Anatomical Parameters for Occipital Condyle Screws: An Analysis of 500 Condyles Using CT Scans.

STUDY DESIGN: Retrospective observational study. OBJECTIVE: To establish occipital condyle dimensions (length, width, height), as well as the medialization angle necessary for safe occipital condyle screw placement in occipitocervical fixation. METHODS: Between 1/2014-6/2014, patients who presented to a single level 1 academic trauma center emergency room and received computed tomography (CT) imaging of the cervical spine as part of routine clinical care were identified. After excluding patients with cervical fractures, neoplastic disease, or infection, 500 condyles representing 250 patients were analyzed. Condyle length, height, and width (all reported in millimeters [mm]) were evaluated on the sagittal, coronal, and axial series, respectively. Medialization angle (reported in degrees) was evaluated on the axial series of CT imaging. Measurements were compared by sex and age. RESULTS: The average condyle length, width, and height were 18.6 millimeters (mm) (range, 14.5-23.0 mm), 10.5 mm (range, 7.4-13.8 mm), and 11.3 mm (7.1-15.3 mm), respectively. Additionally, the average occipital condyle medialization angle was 23° (range, 14-32°). Occipital condyles of men were significantly longer, wider, and taller (all comparisons, p < 0.05). The medialization angle was significantly steeper for women than men (p < 0.05). No measurement differences were appreciated by age. CONCLUSION: Our findings are similar to previous studies in the field; however, length appears slightly shorter. Further, measurement differences were appreciated by sex but not age. Thus, our measurement findings emphasize the importance of preoperative planning utilizing individual patient anatomy to ensure safe placement of occipital condyle screws for optimal outcomes.

Translational Brain Mapping at the University of Rochester Medical Center: Preserving the Mind Through Personalized Brain Mapping.

The Translational Brain Mapping Program at the University of Rochester is an interdisciplinary effort that integrates cognitive science, neurophysiology, neuroanesthesia, and neurosurgery. Patients who have tumors or epileptogenic tissue in eloquent brain areas are studied preoperatively with functional and structural MRI, and intraoperatively with direct electrical stimulation mapping. Post-operative neural and cognitive outcome measures fuel basic science studies about the factors that mediate good versus poor outcome after surgery, and how brain mapping can be further optimized to ensure the best outcome for future patients. In this article, we describe the interdisciplinary workflow that allows our team to meet the synergistic goals of optimizing patient outcome and advancing scientific understanding of the human brain.

Negative-pressure dressing management of recurrent postoperative epidural hematoma and uncontrollable intraoperative hemorrhage in posterior spine surgery: report of 4 cases.

There is a paucity of literature describing the management of recurrent symptomatic postoperative epidural hematoma or uncontrollable intraoperative hemorrhage in posterior spine surgery. Traditional management with hematoma evacuation and wound closure over suction drains may not be effective in certain cases, and it can lead to recurrence and neurological injury. The authors report 3 cases of recurrent symptomatic postoperative epidural hematoma successfully managed with novel open-wound negative-pressure dressing therapy (NPDT), as well as 1 case of uncontrollable intraoperative hemorrhage that was primarily managed with the same technique. The 3 patients who developed a postoperative epidural hematoma became symptomatic 2-17 days after the initial operation. All 3 patients underwent at least 1 hematoma evacuation and wound closure over suction drains prior to recurrence with severe neurological deficit and definitive management with NPDT. One patient was managed primarily with NPDT for uncontrollable intraoperative hemorrhage during posterior cervical laminectomy. All 4 patients had significant risk factors for postoperative epidural hematoma. NPDT for 3-9 days with delayed wound closure was successful in all patients. The 3 patients with recurrent symptomatic postoperative epidural hematoma had significant improvement in their severe neurological deficit. None of the patients developed a postoperative wound infection, and none of the patients required transfusion due to NPDT. NPDT with delayed wound closure may be an option in certain patients, when wound closure over suction drains is unlikely to prevent further neurological injury.

Louis A. Goldstein, MD: A Pioneer in Spinal Deformity Surgery.

MINI: During the first half of the 20th century interest in spinal deformity grew due to common conditions of that era including polio and tuberculosis. This article will discuss Louis Arnold Goldstein, a visionary leader in spinal deformity surgery from Rochester, New York and one of the founders of the Scoliosis Research Society.During the first half of the 20th century interest in spinal deformity grew due to common conditions of that era including polio and tuberculosis. This article will discuss Louis Arnold Goldstein, a visionary leader in spinal deformity surgery from Rochester, New York and one of the founders of the Scoliosis Research Society. Louis A. Goldstein was a talented surgeon, administrator, and clinician scientist. He also started a spine surgery fellowship program that still bears his name and that continues to train complex spine surgeons.

A retrospective analysis of pedicle screws in contact with the great vessels.

OBJECT: Pedicle screws placed in the thoracic, lumbar, and sacral spine occasionally come in contact with the aorta, vena cava, or iliac vessels. When such screws are seen on postoperative imaging in an asymptomatic patient, the surgeon must decide whether it is riskier to revise the screw or to observe it. The authors hypothesized that the incidence of screw placement causing perioperative vessel injury is low and, further, that screws placed in contact with major vessels do not always result in vessel injury. METHODS: A retrospective review of the operative records of 182 consecutive patients undergoing thoracic, lumbar, and lumbosacral pedicle screw fusion was performed to determine the frequency of intraoperative vessel injury. Postoperative imaging for 107 patients was available to determine the incidence of screws in contact with major vessels. Charts were examined to determine if any adverse sequelae had resulted from malpositioned screws. Patient outcomes were documented. RESULTS: There were no intraoperative vessel injuries or deaths in 182 consecutive operations. One hundred seven patients with available postoperative films had 680 pedicle screws placed between T-3 and the sacrum during 115 operations. No patient had arterial screw penetration or deformation on postoperative imaging. Thirty-three of the 680 inserted screws were in contact with a major vessel on routine postoperative imaging. The contacted vessels included the aorta (4 cases), the iliac artery (7 cases), and the iliac veins (22 cases). Patients were followed up until death or November 2009, for a mean follow-up of 44 months (median 44 months, range 5-109 months). None of the patients with vessel contact was noted to suffer symptoms or sequelae as a result of vessel contact. Radiographic follow-up as long as 50 months after surgery revealed no detectable vessel abnormality at the contacted site. CONCLUSIONS: Placing pedicle screws in contact with major vessels is a known risk of spinal surgery. The risk of repositioning a screw in contact with a major vessel but causing no symptoms must be weighed against the relative risk of leaving it in place.