Management of lumbar spondylolisthesis: A retrospective analysis of posterior lumbar interbody fusion versus transforaminal lumbar interbody fusion.

Background: One of the most frequent etiologies for spinal surgery is unstable lumbar spondylolisthesis (ULS). To decompress affected structures while maintaining or restoring stability through fusion, surgeons utilize a variety of procedures. When paired with interbody fusion, posterior fusion is most applied, resulting in greater fusion rates. The two most popular techniques for implementing spinal fusion are posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF). As a result, these two procedures have been assessed formally. Methodology: A retrospective analysis of patients who underwent interbody fusion for lumbar stenosis through PLIF and minimally invasive (MI)-TLIF was performed. The patients were followed up for 24 months and fusion rates, Visual Analog Score (VAS), and Oswestry Disability Index (ODI) alongside the MacNab clinical outcome score, were assessed. The Bridwell interbody fusion grading system was used to evaluate fusion rates in computed tomography (CT). Results: Operations were performed in 60 cases where patients suffered from ULS. PLIF was performed on 33 patients (55%) (14 males and 19 females) and 27 patients (45%) (11 males and 16 females) who underwent MI-TLIF. In 87% of our respective cohort, either the L4-5 or the L5-S1 level was operated on. Overall fusion rates were comparable between the two groups; however, the TLIF group improved more in terms of VAS, ODI, and MacNab scores. On average, MI-TLIF surgery was longer and resulted in reduced blood loss. MI-TLIF patients were more mobile than PLIF patients postoperatively. Conclusion: With well-established adequate results in the literature, TLIF offers benefits over other methods used for interbody lumbar fusion in ULS or other diseases of the spine. However, MI-TLIF may procure more advantageous for patients if MI methods are implemented. In this instance, TLIF outperformed PLIF due to shorter operating times, less blood loss, faster ODI recovery, better MacNab scores, and a greater decline in VAS pain ratings.

Surgical nuances of giant neurocysticercosis according to intracranial location in the Southwest region of the Dominican Republic, presentation of cases, and literature review.

Background: Neurocysticercosis (NCC) is the most common infestation of the central nervous system, caused by the larval stage of the pig tapeworm Taenia solium. It is prevalent in regions with poor sanitation and underdevelopment, such as Latin America. Case Description: We present four cases in which they harbored an intraventricular/intraparenchymal, frontal convexity, cerebellomedullary, and intraparenchymal NCC cyst of medium size, respectively. Three of them underwent complete removal of the cyst by craniotomy; the fourth had a shunt for obstructive hydrocephalus first, followed by excision of a suboccipital cyst 8 months later. Conclusion: The intraventricular/intraparenchymal lesion was more complex to treat than its subarachnoid counterparts because the average brain should be transected and dissected away to achieve total removal. Waterjet dissection, arachnoid microdissection, and cyst drainage allowed minor brain damage than capsule coagulation and traction. Populated prospective studies are needed better to understand the surgical nuances of these rare entities.

Catéter epidural roto, una complicación poco frecuente / Broken epidural catheter, a rare complication

Resumen: Actualmente, la anestesia neuroaxial es preferida por sus múltiples ventajas con respecto al manejo del dolor. El procedimiento involucra la colocación de un catéter epidural en el espacio peridural, una complicación muy rara es la ruptura de éste. Se estima una incidencia de 0.002 a 0.004%. El presente trabajo reporta el caso de un paciente masculino de 77 años sometido a una resección transuretral de próstata, que presenta ruptura del catéter durante el retiro. La tomografía reportó la presencia del catéter a nivel subaracnoideo, sin presencia de síntomas en el paciente. Se egresó y a los seis meses de seguimiento no presentaba síntomas. Es de importancia comprender que siempre se debe notificar al paciente en caso de que esto suceda y después realizar estudios de imagen para su localización. Posteriormente se debe valorar la presencia de síntomas y, si existen, considerar una laminectomía para su retiro.

Abstract: Nowadays, neuraxial anesthesia is preferred due to its multiple advantages related to pain management. This procedure involves placing an epidural catheter within the epidural space, with rupture of the catheter being an uncommon complication. Its incidence is around 0.002 to 0.004%. The present work reports the case of a 77-year-old male who underwent a transurethral prostate resection, where the catheter broke while being removed. CT scan reported the presence of the catheter within subarachnoid space, without the patient presenting symptoms. It is important to understand that notifying the patient is a priority in case this complication happens, and then order imaging studies to locate the catheter. Finally, if symptoms are present, a laminectomy should be assessed to remove the remaining piece.

Expanding access to microneurosurgery in low-resource settings: Feasibility of a low-cost exoscope in transforaminal lumbar interbody fusion.

Objectives: Less than a quarter of the world population has access to microneurosurgical care within a range of 2 h. We introduce a simplified exoscopic visualization system for low-resource settings. Materials and Methods: We purchased a 48 megapixels microscope camera with a c-mount lens and a ring light at a total cost of US$ 125. Sixteen patients with lumbar degenerative disk disease were divided into an exoscope group and a microscope group. In each group, we performed four open and four minimally invasive transforaminal lumbar interbody fusions (TLIF). We conducted a questionnaire-based assessment of the user experience. Results: The exoscope achieved similar outcomes with comparable blood loss and operating time as the microscope. It provided similar image quality and magnification. Yet, it lacked stereoscopic perception and the adjustability of the camera position was cumbersome. Most users strongly agreed the exoscope would significantly improve surgical teaching. Over 75% reported that they would recommend the exoscope to colleagues and all users saw its great potential for low-resource environments. Conclusion: Our low-budget exoscope is safe and feasible for TLIF and purchasable at a fraction of the cost of conventional microscopes. It may thus help expand access to neurosurgical care and training worldwide.

A Low-Cost Three-Dimensional Printed Retractor for Transforaminal Lumbar Interbody Fusion.

The authors developed a low-cost surgical retractor to improve surgeon's comfort and facilitate pedicle screw insertion in transforaminal lumbar interbody fusion surgery. The retractor was designed using three-dimensional (3D) modeling software and produced with the help of a 3D printer. It was attached to a mechanic retractor arm. The retractor was anchored to the transverse process through a concave notch at its tip, visualizing the junction between the transverse process and the superior articular process. The gutter-shaped body of the retractor helped stay within the ideal trajectory during screw insertion. The retractor was tested in 20 patients undergoing transforaminal lumbar interbody fusion with satisfactory results. Future models will be generated suitable for surgery of the cervical and thoracic spine.

Development of a Novel Low-Cost Exoscope to Expand Access to Microneurosurgical Care in Low- and Middle-Income Countries.

BACKGROUND: Less than a quarter of the world population has access to microneurosurgical care within a range of 2 hours. We introduce a simplified exoscope system to achieve magnification, illumination, and video recording in low-resource settings. METHODS: We combined an industrial microscope tube, a heavy-duty support arm, a wide-field c-mount digital microscope camera, and a light-emitting diode ring light. All parts were sterilized with ethylene oxide. We performed 13 spinal and 3 cranial surgeries with the help of the low-budget exoscope. RESULTS: The average preoperative setup time was 12.8 minutes. The exoscope provided similar magnification and illumination like a conventional binocular microscope. It allowed operating in a comfortable posture. The field of vision ranged from 30 mm-60 mm. The surgical field was captured by a 16-megapixel two-dimensional camera and projected to a 55-inch high-definition television screen in real time. Image quality was similar to that of a conventional microscope although our exoscope lacked stereoscopic view. Adjusting camera position and angle was time-consuming. Thus, the benefit of the exoscope was most notable in spine surgeries where the camera remained static for most of the time. The total cost of the exoscope was approximately U.S. $ 750. CONCLUSIONS: Our low-budget exoscope offers similar image quality, magnification, and illumination like a conventional binocular microscope. It may thus help expand access to neurosurgical care worldwide. Users may face difficulty adapting to the lack of depth perception in the beginning. Prospective studies are needed to assess its usability and effectiveness compared to the microscope.

Thoracic Percutaneous Vertebroplasty for the Treatment of Vertebral Hemangioma in a Patient With Forestier's Disease: A Case Report.

Percutaneous vertebroplasty consists of an injection of polymethylmethacrylate in the vertebral body, with the aim of reinforcing the bone structure, preventing vertebral collapse, and achieving analgesic and antitumor effects. It is used in the treatment of patients with aggressive vertebral hemangiomas, as well as compression fractures of traumatic etiology and pathological fractures. Forestier's disease is also known as senile ankylosing hyperostosis of the spine. It is characterized by hypertrophy of the anterior longitudinal ligament. Depending on the most prominent place of ossification of this ligament, its clinical symptoms vary, with intense pain being the most relevant. Here, we present the case of a 73-year-old female with complaints of intense, constant pain that did not improve with conservative treatment, located at the level of the Th4Th10 vertebrae, radiating along the intercostal spaces, with eight months of evolution with muscular hypertonism. Magnetic resonance imaging of the thoracic spine showed osteochondritis of the thoracic spine and right-sided scoliosis. For hemangioma of the Th6 vertebral body, the patient was referred to the vertebrology department, where she was admitted to undergo percutaneous vertebroplasty of the affected level under fluoroscopic control. In this study, we report the use of percutaneous vertebroplasty as a minimally invasive treatment in a patient with Forestier's disease, obtaining excellent results, rapid recovery, and minimal hospitalization time, without having to subject the patient to major surgery.