Comparison between O-arm Navigation and Conventional Fluoroscopic Guidance in Corrective Posterior Fixation for Cervical Spinal Injury.

Purpose : To compare the effectiveness of O-arm navigation with that of conventional fluoroscopic guidance in corrective posterior fixation for cervical spinal injury. Methods : This retrospective comparative study involved 11 consecutive patients who underwent corrective posterior fixation using O-arm navigation or conventional fluoroscopy for cervical spinal injury between February 2016 and May 2021. Patient-specific characteristics (age and sex), number of screws, number of pedicle screws, accuracy of pedicle screw insertion, number of vertebral bodies fixed, operating time, and length of hospital stay were analyzed using the t-test. A P-value < 0.05 was considered statistically significant. Results : Corrective posterior fixation was performed under O-arm navigation in 5 patients and under conventional fluoroscopic guidance in 6. A significantly greater number of pedicle screws was used in the O-arm group (6.4 vs 2.7, P = 0.046). According to the Neo classification for pedicle screw placement, there were no grade 2 or 3 breaches. No other items showed a significant difference between the groups (P > 0.05). Conclusion : O-arm navigation can improve the accuracy of cervical pedicle screw insertion. Its introduction could expand the indications for use of pedicle screws in posterior fixation of cervical spinal injury beyond those that are possible using conventional fluoroscopy. J. Med. Invest. 69 : 273-277, August, 2022.

Successful treatment of intractable pseudomeningocele with FXIII deficiency by surgery and FXIII replacement therapy: A case report.

Pseudomeningocele is an extradural cystic collection of cerebrospinal fluid (CSF) and is rare and typically asymptomatic. However, pseudomeningocele is sometimes associated with symptoms. Whether symptomatic pseudomeningocele is best treated conservatively or surgically remains controversial. Factor XIII (FXIII) is a blood coagulation factor that also promotes fibroblast proliferation during wound healing. Although treatment of postsurgical CSF leakage with FXIII has been reported, there have been no reports on surgical treatment and FXIII replacement therapy of pseudomeningocele with FXIII deficiency. We report a case of pseudomeningocele with FXIII deficiency that was successfully treated by surgery and FXIII replacement therapy. The patient presented with symptoms of intracranial hypotension syndrome that had started a few months after laminectomy for thoracic ossification of the ligamentum flavum 2 years earlier. Magnetic resonance imaging and delayed computed tomography myelography confirmed a diagnosis of pseudomeningocele. Epidural blood patch treatment was performed twice but did not result in improvement. Furthermore, the FXIII level decreased to 56%, so the patient was also diagnosed as having acquired FXIII deficiency. We elected to treat the patient by surgery with FXIII replacement therapy. The dural injury was repaired using an artificial dura mater patch, fibrin glue, and polyglycolic acid sheets. The FXIII level was 74%-135% during the perioperative period. The patient had a good postoperative course. Postoperative magnetic resonance images showed resolution of the pseudomeningocele. There was no recurrence during 6 months of follow-up. Perioperative FXIII replacement may be a useful treatment for pseudomeningocele with FXIII deficiency.

Risk Management for Avoidance of Major Vascular Injury due to Lateral Transpsoas Approach.

STUDY DESIGN: A retrospective study using 323 contrast-enhanced, multi-planner three-dimensional computed (3D-CT) scans. OBJECTIVE: The aim of this study was to identify risk factors for injury to the major vessels in the lateral transpsoas approach. SUMMARY OF BACKGROUND DATA: To avoid critical complications such as major vessel injury, it is essential to examine anatomical information related to preoperative risk management that is specific to the lateral transpsoas approach. METHODS: The abdominal contrast-enhanced, multi-planner 3D-CT scans of 323 consecutive subjects (203 males and 120 females, 15-89 years old) were retrospectively reviewed. The true axial views were used for evaluation of the locations of the major vein and artery at L3 to L4 and L4 to L5. According to the Moro system, the axial view was divided into 6 zones from the front side (A, I II, III, IV, P) and the locations of the dorsal tangential line of the major vessels were evaluated. RESULTS: At the L3 to L4 level, the dorsal tangential line of the major vein located in zone A was found in 18% of subjects, in zone I in 74%, and in zone II in 8%. The line of the major artery was located in zone A in 92.6% of subjects and in zone I in 7.1%. At the L4 to L5 level, the line of the major vein was located in zone A in 5% of subjects, in zone I in 75%, in zone II in 20%, and in zone III in only 1 subject. The line of the major artery was identified in zone A in 87% of subjects, in zone I in 12%, and in zone II in 1%. Women had significant dorsal-migrated veins and arteries at both spinal levels (P < 0.01). CONCLUSION: To avoid critical complications in extreme lateral lumbar interbody fusion, careful preoperative radiological evaluation of the major vessels and intraoperative care are important. LEVEL OF EVIDENCE: 3.

Reconstruction of Extensor Tendon Dislocation Due to Chronic Sagittal Band Rupture of the Thumb Metacarpophalangeal Joint: A Case Report.

CASE: We report a case of recurrent dislocation of the extensor pollicis longus and extensor pollicis brevis tendons due to chronic rupture of the radial sagittal band of the metacarpophalangeal joint of the thumb. CONCLUSION: Successful restabilization of these tendons was achieved by transferring a half-slip of the abductor pollicis brevis tendon.

Open dislocation of the proximal interphalangeal joint of the little finger subsequent to chronic radial collateral ligament injury: a case report of primary ligament reconstruction with a half-slip of the flexor digitorum superficialis: Case Report.

Open dislocation of the proximal interphalangeal (PIP) joint is relatively rare. We report a case of a 32-year-old man who had open dislocation of the PIP joint of the little finger while playing American football. He had a history of chronic radial collateral ligament injury. We reconstructed the radial collateral ligament with a half-slip of the flexor digitorum superficialis tendon.

Induction of prolonged, continuous slow-wave sleep by blocking cerebral H1 histamine receptors in rats.

BACKGROUND AND PURPOSE: Classic H(1) histamine receptor (H(1)R) antagonists are non-selective for H(1)R and known to produce drowsiness. Modern antihistamines are more selective for H(1)R, and are 'non-drowsy' presumably due to reduced permeability through the blood-brain barrier. To characterize both histaminergic sleep regulation and the central actions of antihistamines, in the present study we analysed the effect of classic and modern antihistamines on rats' sleep using continuous i.c.v. infusions. EXPERIMENTAL APPROACH: Effects of classic (d-chlorpheniramine; d-CPA) and second-generation (cetirizine) antihistamines on sleep were compared after i.p. injections or continuous i.c.v. infusions into rats. Fluorescent cetirizine/DBD-pz was synthesized to trace the approximate distribution of cerebral cetirizine. Furthermore, the effects of H(1) R antagonists on cultured preoptic neurons were examined using calcium imaging. KEY RESULTS: d-CPA 4 mg·kg(-1) i.p. increased non-rapid eye movement (REM) sleep whereas 10-40 mg·kg(-1) d-CPA decreased non-REM sleep at dark onset time. Nocturnal i.c.v. infusions of d-CPA (10 µmol·100 µL(-1)·10 h(-1)) increased drowsiness but not non-REM sleep, whereas the same i.c.v. infusions of cetirizine significantly increased non-REM sleep, abolished REM sleep, and decreased wakefulness for more than 10 h. The medial preoptic area contained the greatest fluorescent labelling after i.c.v. cetirizine/DBD-pz infusions. Histamine-induced Ca(2+) increases in medial preoptic neurons were blocked by d-CPA or cetirizine, whereas d-CPA, but not cetirizine, increased Ca(2+) irrespective of antihistaminergic activity at ≥ 100 µM. CONCLUSION AND IMPLICATIONS: The excitatory action of d-CPA may explain the seemingly inconsistent actions of d-CPA on sleep. Cerebral H(1)R inhibition by cetirizine induces synchronization of cerebral activity and prolonged, continuous slow-wave sleep.