RESUMO
Background Transforaminal lumbar interbody fusion (TLIF) is a common surgical procedure for lumbar spondylolisthesis and intervertebral foraminal stenosis. Sacroiliac joint ankylosis is also known to occur in patients without axial spondyloarthritis. When sacroiliac joint bony ankylosis occurs and sacroiliac joint mobility is lost, stresses from the lower extremities to the lumbar spine are no longer buffered and are expected to be concentrated between the fifth lumbar (L5) and the first sacral (S1) vertebrae. We hypothesized that sacroiliac joint bony ankylosis could adversely affect L5/S1 intervertebral fusion and investigated the postoperative intervertebral fusion rate in single intervertebral TLIF on L5/S1 among patients with bony ankylosis of the sacroiliac joint. Methods Seventy-two patients who had undergone TLIF in the L5/S1 single intervertebral segment since 2014 and had a follow-up of at least one year after surgery were included in the study. Seventy-two patients were divided into the following two groups for comparison: group A consisted of 17 patients with bony ankylosis of the sacroiliac joint on either side on preoperative CT, and group N consisted of 55 patients without ankylosis. We investigated the intervertebral segment fusion rate one year postoperatively. Fisher's exact tests were used for statistical analysis, with a significance level of P < 0.05. Results Twelve patients (71%) in group A and 50 patients (91%) in group N had a fusion of the L5/S1 intervertebral segment one year after TLIF surgery, with a significantly lower rate in group A (P = 0.049). Conclusions We conclude that the presence of preoperative sacroiliac joint bony ankylosis is a risk factor for postoperative intervertebral fusion failure after single-segment TLIF at L5/S1.
RESUMO
In carotid artery stenting (CAS) for highly tortuous carotid stenosis, it is often difficult to guide rigid devices such as carotid stents. There are various adjunctive techniques using a guidewire: the buddy wire technique, the sheep technique, and the stiff guide technique. We report a case in which the tortuous vessel was straightened and a stent could be inserted. A 64-year-old man with amaurosis had highly tortuous left carotid stenosis. Despite the best medical treatments, he often had transient cerebral ischemic symptoms, so we planned CAS. We could insert the first stent, but the proximal vessel was kinked by the placement of the stent. It was so tortuous that the second stent could not be inserted by adjunctive techniques. Therefore, the proximal balloon was inflated and pulled back to straighten the tortuous vessel, and then we could insert the stent. We named this technique the "snake hunt technique" because it was just like catching a snake given that the tortuous vessel was stretched. This technique could be a troubleshooting step when it is difficult to insert a stiff device such as a stent or balloon even with the use of various adjunctive techniques.
