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.

Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis

2010 ◽  
Vol 28 (3) ◽  
pp. E6 ◽  
Author(s):  
Neel Anand ◽  
Rebecca Rosemann ◽  
Bhavraj Khalsa ◽  
Eli M. Baron
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Short Form ◽  
Operating Time ◽  
Adult Scoliosis ◽  
Estimated Blood Loss ◽  
The Mean

Object The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion. Methods This was a retrospective study of 28 consecutive patients who underwent minimally invasive correction and fusion over 3 or more levels for adult scoliosis. Hospital and office charts were reviewed for clinical data. Functional outcome data were collected at each visit and at the last follow-up through self-administered questionnaires. All radiological measurements were obtained using standardized computer measuring tools. Results The mean age of the patients in the study was 67.7 years (range 22–81 years), with a mean follow-up time of 22 months (range 13–37 months). Estimated blood loss for anterior procedures (transpsoas discectomy and interbody fusions) was 241 ml (range 20–2000 ml). Estimated blood loss for posterior procedures, including L5–S1 transsacral interbody fusion (and in some cases L4–5 and L5–S1 transsacral interbody fusion) and percutaneous screw fixation, was 231 ml (range 50–400 ml). The mean operating time, which was recorded from incision time to closure, was 232 minutes (range 104–448 minutes) for the anterior procedures, and for posterior procedures it was 248 minutes (range 141–370 minutes). The mean length of hospital stay was 10 days (range 3–20 days). The preoperative Cobb angle was 22° (range 15–62°), which corrected to 7° (range 0–22°). All patients maintained correction of their deformity and were noted to have solid arthrodesis on plain radiographs. This was further confirmed on CT scans in 21 patients. The mean preoperative visual analog scale and treatment intensity scale scores were 7.05 and 53.5; postoperatively these were 3.03 and 25.88, respectively. The mean preoperative 36-Item Short Form Health Survey and Oswestry Disability Index scores were 55.73 and 39.13; postoperatively they were 61.50 and 7, respectively. In terms of major complications, 2 patients had quadriceps palsies from which they recovered within 6 months, 1 sustained a retrocapsular renal hematoma, and 1 patient had an unrelated cerebellar hemorrhage. Conclusions Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.

scholarly journals Minimally invasive dual iliac screw, dual rod fixation in a rare case of pathological sacral fracture from a paraganglionoma: a technique description

2017 ◽  
Vol 27 (3) ◽  
pp. 316-320 ◽  
Author(s):  
Muhammed Yaser Hasan ◽  
Gabriel Liu
Keyword(s):  
Minimally Invasive ◽  
Sacral Fracture ◽  
Neoplastic Disease ◽  
First Case ◽  
Screw Breakage ◽  
Iliac Screw ◽  
Additional Stability ◽  
Instrumentation Failure

The management of lumbosacral neoplastic disease can be demanding, often requiring complex reconstruction. In the context of extensive sacral involvement, the risk of iliac screw breakage is greater. Few studies advocate the use of dual iliac screw techniques to reduce implant failure. In this report, the authors have described the first case of percutaneous dual iliac screw, dual rod insertion as part of a minimally invasive spinopelvic stabilization in a patient with a sacral fracture from a paraganglionoma. The patient underwent percutaneous L-2 to ilium fixation. A dual iliac screw, dual rod construct was used for stabilizing the left lumbopelvic junction. At the 1-year follow-up, the patient remained asymptomatic, with radiographs showing no signs of instrumentation failure. Minimally invasive dual iliac screw, dual rod fixation is a viable option in cases in which additional stability is required due to extensive neoplastic disease or active individuals have increased functional demands. Short-term results in this report are encouraging; however, more research is warranted to establish the procedure’s long-term safety.

scholarly journals Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion Surgery: An Analysis of Opioids, Nonopioid Analgesics, and Perioperative Characteristics

2019 ◽  
Vol 9 (6) ◽  
pp. 624-629 ◽  
Author(s):  
Aaron Hockley ◽  
David Ge ◽  
Dennis Vasquez-Montes ◽  
Mohamed A. Moawad ◽  
Peter Gust Passias ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Opioid Use ◽  
Estimated Blood Loss ◽  
History Of ◽  
Nonopioid Analgesics

Study Design: Retrospective study of consecutive patients at a single institution.Objective: Examine the effect of minimally invasive surgery (MIS) versus open transforaminal lumbar interbody fusion (TLIF) surgery on long-term postoperative narcotic consumption. Objective: Examine the effect of minimally invasive versus open TLIF on short-term postoperative narcotic consumption. Methods: Differences between MIS and open TLIF, including inpatient opioid and nonopioid analgesic use, discharge opioid use, and postdischarge duration of narcotic usage were compared using appropriate statistical methods. Results: A total of 172 patients (109 open; 63 MIS) underwent primary TLIF. There was no difference in baseline characteristics. The MIS TLIF cohort had a significantly shorter operative time (223 vs 251 min, P = .006) and length of stay (2.7 vs 3.7 days, P < .001) as well as less estimated blood loss (184 vs 648 mL, P < .001). MIS TLIF had significantly less total inpatient opioid usage (167 vs 255 morphine milligram equivalent [MME], P = .006) and inpatient oxycodone usage (71 vs 105 mg, P = .049). Open TLIF cases required more ongoing opiate usage at 3-month follow-up (36% open vs 21% MIS, P = .041). A subanalysis found that patients who underwent an open TLIF with a history of preoperative opioid use are significantly more likely to remain on opioids at 6-week follow-up (87% vs 65%, P = .027), 3-month follow-up (63% vs 31%, P = .008), and 6-month follow-up (50% vs 21%, P = .018) compared with MIS TLIF. Conclusion: Patients undergoing MIS TLIF required less inpatient opioids and had a decreased incidence of opioid dependence at 3-month follow-up. Patients with preoperative opioid use undergoing MIS TLIF are less likely to require long-term opioids.

Transfacet Minimally Invasive Transforaminal Lumbar Interbody Fusion With an Expandable Interbody Device—Part II: Consecutive Case Series

2020 ◽  
Vol 19 (5) ◽  
pp. 518-529
Author(s):  
Jawad M Khalifeh ◽  
Christopher F Dibble ◽  
Priscilla Stecher ◽  
Ian Dorward ◽  
Ammar H Hawasli ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Rating Scale ◽  
Case Series ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
The Mean

Abstract BACKGROUND Advances in operative techniques and instrumentation technology have evolved to maximize patient outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). The transfacet MIS-TLIF is a modified approach to the standard MIS-TLIF that leverages a bony working corridor to access the disc space for discectomy and interbody device placement. OBJECTIVE To evaluate clinical and radiographic results following transfacet MIS-TLIF using an expandable interbody device. METHODS We performed a retrospective review of consecutive patients who underwent transfacet MIS-TLIF for degenerative lumbar spondylolisthesis. Patient-reported outcome measures for pain and disability were assessed. Sagittal lumbar segmental parameters and regional lumbopelvic parameters were assessed on upright lateral radiographs obtained preoperatively and during follow-up. RESULTS A total of 68 patients (61.8% male) underwent transfacet MIS-TLIF at 74 levels. The mean age was 63.4 yr and the mean follow-up 15.2 mo. Patients experienced significant short- and long-term postoperative improvements on the numeric rating scale for low back pain (–2.3/10) and Oswestry Disability Index (−12.0/50). Transfacet MIS-TLIF was associated with an immediate and sustained reduction of spondylolisthesis, and an increase in index-level disc height (+0.71 cm), foraminal height (+0.28 cm), and segmental lordosis (+6.83°). Patients with preoperative hypolordosis (&lt;40°) experienced significant increases in segmental (+9.10°) and overall lumbar lordosis (+8.65°). Pelvic parameters were not significantly changed, regardless of preoperative alignment. Device subsidence was observed in 6/74 (8.1%) levels, and fusion in 50/53 (94.3%) levels after 12 mo. CONCLUSION Transfacet MIS-TLIF was associated with clinical improvements and restoration of radiographic sagittal segmental parameters. Regional alignment correction was observed among patients with hypolordosis at baseline.

scholarly journals The Ilizarov technique in treating denervated ankle-foot deformities

2021 ◽  
Vol 9 (4) ◽  
pp. 255-268
Author(s):  
Dong Wang ◽  
Jun-Jun Shi ◽  
Le Zhang ◽  
Ying-Wei Jia ◽  
Hu-Yun Qiao ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Minimally Invasive ◽  
Nerve Injury ◽  
Common Peroneal Nerve ◽  
Foot Deformities ◽  
Ilizarov Technique ◽  
Significant Difference ◽  
Long Term Follow Up

Background:Neurological injuries or diseases may cause ankle-foot deformities that seriously affect patients’ quality of life.Objective:This study aimed to explore the feasibility of the Ilizarov technique for treating complex ankle-foot deformity with neurotrophic disorders.Methods:In this retrospective study, 10 patients, including 6 males and 4 females, with complex ankle-foot deformities with nerve injury were treated from January 2014 to May 2019. The age of the patients ranged from 13 to 57 years with an average of 27.9 years. The reasons of nerve injury were as follows: sequelae of spina bifida in five patients, post-traumatic injury of the common peroneal nerve and tibial nerve in four patients, and subacute degeneration of the spinal cord in one patient. Minimally invasive surgery was used for osteotomy, muscle strength balance, and external ring frame fixation, and various deformities were gradually corrected after the operation. The ankle- foot function was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score before surgery and at long-term follow-up after surgery.Results: All 10 patients were followed up for 12 months to 3 years, with an average of 1.9 years. The deformities of all 10 patients were corrected; and of the 10 patients, three partially recovered their nerve function. A significant difference (p < 0.001) between the AOFAS score (81.6 ± 10.45) evaluated in the long-term follow-up and that evaluated preoperatively (31.1 ± 14.69). The AOFAS comprehensive score was excellent in two patients, good in six patients, and fair in two patients.Conclusion:The Ilizarov technique combined with minimally invasive osteotomy and muscle strength balance could safely correct complex ankle-foot deformities with neurotrophic disorders.

scholarly journals Minimally invasive anterior and lateral transpsoas approaches for closed reduction of grade II spondylolisthesis: initial clinical and radiographic experience

2018 ◽  
Vol 44 (1) ◽  
pp. E4 ◽  
Author(s):  
David S. Xu ◽  
Konrad Bach ◽  
Juan S. Uribe
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Case Series ◽  
Lumbar Interbody Fusion ◽  
Complete Reduction ◽  
Estimated Blood Loss ◽  
Grade Ii ◽  
The Mean

OBJECTIVEMinimally invasive anterior and lateral approaches to the lumbar spine are increasingly used to treat and reduce grade I spondylolisthesis, but concerns still exist for their usage in the management of higher-grade lesions. The authors report their experience with this strategy for grade II spondylolisthesis in a single-surgeon case series and provide early clinical and radiographic outcomes.METHODSA retrospective review of a single surgeon’s cases between 2012 and 2016 identified all patients with a Meyerding grade II lumbar spondylolisthesis who underwent minimally invasive lateral lumbar interbody fusion (LLIF) or anterior lumbar interbody fusion (ALIF) targeting the slipped level. Demographic, clinical, and radiographic data were collected and analyzed. Changes in radiographic measurements, Oswestry Disability Index (ODI), and visual analog scale (VAS) scores were compared using the paired t-test and Wilcoxon signed rank test for continuous and ordinal variables, respectively.RESULTSThe average operative time was 199.1 minutes (with 60.6 ml of estimated blood loss) for LLIFs and 282.1 minutes (with 106.3 ml of estimated blood loss), for ALIFs. Three LLIF patients had transient unilateral anterior thigh numbness during the 1st week after surgery, and 1 ALIF patient had transient dorsiflexion weakness, which was resolved at postoperative week 1. The mean follow-up time was 17.6 months (SD 12.5 months) for LLIF patients and 10 months (SD 3.1 months) for ALIF patients. Complete reduction of the spondylolisthesis was achieved in 12 LLIF patients (75.0%) and 7 ALIF patients (87.5%). Across both procedures, there was an increase in both the segmental lordosis (LLIF 5.6°, p = 0.002; ALIF 15.0°, p = 0.002) and overall lumbar lordosis (LLIF 2.9°, p = 0.151; ALIF 5.1°, p = 0.006) after surgery. Statistically significant decreases in the mean VAS and the mean ODI measurements were seen in both treatment groups. The VAS and ODI scores fell by a mean value of 3.9 (p = 0.002) and 19.8 (p = 0.001), respectively, for LLIF patients and 3.8 (p = 0.02) and 21.0 (p = 0.03), respectively, for ALIF patients at last follow-up.CONCLUSIONSEarly clinical and radiographic results from using minimally invasive LLIF and ALIF approaches to treat grade II spondylolisthesis appear to be good, with low operative blood loss and no neurological deficits. Complete reduction of the spondylolisthesis is frequently possible with a statistically significant reduction in pain scores.

Use of Tubular Retractors for Minimally Invasive Resection of Deep-Seated Cavernomas

2019 ◽  
Vol 18 (6) ◽  
pp. 629-639 ◽  
Author(s):  
Daniel G Eichberg ◽  
Long Di ◽  
Ashish H Shah ◽  
Michael E Ivan ◽  
Ricardo J Komotar ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Seizure Control ◽  
Case Series ◽  
Neurologic Deficit ◽  
Developmental Venous Anomaly ◽  
Access System ◽  
Low Profile ◽  
Class 1

Abstract BACKGROUND Cavernomas located in subcortical or eloquent locations are difficult lesions to access safely. Tubular retractors, which distribute retraction pressure radially, have been increasingly employed successfully. These retractors may be beneficial in subcortical cavernoma resection. OBJECTIVE To review a single institution's case series to determine the safety profile and efficacy of transcortical-transtubular cavernoma resections and to describe our transtubular operative technique. METHODS We reviewed a single institution's transcortical-transtubular cavernoma resections using either BrainPath (NICO, Indianapolis, Indiana) or ViewSite Brain Access System (Vycor Medical, Boca Raton, Florida) tubular retractors performed from 2013 to 2018 (n = 20). RESULTS Gross total resection was achieved in all patients. When a developmental venous anomaly (DVA) was present, avoidance of DVA resection was achieved in all cases (n = 4). All patients had a supratentorial cavernoma with mean depth below cortical surface of 44.1 mm. Average postoperative clinical follow-up was 20.4 wk. Early neurologic deficit rate was 10% (n = 2); permanent neurologic deficit rate was 0%. One patient (5%) experienced early postoperative seizures (&lt; 1 wk postop). No patients experienced late seizures (&gt; 1 wk follow-up). Engel class 1 seizure control at final clinical follow-up was achieved in 87.5% of patients presenting with preoperative epilepsy. CONCLUSION Tubular retractors provide a low-profile, minimally invasive operative corridor for resection of subcortical cavernomas. There were no permanent neurologic complications in our series of 20 cases, and long-term seizure control was achieved in all patients. Thus, tubular retractors appear to be a safe and efficacious tool for resection of subcortical cavernomas.

Multimodality Treatment of Conus Medullaris Arteriovenous Malformations: 2 Decades of Experience With Combined Endovascular and Microsurgical Treatments

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 100-108 ◽  
Author(s):  
David A. Wilson ◽  
Adib A. Abla ◽  
Timothy D. Uschold ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Case Series ◽  
Multimodality Treatment ◽  
Bowel Function ◽  
Conus Medullaris ◽  
Vascular Lesions ◽  
First Case ◽  
Microsurgical Resection

Abstract BACKGROUND: Conus medullaris arteriovenous malformations (AVMs) are rare, challenging spinal vascular lesions that cause progressive debilitating myeloradiculopathy. Only sporadic reports of conus AVMs have been published. OBJECTIVE: To better define the presentation, prognosis, and optimal treatment of these lesions, we present the first case series of conus AVMs, reflecting over 2 decades of experience with a multimodality endovascular and surgical approach. METHODS: We retrospectively reviewed the charts of 16 patients with a conus AVM evaluated at our institution from 1989 to 2010. For each patient, the following clinical data were collected: age, sex, symptoms, angiographic findings, type of treatment, complications, degree of angiographic obliteration, recurrence at follow-up, and need for re-treatment. Ambulatory status, Frankel Grade, motor function, and bladder/bowel function were assessed before treatment, at discharge, and at last follow-up. RESULTS: All 16 patients were treated. Eight (50%) patients underwent embolization followed by microsurgical resection, and 8 (50%) underwent microsurgical resection only. The rate of complete angiographic obliteration was 88%. At last follow-up (mean, 70 months), 43% of patients neurologically improved, 43% were stable, and 14% worsened in comparison with before treatment. During follow-up, 3 recurrences were detected, including the only 2 instances of long-term neurological decline. In the absence of recurrence, all patients ambulatory before treatment remained ambulatory at follow-up, whereas 75% of the initially nonambulatory patients regained the ability to walk. CONCLUSION: Although conus AVMs are challenging to treat, excellent long-term outcomes are possible with a multimodality approach. Recurrence is associated with long-term neurological decline and calls for close follow-up.

Minimally Invasive Sacroiliac Joint Fusion, Radiofrequency Denervation, and Conservative Management for Sacroiliac Joint Pain: 6-Year Comparative Case Series

Neurosurgery ◽  
2017 ◽  
Vol 82 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Vicente Vanaclocha ◽  
Juan Manuel Herrera ◽  
Nieves Sáiz-Sapena ◽  
Marlon Rivera-Paz ◽  
Francisco Verdú-López
Keyword(s):  
Minimally Invasive ◽  
Conservative Management ◽  
Sacroiliac Joint ◽  
Oswestry Disability Index ◽  
Case Series ◽  
Work Status ◽  
Opioid Use ◽  
Radiofrequency Denervation

Abstract BACKGROUND Sacroiliac joint (SIJ) pain is an under-recognized condition. Substantial information supports the safety and effectiveness of SIJ fusion (SIJF). Long-term follow-up after SIJF has not been reported. OBJECTIVE To determine responses to conservative management (CM), SIJ denervation, and SIJF in patients with SIJ pain unresponsive to CM. METHODS Retrospective study with long-term (up to 6 yr) follow-up of 137 patients with SIJ pain seen in an outpatient neurosurgery clinic who received either CM (n = 63), sacroiliac denervation (n = 47), or minimally invasive SIJF (n = 27). At each routine clinic visit, patients completed pain scores and Oswestry Disability Index. Additional data were extracted from medical charts. RESULTS Patients treated with continued CM had no long-term improvement in pain (mean worsening of 1 point) or disability (mean Oswestry Disability Index worsened by 4-6 points), increased their use of opioids, and had poor long-term work status. SIJF patients had large improvements in SIJ pain (mean 6 points), large improvements in disability (mean 25 points), a decrease in opioid use, and good final work status. Sacroiliac denervation patients had intermediate responses (0-1 and 1-2 points, respectively). CONCLUSION In patients with SIJ pain unresponsive to CM, SIJF resulted in excellent long-term clinical responses, with low opioid use and better work status compared to other treatments.

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