Lumbar decompression and fusion for symptomatic spinal stenosis in a patient with chronic thoracic sensory level from prior transverse myelitis: a case report.

BACKGROUND: Many patients with transverse myelitis suffer from sensory loss below the spinal level of the lesion. This is commonly associated with chronic neuropathic pain. However, the presence of somatic pain below a complete thoracic sensory level after transverse myelitis is exceptionally rare, and it is unclear if surgical decompression is an effective form of treatment for these patients. CASE PRESENTATION: In this report, we describe a 22-year-old Caucasian female who suffered from chronic lumbar back pain despite a complete thoracic sensory level secondary to prior transverse myelitis. Imaging demonstrated multilevel central stenosis below the sensory level, and her pain improved after surgical decompression. To our knowledge, this is the first reported case of symptomatic lumbar stenosis below a sensory level after transverse myelitis successfully treated with surgical decompression. CONCLUSION: This is the first reported case of a patient with symptomatic lumbar stenosis after transverse myelitis whose lower back pain and quality of life improved following surgical decompression and fusion. This case provides evidence that typical lumbago is possible in patients with sensory loss from transverse myelitis, and standard lumbar decompression may provide benefit for these patients.

Cervical spinal arteriovenous fistula with ventral perimedullary venous drainage.

BACKGROUND: Spinal arteriovenous fistula (AVF) represents the most common type of spinal vascular lesions and is often associated with progressive neurological dysfunction. METHOD: Here, we present a unique case of a spinal vascular malformation that does not fit the traditional classification schemes. The patient presented with progressive neurologic deficits resembling partial Brown-Sequard syndrome and was subsequently found to have a lesion resembling type I spinal AVF. However, this intradural fistula drained into the ventral venous plexus rather than dorsal. CONCLUSION: Recognizing these rare anatomical variants is paramount in achieving successful obliteration and improved functional outcome for patients.

Minimally Invasive, Far Lateral Lumbar Microdiscectomy with Intraoperative Computed Tomography Navigational Assistance and Electrophysiological Monitoring.

BACKGROUND: Patients with far lateral disc herniation (FLDH) experience more severe pain and sensory symptoms compared with those with paracentral disc herniation. In addition, surgical intervention has both been more challenging and resulted in poorer outcomes. METHODS: We report our experience with intraoperative computed tomography (iCT) navigation-assisted minimally invasive tubular microdiscectomy via a paramedian approach with electrophysiological monitoring for precise 3-dimensional anatomical localization and early electrophysiological identification of the exiting nerve. RESULTS: Five patients presenting with weakness and pain refractory to conservative management underwent iCT navigation surgery for lumbar FLDH with electrophysiological monitoring. The mean decrease in the visual analog scale pain score was -7.1 and the modified MacNab criteria outcomes were good in 1 patient and excellent in 4 patients. CONCLUSIONS: These results from a small group of patients suggest this is a safe approach with the potential for improved outcomes in the surgical treatment of FLDH.

Minimally invasive direct lateral, retroperitoneal transforaminal approach for large L1-2 disc herniations with intraoperative CT navigational assistance: technical note and report of 3 cases.

Upper lumbar (L1-2, L2-3) disc herniations are distinct in their diffuse presenting clinical symptomatology and have poorer outcomes with surgical intervention than those following mid and lower lumbar disc herniations and disc surgery. The authors present the cases of 3 patients with L1-2 disc herniations and significant stenosis of the spinal canal. The surgical approach used here combined the principles of transforaminal percutaneous endoscopic discectomy and the extreme lateral lumbar interbody fusion procedures with intraoperative CT-guided navigational assistance. The approach provides a safe corridor of direct visualization to the ventral thecal sac with minimal bony resection and could, in principle, reduce neurological injury and biomechanical instability, which likely contribute to poor outcomes at this level.

Self-inflicted nail-gun injury with cranial penetration and use of intraoperative computed tomography.

BACKGROUND: Management of penetrating cranial trauma remains a high acuity and imaging intense neurosurgical disorder. Imaging of vital structures, including angiography, is typically conducted to understand the proximity of vital structures in comparison to a foreign body and prepare for intraoperative complications such as hemorrhage. Preservation of function following initial injury in cases where minimal neurological deficit exists is essential. CASE DESCRIPTION: Here, we present a case using intraoperative computed tomography to assist in early detection and resolution of hemorrhage in the surgical management of an intact patient with self-inflicted penetrating cranial trauma. CONCLUSIONS: This method may aid in early detection of hemorrhage and prevention of consequential neurological deterioration or emergent need for secondary surgery.

Transforaminal Endoscopic Solution to a Kyphoplasty Complication: Technical Note.

Kyphoplasty is a minimally invasive spine surgical procedure performed to stabilize and treat the pain caused by a spine compression fracture. Complications are rare with kyphoplasty and include cement extrusion into the vertebral canal leading to spinal cord or nerve root compression. Herein, the authors present a case of a 72-year-old woman who presented with symptoms of a right L2 radiculopathy after a kyphoplasty procedure. Computed tomography imaging showed leakage of the kyphoplasty cement into the neural foramen above and medial to the right L2 pedicle. A transforaminal endoscopic surgical approach was used to remove the cement and decompress the L2 nerve. The patient's postoperative clinical course was uneventful. Clinicians should be aware that for the treatment of complications to vertebroplasty and kyphoplasty procedures, minimally invasive transforaminal endoscopic surgery is one option to avoid the destabilizing effects of laminectomy and facetectomy.

Transforaminal Endoscopic Foraminoplasty and Discectomy for the Treatment of a Thoracic Disc Herniation.

Transforaminal endoscopic spine surgery has emerged internationally as a minimally invasive technique that can be performed in an awake patient in the outpatient setting. Advances in high-definition endoscopic camera technologies as well as the availability of specialty graspers, reamers, drills, and other instruments that can be used down a working channel endoscope have made a myriad of spine diseases accessible to the minimally invasive spine surgeon. The major challenge inherent in the surgical treatment of thoracic disc disease is that the disc herniation is often ventral to the spinal cord. The transforaminal approach and the angled endoscopic camera are an ideal combination for creating a technical advantage to accessing thoracic disc disease.