Subdural Direct Wave Intraoperative Neurophysiological Monitoring in Intramedullary Spinal Cord Tumor Resection: Case Report.

Direct wave (D-wave) intraoperative neurophysiological monitoring (IONM) is used during intramedullary spinal cord tumor (IMSCT) resection to assess corticospinal tract (CST) integrity. There are several obstacles to obtaining consistent and reliable D-wave monitoring and modifications to standard IONM procedures may improve surgical resection. We present the case of a subependymoma IMSCT resection at the T2-T6 spinal levels where subdural D-wave monitoring was implemented. A 47-year-old male was presented with a five-year history of numbness in his right foot eventually worsening to sharp upper back pain with increased lower extremity spasticity. MRI revealed an expansile non-contrast enhancing multi-loculated cystic lesion spanning T2-T6 as well as a separate T1-T2 lesion. A T2-T6 laminoplasty was performed for intramedullary resection of the lesion. A spinal electrode was placed in the epidural space caudal to the surgical site to monitor CST function; however, action potentials could not be obtained. Post durotomy, the electrode was placed in the subdural space under direct visualization. This resulted in a reliable D-wave recording, which assisted surgical decision-making during the procedure upon D-wave and limb motor evoked potential attenuation. Surgical intervention led to the recovery of the D-wave recording. Subdural D-wave monitoring serves as an alternative in patients where reliable D-waves from the epidural space are unable to be obtained. Further investigation is required to improve the recording technique, including exploring various types of contacts and lead placement locations.

Outcomes of Patients With Parkinson Disease Undergoing Cervical Spine Surgery for Radiculopathy and Myelopathy With Minimum 2-Year Follow-up.

STUDY DESIGN: This was a retrospective cohort analysis. OBJECTIVE: To identify the impact of Parkinson disease (PD) on 2-year postoperative outcomes following cervical spine surgery (CSS). SUMMARY OF BACKGROUND DATA: (PD) patients are prone to spine malalignment and surgical interventions, yet little is known regarding outcomes of CSS among PD patients. MATERIALS AND METHODS: All patients from the Statewide Planning and Research Cooperative System with cervical radiculopathy or myelopathy who underwent CSS were included; among these, those with PD were identified. PD and non-PD patients (n=64 each) were 1:1 propensity score-matched by age, sex, race, surgical approach, and Deyo-Charlson Comorbidity Index (DCCI). Demographics, hospital-related parameters, and adverse postoperative outcomes were compared between cohorts. Logistic regression identified predictive factors for outcomes. RESULTS: Overall, patient demographics were comparable between cohorts, except that DCCI was higher in PD patients (1.28 vs. 0.67, P=0.028). PD patients had lengthier mean hospital stays than non-PD patients (6.4 vs. 4.1 d, P=0.046). PD patients also incurred comparable total hospital expenses ($69,565 vs. $57,388, P=0.248). Individual medical complication rates were comparable between cohorts; though PD patients had higher rates of postoperative altered mental status (4.7% vs. 0%, P=0.08) and acute renal failure (10.9% vs. 3.1%, P=0.084), these differences were not significant. Yet, PD patients experienced higher rates of overall medical complications (35.9% vs. 18.8%, P=0.029). PD patients had comparable rates of individual and overall surgical complications. The PD cohort underwent higher reoperation rates (15.6% vs. 7.8%, P=0.169) compared with non-PD patients, though this difference was not significant. Of note, PD was not a significant predictor of overall 2-year complications (odds ratio=1.57, P=0.268) or reoperations (odds ratio=2.03, P=0.251). CONCLUSION: Overall medical complication rates were higher in patients with PD, while individual medical complications as well as surgical complication and reoperation rates after elective CSS were similar in patients with and without PD, though PD patients required longer hospital stays. Importantly, a baseline diagnosis of PD was not significantly associated with adverse two-year medical and surgical complications. This data may improve counseling and risk-stratification for PD patients before CSS. LEVEL OF EVIDENCE: Level III.

Osteoporosis and Spine Surgery: A Critical Analysis Review.

Despite being part of the aging process, early and adequate management of osteoporosis mitigates adverse outcomes associated with low bone mineral density. Although the health-care burden of osteoporosis is on the rise, screening and management of osteoporosis are not yet an integral part of preoperative patient evaluation in spine surgery. Patients with osteoporosis should undergo multidisciplinary evaluation and management, including lifestyle modifications and initiation of multiple therapeutic modalities. Integrating osteoporosis in preoperative optimization and surgical planning for patients undergoing spine surgery has the potential to mitigate osteoporosis-related postoperative complications.