit surveillance. CONCLUSIONS: Our study is consistent with literature reports about ALIF complications, finding an incidence of 1.7%. Therefore, ALIF is an excellent alternative for spine procedures, especially for the levels L5-S1 that require sagittal balance restoration. The approaches were performed without a vascular "access" surgeon and presented complication rates similar to those described in the literature.

Craniocervical junction diseases treatment with a minimally invasive approach / Abordagem minimamente invasiva para tratamento de lesões da união craniocervical / Abordaje minimamente invasivo para tratamiento de lesiones de la union craneocervical

Objective: To introduce a new minimally invasive surgical approach to anterior and lateral craniocervical junction diseases, preserving the midline posterior cervical spine stabilizing elements and reducing the inherent morbidity risk associated with traditional approaches. Methods: We describe a novel surgical technique in four cases of extra-medullary anterolateral compressive lesions located in the occipito-cervical junction, including infections and intra- and/or extradural tumor lesions. We used a paramedian trasmuscular approach through an anatomical muscle corridor using a micro MaXcess® surgical expandable retractor, with the purpose of reducing morbidity and preserving the posterior muscle and ligamentous tension band. Results: This type of surgical approach provides adequate visualization and microsurgical resection of lesions and reduces muscle manipulation and devascularisation, preserving the tension of the ligament complex. There was minimal blood loss and a decrease in postoperative pain, with rapid start of rehabilitation and shorter hospitalization times. There were no intraoperative complications, and all patients recovered from their pre-operative symptoms. Conclusions: This novel surgical technique is feasible and adequate for the occipito-atlanto-axial complex, with better results than traditional procedures.

Objetivo: Realizamos esforços para desenvolver novas técnicas cirúrgicas para reduzir a morbidade e a mortalidade. Métodos: Descrevemos uma técnica cirúrgica nova em quatro casos de lesões extramedulares compressivas anterolaterais da junção occipitocervical, que incluem infecções e lesões tumorais intra e extradurais. As lesões foram excisadas por uma nova técnica cirúrgica minimamente invasiva, por meio de um corredor anatômico muscular, utilizando-se o afastador expansível MaXcess® (Nuvasive Inc., San Diego, CA, EUA) visando reduzir a morbidade e preservar a banda de tensão músculo-ligamentar. Resultados: Esse tipo de abordagem proporcionou visualização e excisão microcirúrgica adequada das lesões, com redução da manipulação muscular, preservando a tensão do complexo ligamentar nucal. Houve perda de sangue mínima, além da redução da dor pós-operatória, início rápido da reabilitação e pequena estadia hospitalar. Não foram observadas complicações intraoperatórias e os pacientes não tiveram mais os sintomas apresentados no pré-operatório. Conclusões: Essa nova técnica cirúrgica é uma opção de tratamento na região do complexo occipito-atlanto-axial anterolateral, com resultados superiores aos dos procedimentos tradicionais.

Objetivo: Se han realizado esfuerzos por desarrollar nuevas técnicas quirúrgicas que reduzcan morbimortalidad. Métodos: Describimos una novedosa técnica quirúrgica de tratamiento en cuatro casos de lesiones extramedulares compresivas anterolaterales de la unión occipitocervical que incluyen infecciones y lesiones tumorales intra y extradurales. Las lesiones fueron extirpadas por una nueva técnica quirúrgica mínimamente invasiva a través de un corredor anatómico muscular, utilizándose el retractor expansible MaXcess® (Nuvasive Inc., San Diego, CA, EEUU) con el objetivo de reducir la morbilidad y preservar la banda de tensión músculo-ligamentaria. Resultados: Este tipo de abordaje aportó adecuada visualización y resección microquirúrgica de las lesiones, con reducción de la manipulación muscular, preservando la tensión del complejo ligamentario nucal. Hubo mínima pérdida sanguínea además de disminución de dolor post-operatorio, rápido inicio de rehabilitación y corta estancia hospitalaria. No se presentaron complicaciones intraoperatorias y los pacientes se recuperaron de la sintomatología preoperatoria. Conclusiones: Esta nueva técnica quirúrgica se perfila como una opción de tratamiento a nivel del complejo occipito-atlanto-axial anterolateral con resultados superiores a los procedimientos tradicionales.

Técnica mínimamente invasiva para descompresión y estabilización dinámica con sistema pedicular en enfermedad degenerativa de la columna lumbar. Reporte preliminar de casos y revisión de la literatura / Minimally invasive technique for decompression and dynamic stabilization with pedicle system in degenerative lumbar spine. Preliminary report of cases and literature review

El dolor lumbar constituye una patología de alta incidencia y costos, transformándose en un problema de salud pública. Cuando la causa es secundaria a compresión de estructuras neurales la indicación quirúrgica es clara; sin embargo, cuando a ésta se asocian características biomecánicas del dolor no es claro el manejo que se debe seguir y las medidas terapéuticas no siempre tienen buenos resultados. Durante mucho tiempo se ha manejado el concepto de inestabilidad como causal del componente biomecánico de la lumbalgia crónica; de tal manera, la fusión del segmento espinal se ha convertido en la medida terapéutica de elección. Sin embargo, a pesar de una depuración de la técnica, y de tasas de fusión cercanas al 100%, el resultado clínico no se correlaciona y, por el contrario, aparecen complicaciones como la enfermedad del segmento adyacente a la fusión. Se han propuesto entonces formas de estabilización que conserven el movimiento, prefiriéndose los sistemas basados en tornillos transpediculares por su larga durabilidad y mejor control del movimiento. Reportamos tres casos de enfermedad degenerativa lumbar asociada a compresión de estructuras nerviosas que requerían estabilización adicional y en los que se prefirió, por la edad de los pacientes y otros factores a favor, la colocación del sistema dinámico de estabilización posterior COSMIC. Presentamos un reporte preliminar de casos con resultados alentadores de una técnica de fijación transpedicular dinámica como una opción al tratamiento tradicional de fusión estático y rígido, para el manejo de la enfermedad degenerativa de la columna lumbar y el dolor lumbar crónico.