scholarly journals Neurological Complications after Lateral Transpsoas Approach to Anterior Interbody Fusion with a Novel Flat-Blade Spine-Fixed Retractor

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Pierce Nunley ◽  
Faheem Sandhu ◽  
Kelly Frank ◽  
Marcus Stone
Keyword(s):  
Surgical Approach ◽  
Interbody Fusion ◽  
Neurological Complications ◽  
Neurologic Complication ◽  
Neurologic Complications ◽  
Residual Symptoms ◽  
Transpsoas Approach ◽  
Retrospective Data Collection ◽  
One Year

Introduction. The lateral lumbar interbody fusion (LLIF) surgical approach has potential advantages over other approaches but is associated with some unique neurologic risks due to the proximity of the lumbosacral plexus. The present study analyzed complications following LLIF surgical approach using a novel single flat-blade retractor system.Methods. A retrospective data collection of patients receiving LLIF using a novel single flat-blade retractor system at two institutions in the US. Inclusion criteria were all patients receiving an LLIF procedure with the RAVINE® Lateral Access System (K2M, Inc., Leesburg, VA, USA). There was no restriction on preoperative diagnosis or number of levels treated. Approach-related neurologic complications were collected and analyzed postoperatively through a minimum of one year.Results. Analysis included 253 patients with one to four treated lateral levels. Immediate postoperative neurologic complications were present in 11.1% (28/253) of patients. At one-year follow-up the approach-related neurologic complications resolved in all except 5 patients (2.0%).Conclusion. We observed an 11.1% neurologic complication rate in LLIF procedures. There was resolution of symptoms for most patients by 12-month follow-up, with only 2% of patients with residual symptoms. This supports the hypothesis that the vast majority of approach-related neurologic symptoms are transient.

scholarly journals 2333. Influenza-Related Neurologic Complications in Hospitalized Children with Underlying Neurologic Disorders

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S801-S801
Author(s):  
Sarah Frankl ◽  
Susan E Coffin ◽  
Sanjeev Swami ◽  
Jennifer McGuire
Keyword(s):  
Vaccine Coverage ◽  
Neuromuscular Disorders ◽  
Tertiary Care ◽  
Severe Infection ◽  
Neurological Complications ◽  
Post Exposure Prophylaxis ◽  
Neurologic Complication ◽  
Neurologic Complications ◽  
Neurologic Disorders ◽  
Increased Risk

Abstract Background Children with underlying neurological and neuromuscular conditions are considered “high risk” for developing severe infection due to influenza. Prior reports highlighted this population’s increased risk for respiratory failure. Little is known about neurological complications experienced by children with pre-existing neurologic disorders (PNDs) when infected with influenza. Methods Retrospective cohort study of children 0.5–18.0 years old hospitalized at a tertiary care pediatric hospital between August 2010 and June 2017 with laboratory-confirmed influenza. Eligible children were identified by electronic medical record query for influenza assay CPT codes with positive results during an admission; cases were confirmed by chart review. Demographics and clinical data were abstracted. Results A total of 1217 immune competent children (median age 5.5 [IQR 2.2–9.8] years) were hospitalized with laboratory-confirmed influenza during the study period. About 28% (341/1217) had at least one PND, including epilepsy (n = 105), developmental delay or intellectual disability (n = 234), neurogenetic or metabolic disorders (n = 77), neuromuscular disorders (n = 22) and others (n = 253). Compared with previously healthy peers, these children were more often admitted to the intensive care unit (31% vs. 16%, P < 0.001), had a longer length of stay (3 vs. 2 days, P < 0.001), and had a higher incidence of neurologic complications (23% vs. 6%, P < 0.001). Seizures (18% vs. 4%, P < 0.001) and encephalopathy (8% vs. 2%, P < 0.001) in particular were more common in children with PNDs, but other neurologic complications occurred in comparable proportions (3% vs. 1%, P = 0.088). Only 49% of the overall cohort had documented annual influenza vaccine; coverage was slightly better for children with PNDs than those without (55% vs. 48%, P = 0.017). The odds of having a neurologic complication in children with documented vaccination was nearly half that of other children when adjusted for age, influenza strain, and any PND (adjusted OR 0.64, 95% CI 0.44–0.94, P = 0.021). Conclusion The excess risk of neurological complications in children with PNDs highlights the importance of vaccinating this population. Additional consideration should be given to post-exposure prophylaxis for children with PNDs who have not received vaccine. Disclosures All authors: No reported disclosures.

scholarly journals Periareolar augmentation mastopexy: A new approach dealing with the cases as tuberous breasts

2016 ◽  
Vol 49 (02) ◽  
pp. 172-177 ◽  
Author(s):  
Roberto Moltó-García ◽  
María Eloísa Villaverde-Doménech ◽  
Virina González-Alonso ◽  
Francisco Ripoll-Orts ◽  
Eduardo Simon-Sanz
Keyword(s):  
Surgical Technique ◽  
Surgical Approach ◽  
Surgical Techniques ◽  
Inferior Pole ◽  
Malpractice Claims ◽  
One Year ◽  
Periareolar Mastopexy ◽  
Augmentation Mastopexy ◽  
New Surgical Technique

ABSTRACTBackground: Periareolar augmentation mastopexy is one of the most demanded operations at Plastic Surgery clinics. Nevertheless, it is one of the leads of malpractice claims in United States caused by the high patient expectations and the standard surgical techniques which may result in common complications. The aim of this report is to present a new surgical approach to solve these complications. Methods: After establishing a working hypothesis, we performed a revision study of our patients and we came to the following conclusion: in order to perform a periareolar mastopexy for ptosis correction, breast has to be tuberous at any level and to have abnormally short inferior pole. These findings may explain the main complications from periareolar augmentation mastopexy with the standard surgical techniques. Consequently, we started a prospective observational study including 56 patients following a new surgical technique which deals the cases as tuberous breasts. Results: During three years, fifty-six periareolar mastopexies were performed with this new surgical approach with one year follow-up. No major complications were observed and 40 of the patients (71%) described the results as very positive. Conclusion: “If a periareolar mastopexy can be performed, then it must be a tuberous breast”. According to this, a new surgical technique for periareolar augmentation mastopexy has been developed obtaining an improvement in our surgical results and achieving a totally different view on this pathology, which has not been reported in literature yet.

R415 – Recurrence of Nasopharyngeal Angiofibroma (NPF) Study

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P182-P182
Author(s):  
Vardhan Vishnu ◽  
R. Martha
Keyword(s):  
Prospective Study ◽  
Recurrence Rate ◽  
Surgical Approach ◽  
Statistical Difference ◽  
Duration Of Symptoms ◽  
Nasopharyngeal Angiofibroma ◽  
Appropriate Treatment ◽  
One Year ◽  
The Right

Problem Study of correlation of recurrence of NPF with its histopathologic appearance. Methods A retrospective and prospective study of 184 NPF cases identified, treated in Government Ear Nose Throat Hospital, and followed over a period of 26 years (1981–2006) and their histopathological slides are preserved, their recurrence rate is documented. The histopathology of NPF is varied - composed of vascular and fibrous components and their proportion varied. In our study we will undertake the review of histopathology slides that are already preserved and would also like to study the new recurrent cases in the coming 6 months. Results All recurrences were observed with in one year of of treatment and the recurrence rate was 19.66%. Recurrence had no correlation with age of patient, duration of symptoms, or surgical approach but correlated with stage of tumor at presentation (p less than 0.05). Preoperative embolisation was done in 16.85% cases and did not show any statistical difference in recurrence rate between the embolised and non embolised. Conclusion The correlation between the histopathological appearance and the recurrence rate will help in choosing the right approach for surgery and also postoperative follow-up to detect the recurrence at the earliest. Significance Histopathological detail can help in knowing the prognosis in terms of chances of recurrence and also guide for follow up at close intervals and advocate the appropriate treatment at the earliest.

scholarly journals Oblique Lumbar Interbody Fusion with Stand-Alone Cages for the Treatment of Degenerative Lumbar Spondylolisthesis: A Retrospective Study with 1-Year Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yachong Huo ◽  
Dalong Yang ◽  
Lei Ma ◽  
Haidong Wang ◽  
Wenyuan Ding ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Disc Height ◽  
Degenerative Lumbar Spondylolisthesis ◽  
The Mean ◽  
One Year ◽  
Psoas Major ◽  
Lumbar Spondylolisthesis ◽  
Oblique Lateral Interbody Fusion ◽  
Lateral Interbody

Patients with degenerative lumbar spondylolisthesis (DLS) often suffer from years of low back pain (LBP) due to instability of the lumbar spine and the reduction of disc height. Since January 2016, we have performed oblique lateral interbody fusion (OLIF) on 154 patients. Among these, 56 patients who suffered from DLS underwent OLIF with stand-alone cages. Forty-two patients with a follow-up time that exceeded 1-year were enrolled for this study. The forty-two patients were followed up for at least one year. Operation segments ranged from L3-4 to L4-5. All the patients were with 1-level fusion. The mean postoperative ventral-disc height and dorsal-disc height increased significantly compared with preoperative (P<0.05). A significant postoperative increase was also observed in the mean operative segmental lordotic angle and the whole lumbar lordotic angle (P<0.05). Compared with preoperative, the postoperative VAS significantly decreased with no significant increase in the VAS in the last follow-up. The LBP was significantly relieved. The mean postoperative VAS of LBP decreased significantly compared with the preoperative ((1.6 ± 0.8) vs. (7.8 ± 0.8)). Postoperative complications included psoas major abscess and intervertebral space infection (1/56). Except for one patient whose cage subsided during the last follow-up, the other patients had good cage position. The one whose cage collapsed complained no symptoms including LBP. OLIF with stand-alone cages should be considered as a safe and effective option which can effectively alleviate LBP for the treatment of DLS.

scholarly journals Safety of a novel modular cage for transforaminal lumbar interbody fusion − clinical cohort study in 20 patients with degenerative disc disease

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 24
Author(s):  
Mohamed Elmekaty ◽  
Emad ElMehy ◽  
Peter Försth ◽  
Anna MacDowall ◽  
Ahmed El Elemi ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Screw Loosening ◽  
Non Union ◽  
Cage Subsidence ◽  
One Year

Introduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation. Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence. Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone (PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan. Results: 20 patients (age 66 ± 10 years, 65% female, BMI 28 ± 5 kg/m2) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 ± 14.5 and 7.3 ± 3.6 to 52.7 ± 9.1 and 10.5 ± 3.5 (p =  0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred. Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage.

scholarly journals Dysplastic L5-S1 Spondyloptosis in a 3-Year-Old Child: A Case Report and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Vikas Tandon ◽  
Rahul Kaul ◽  
Harvinder Singh Chhabra ◽  
Ankur Nanda
Keyword(s):  
Interbody Fusion ◽  
Pedicle Screws ◽  
Lower Limbs ◽  
Daily Routine ◽  
Surgery Patient ◽  
Initial Stage ◽  
History Of ◽  
Definitive Surgery ◽  
One Year

A three-year-old girl presented with primary complaint of severe low back pain with radiation to both lower limbs below the knees since 2 months following history of fall and marked restriction of her daily routine activities. After clinicoradiological evaluation she was diagnosed of having dysplastic L5-S1 spondyloptosis. A staged procedure was planned after thorough discussion with her parents. During initial stage she underwent posterior decompression along L5-S1 segment including exposure of bilateral L5 and S1 nerve roots followed by instrumented reduction (L3-S2 5.5 mm pedicle screws) utilizing a rotational-translational technique. No interbody fusion was done at L5-S1 level and inner nuts of bilateral L3, L4, and S2 screws were intentionally kept loose. Subsequently after about symptom-free three-year follow up, she presented with recurrence of symptoms and underwent revision surgery as per initial plan discussed with her parents. Removals of posterior implants were done followed by stabilization with larger diameter pedicle screws (6.5 mm) at L5 and S1 level. During the same stage through anterior transperitoneal approach L5-S1 interbody fusion was done. At one-year follow-up after second-stage definitive surgery, patient remains symptom-free and fully active without any radiological evidence of reduction loss or implant failure.

scholarly journals Cross-Linking as an Adjuvant Treatment for Tectonic Corneal Lamellar Graft Preparation

2013 ◽  
Vol 7 (1) ◽  
pp. 79-81 ◽  
Author(s):  
George D. Kymionis ◽  
Argyro D. Plaka ◽  
Vasilios F. Diakonis ◽  
Michael A. Grentzelos ◽  
Georgios A. Kontadakis ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Anterior Segment ◽  
Case Series ◽  
Corneal Graft ◽  
Cross Linking ◽  
Ultraviolet A ◽  
Tectonic Reconstruction ◽  
Operative Complications ◽  
One Year

Purpose: To describe a new surgical approach for the tectonic reconstruction of the anterior ocular segment and the management of scleral and conjuctival melting. Methods: Case series of patients demonstrating anterior segment anomalies, such as scleral and conjunctival melting. The anterior stromal part of a pre-cut corneal graft for Descemet’s stripping automated endothelial keratoplasty (DSAEK) was cross-linked with riboflavin and ultraviolet A irradiation and was used to cover scleral (scleral melting in a patient with necrotizing scleritis, one case) and conjuctival (dehiscence of the conjunctiva in patients with anti-glaucomatous valve exposure, two cases) areas. The endothelial part of all corneal grafts was used for DSAEK in patients with need of corneal endothelial transplantation. Results: Repair of scleral and conjuctival melting was successful in all cases. No intra- or post- operative complications occured. Visual acuity of all patients remained stable during the follow up period. One year postoperatively the corneal graft remained in place and no signs of inflammation were evident, while all grafts were epithelialized. Conclusions: The use of cross-linked corneal graft for the tectonic reconstruction of the anterior ocular segment represents an adequate surgical approach for the management of scleral and conjuctival melting; while, at the same time it offers the advantage of using one corneal graft for two recipients.

Abdominal wall paresis as a complication of minimally invasive lateral transpsoas interbody fusion

2011 ◽  
Vol 31 (4) ◽  
pp. E18 ◽  
Author(s):  
Elias Dakwar ◽  
Tien V. Le ◽  
Ali A. Baaj ◽  
Anh X. Le ◽  
William D. Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Abdominal Wall ◽  
Nerve Injury ◽  
Interbody Fusion ◽  
Operative Procedure ◽  
Case Series ◽  
Transpsoas Approach ◽  
First Case

Object The minimally invasive lateral transpsoas approach for interbody fusion has been increasingly employed to treat various spinal pathological entities. Gaining access to the retroperitoneal space and traversing the abdominal wall poses a risk of injury to the major nervous structures. Nerve injury of the abdominal wall can potentially lead to paresis of the abdominal musculature and bulging of the abdominal wall. Abdominal wall nerve injury resulting from the minimally invasive lateral retroperitoneal transpsoas approach has not been previously reported. The authors describe a case series of patients presenting with paresis and bulging of the abdominal wall after undergoing a minimally invasive lateral retroperitoneal approach. Methods The authors retrospectively reviewed all patients who underwent a minimally invasive lateral transpsoas approach for interbody fusion and in whom development of abdominal paresis developed; the patients were treated at 4 institutions between 2006 and 2010. All data were recorded including demographics, diagnosis, operative procedure, positioning, hospital course, follow-up, and complications. The onset, as well as resolution of the abdominal paresis, was reviewed. Results The authors identified 10 consecutive patients in whom abdominal paresis developed after minimally invasive lateral transpsoas spine surgery out of a total of 568 patients. Twenty-nine interbody levels were fused (range 1–4 levels/patient). There were 4 men and 6 women whose mean age was 54.1 years (range 37–66 years). All patients presented with abdominal paresis 2–6 weeks postoperatively. In 8 of the 10 patients, abdominal wall paresis had resolved by the 6-month follow-up visit. Two patients only had 1 and 4 months of follow-up. No long-term sequelae were identified. Conclusions Abdominal wall paresis is a rare but known potential complication of abdominal surgery. The authors report the first case series associated with the minimally invasive lateral transpsoas approach.

scholarly journals Reconstruction of the long urethral strictures with the buccal mucosal free graft

2014 ◽  
Vol 61 (1) ◽  
pp. 41-44
Author(s):  
Ivan Ignjatovic ◽  
Dragoslav Basic ◽  
Jablan Stankovic ◽  
Milan Potic ◽  
Ljubomir Dinic
Keyword(s):  
Urethral Reconstruction ◽  
Graft Material ◽  
Free Graft ◽  
Residual Symptoms ◽  
Urethral Strictures ◽  
Buccal Mucosal Graft ◽  
Exact Evaluation ◽  
Primary Graft Failure ◽  
One Year

Introduction: Reconstruction of the long urethral strictures is a difficult task in urology. The most frequently used method is augmentation with the free buccal mucosal graft. Material and methods: Restrospective analysis of 57 patients with the long urethral stricture was performed. All patients were evaluated endoscopically and radiologically before the surgery. Buccal mucosal graft harvested from the inner side of the cheek (unilateral or bilateral) was used for the urethral reconstruction in all patients. Follow-up was one year. Results: Complete follow up is achieved in 44/57 (77.2%)patients. The most important etiology of the strictures was previous iatrogenic trauma (instrumentation). The strictures were the most frequently located in the bulbar urethra. Preoperative exact evaluation of the stricture length was possible in only 35/57 patients (61.4%). Overall success rate of the surgery was 38/44 (86.3%). Complications occurred in 6/44 (13.7%) of patients-primary graft failure and urinary fistula. Mean preoperative IPSS was 19,2?5,2, and postoperative 10.3?3,2 (p<0.0001). IPSSQOL was 4.9?3.7 before the surgery, 2.9?1,1 after the surgery(p<0.001). Persistent urinary infection was present in 12/44(27.2%) patients. Conclusion: Buccal mucosal free graft could be successfully used in the reconstruction of long urethral strictures. However, complications are not uncommon, and residual symptoms still exist after the surgery, and could not be neglected.

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