Practice Patterns of Spine Surgeons Regarding Osteoporosis: An International Survey.

BACKGROUND: Osteoporosis (OP) represents a great challenge for the spine surgeon. Despite having effective pharmacological treatments for OP and surgical technical innovations, the awareness of spine surgeons regarding OP seems low. The purpose of this research was to assess practice patterns on the diagnosis and treatment of spine surgeons regarding OP. METHODS: An electronic survey of ten multiple-choice questions was administered to members of the European Association of Neurosurgical Societies (EANS). The survey asked about the specialty, the workplace, and practice patterns and attitudes regarding OP and spine fusion surgery, pseudoarthrosis, and vertebral compression fractures (VCF). RESULTS: A total of 122 surgeons completed the survey. In patients with suspected OP, 31.4% of surgeons would refer the patient to the OP specialist before surgery and 21.5% chose to perform the surgery without additional studies. A 66.4% of respondents would modify the surgical strategy in the case of OP. The most popular surgical techniques elected were cemented augmented screws (77.9%) and long-segment instrumentation (45.1%). Regarding pseudoarthrosis, 29.5% of surgeons opted to refer to the OP specialist, and 23.8% didn't consider any additional studies Concerning VCF management, 41.32% of respondents would refer the patient for treatment of OP, and the most common therapeutic strategy was conservatively treatment for 4 to 6 weeks and vertebroplasty or kyphoplasty if no improvement (55.74%).There was a higher proportion of surgeons that would not consider preoperative studies or referring patients with suspected OP for spine surgery (χ2 = 4.48, P = .03) and pseudoarthrosis (χ2 = 9.5, P = .002) compared to VCF. CONCLUSIONS: There was a greater awareness regarding optimizing OP management in VCF compared to patients with suspected OP for spine arthrodesis or pseudoarthrosis. There still opportunities for improvement for the timely diagnosis and treatment of OP in spine surgery patients.

A Rare Case of Negative-Pressure Hydrocephalus: A Plausible Explanation and the Role of Transmantle Theory.

BACKGROUND: Negative-pressure hydrocephalus is a rare condition with the development of symptomatic hydrocephalus despite subnormal intracranial pressure (ICP). The etiology remains unclear. Some authors proposed that the differential pressure between the ventricular space and the subarachnoid space over cerebral convexity leads to the development of ventriculomegaly, namely as the transmantle pressure theory. CASE DESCRIPTION: A 49-year-old patient with a left Sylvian fissure arachnoid cyst underwent several surgeries including cystoperitoneal shunts and fenestrations of the cyst. The patient developed a cerebrospinal fluid fistula from the cranial wound was complicated by bacterial meningitis. Consequently, the shunt was removed, and external cyst drainage was placed. After 9 days, the patient developed acute hydrocephalus requiring external ventricular drainage (EVD). Two days later, after overdrainage of the external cyst drain, the patient suffered neurologic deterioration. The ICP measured by the EVD was -4 cm H2O, and a computed tomography scan demonstrated progression of the hydrocephalus. The external cyst drainage was shut off and the EVD level was adjusted to produce between 5 and 10 mL/hour of cerebrospinal fluid under a subatmospheric pressure set at -5 cm H2O, and gradually raised in increments of 1 cm every 3 days until a positive ICP occurred. Once clinical and radiographic stability was accomplished, a programmable ventriculoperitoneal shunt was inserted set to 30 mm H2O. A marked clinical and radiologic improvement was observed in the follow-up. CONCLUSIONS: This negative-pressure hydrocephalus case report supports the main role of the transmantle pressure theory. The subatmospheric EVD method and a low-pressure valve resulted in excellent clinical and radiographic outcomes.

Dental multisection CT for the placement of oral implants: technique and applications.

Dental computed tomography (CT) is a diagnostic examination for the preoperative evaluation of patients who will undergo placement of oral implants. It can be performed with multidetector CT or more recently with cone-beam CT. The growing older population and the consequent development of edentulism have increased the number of imaging studies performed for preoperative evaluation of dental implantation. Thus, radiologists are becoming more frequently involved in this type of testing. Dental CT is superior to conventional x-ray techniques because superimposition and distortion are eliminated; therefore, possible complications such as injury of the neurovascular bundle and perforation of the maxillary sinuses can be avoided. This noninvasive and fast method provides accurate information about the positions of important structures to allow one to determine the implant required. Dental CT enables analysis of the state, quality, and quantity of bone on two-dimensional and three-dimensional reformatted images, and its high spatial resolution allows exact measurements of the length and width of the alveolar ridge. Inclusion of all this information in the radiology report facilitates achievement of a successful implantation.