An algorithmic strategy for selecting a surgical approach in cervical deformity correction

2014 ◽  
Vol 36 (5) ◽  
pp. E5 ◽  
Author(s):  
Shannon Hann ◽  
Nohra Chalouhi ◽  
Ravichandra Madineni ◽  
Alexander R. Vaccaro ◽  
Todd J. Albert ◽  
...  
Keyword(s):  
Surgical Management ◽  
Surgical Approach ◽  
Surgical Techniques ◽  
Deformity Correction ◽  
Preoperative Assessment ◽  
Cervical Kyphosis ◽  
Cervical Deformity ◽  
Category Type ◽  
Big Picture ◽  
Algorithmic Strategy

Adult degenerative cervical kyphosis is a debilitating disease that often requires complex surgical management. Young spine surgeons, residents, and fellows are often confused as to which surgical approach to choose due to lack of experience, absence of a systematic method of surgical management, and today's plethora of information regarding surgical techniques. Although surgeons may be able to perform anterior, posterior, or combined (360°) approaches to the cervical spine, many struggle to rationally choose an appropriate approach for deformity correction. The authors introduce an algorithm based on morphology and pathology of adult cervical kyphosis to help the surgeon select the appropriate approach when performing cervical deformity surgery. Cervical deformities are categorized into 5 different prevalent morphological types encountered in clinical settings. A surgical approach tailored to each category/type of deformity is then discussed, with a concrete case illustration provided for each. Preoperative assessment of kyphosis, determination of the goal for surgery, and the complications associated with cervical deformity correction are also summarized. This article's goal is to assist with understanding the big picture for surgical management in cervical spinal deformity.

184 Effect of Cervical Deformity Correction on Spinal Cord Volume and Stenosis

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 248-249
Author(s):  
Peter G Passias ◽  
Gregory W Poorman ◽  
Charless Wang ◽  
Themistocles Protopsaltis ◽  
Christopher I Shaffrey ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Preliminary Analysis ◽  
Deformity Correction ◽  
Cervical Kyphosis ◽  
Cervical Deformity ◽  
Bivariate Correlation ◽  
Correlation Tests ◽  
Decompression Procedure ◽  
Radiographic Alignment ◽  
Spinal Cord Volume

Abstract INTRODUCTION There persists a debate on whether simple isolation of points of stenosis is sufficient or whether certain deformities must also be mitigated to restore neurologic concerns in patients with spinal deformity. Despite indications that cervical kyphosis has a significant effect on spinal cord volume, there remains no studies examining pre- and post-operative effect of deformity corrections on spinal cord volume and number of stenotic levels. METHODS Cervical deformity patients with pre-operative and 1-year MRI’s available were assessed for spinal canal volume at each interspace and at each body from C2-C7/T1. Stenotic vertebral levels were measured using Pavlov's method from C2-T1. Changes in spinal cord volume and number of stenotic levels from baseline to 1-year according to decompression technique used (laminectomy, foraminotomy, discectomy, or corpectomy) and type of pre-operative cervical deformity were measured using t-tests, and improvement in radiographic alignment and myelopathy scores using bivariate correlation tests. RESULTS >14 patients were evaluated. 11 received an osteotomy, 8 a decompression procedure, 6 received a posterior-only approach while the remaining received anterior-then-posterior approach. Patients presented with an average canal volume of 272.4 mm2 and 4.6 stenotic levels. At 1-year, average canal volume was 343.8 (29% increase), and average stenotic levels was 2.9. Patients with deformity apices in the cervical spine had less baseline canal volume (cervical apex: 231.6 mm2 vs. lower apex: 303.6 mm2, P = 0.022) as well as more stenotic levels cervical apex: 6.0 vs. lower apex: 3.4, P = 0.049). There was no significant relationship between decompressive techniques and volume (with decompression: ? +75mm2, w/o: ? +64mm2, P = 0.591). CONCLUSION This analysis shows a 29% increase in canal volume and correction of stenosis in cervical deformity patients. Realignment resulted in an increase in canal volume irrespective of decompression procedure. This preliminary analysis highlights a need for further investigation of spinal cord changes in deformity cases.

scholarly journals Dandy-Walker Syndrome Associated with Scoliosis: Clinical Presentation, Preoperative Assessment, and Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Athanasios I. Tsirikos ◽  
Sarah J. Wordie
Keyword(s):  
Skeletal Maturity ◽  
Surgical Techniques ◽  
Deformity Correction ◽  
Preoperative Assessment ◽  
Posterior Spinal Fusion ◽  
Postoperative Recovery ◽  
Uneventful Recovery ◽  
Scoliosis Correction ◽  
Assessment And Treatment ◽  
Cranial Fossa

Dandy-Walker syndrome (DWS) affects the posterior cranial fossa resulting in characteristic dysmorphic facial and body features. Scoliosis is not typically reported as an extracranial manifestation of this condition. We present a 12-year-old female patient who developed a right thoracic scoliosis measuring 60° with increased lumbar lordosis. Scoliosis correction was indicated to alleviate back pain, improve cosmesis, and prevent respiratory complications. A multidisciplinary preoperative assessment included cardiac, respiratory, anaesthetic, and neurology reviews. She underwent a posterior spinal fusion from T2 to L3 with pedicle hook/screw and rod instrumentation and a combination of locally harvested autologous and allograft bone. This resulted in excellent deformity correction and a balanced spine in the coronal and sagittal planes. The patient made an uneventful recovery and returned gradually to her normal level of activities. She was monitored in clinic until she completed her growth (4 years after surgery); the satisfactory surgical outcome was maintained at follow-up and was associated with high patient satisfaction. Scoliosis can occur in children with DWS with resemblance to adolescent idiopathic scoliosis in regard to type of coronal deformity, age at presentation, surgical techniques, and postoperative recovery. Early identification of scoliosis in patients with DWS can allow preoperative planning and prompt surgical management in order to reduce the risk of significant morbidity which can occur if the scoliosis is allowed to deteriorate. Excellent deformity correction can be achieved and maintained beyond skeletal maturity in order to improve physical appearance, as well as preserve level of function and quality of life.

Choanal Atresia: Historical Perspective and Surgical Management

1995 ◽  
Vol 112 (5) ◽  
pp. P80-P80
Author(s):  
Arthur S. Hengerer
Keyword(s):  
Surgical Management ◽  
Surgical Approach ◽  
Historical Perspective ◽  
Choanal Atresia ◽  
Surgical Techniques ◽  
Educational Objectives ◽  
Know How ◽  
Surgery Technique

Educational objectives: To understand the origin of this congenital problem and its treatment from historical perspective; to know the surgical techniques available to manage or correct the problem; and to know how to choose the correct surgical approach and fine points of surgery technique.

Front-Back Cervical Deformity Correction by Anterior Cervical Discectomy and Fusion With Posterior Instrumentation: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ethan S Srinivasan ◽  
Isaac O Karikari ◽  
Theresa Williamson ◽  
Christopher I Shaffrey ◽  
Khoi D Than
Keyword(s):  
Neck Pain ◽  
Posterior Instrumentation ◽  
Deformity Correction ◽  
Anterior Cervical Discectomy ◽  
Cervical Kyphosis ◽  
Instrumented Fusion ◽  
Cervical Discectomy ◽  
Cervical Deformity ◽  
Posterior Element ◽  
Vertebral Bodies

Abstract Front-back procedures for cervical deformity permit the correction of cervical kyphosis in the setting of unfused facets. Here, we highlight the operative treatment of a 65-yr-old female entailing a 4-level anterior cervical discectomy and fusion (ACDF) at C3-C4, C4-C5, C5-C6, and C6-C7 with hyperlordotic interbody implants, supplemented by a posterior C2-T2 instrumented fusion. The patient initially presented with symptoms of treatment-refractory neck pain while neurologically intact on examination. Her imaging demonstrated significant cervical kyphosis measuring 46° as the Cobb angle between C2 and C7 without neural compression. The patient consented to the procedure and publication of their image. After 2 d of traction, the operation proceeded with the patient initially in a supine position with dissection medial to the sternocleidomastoid muscle down to the vertebral bodies. Discectomies were performed at each level followed by installation of the interbody implants. After closure of this access wound, the patient was turned to a prone position for the posterior element of the operation. The posterior bony elements were exposed and a C2-T2 instrumented fusion performed. Postoperative imaging demonstrated improvement of her sagittal cervical curvature and the patient described improvement in her neck pain.

Surgical Management of Patients With 22q11.2 Deletion Syndrome

2019 ◽  
Vol 4 (5) ◽  
pp. 857-869
Author(s):  
Oksana A. Jackson ◽  
Alison E. Kaye
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Surgical Decision ◽  
Obstructive Sleep ◽  
Spine Abnormalities ◽  
Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

126. Proximal and distal reciprocal alignment changes following cervical deformity correction

2021 ◽  
Vol 21 (9) ◽  
pp. S63
Author(s):  
Renaud Lafage ◽  
Justin S. Smith ◽  
Themistocles S. Protopsaltis ◽  
Eric O. Klineberg ◽  
Gregory M. Mundis ◽  
...  
Keyword(s):  
Deformity Correction ◽  
Cervical Deformity

scholarly journals Skin-, nipple-, and areola-sparing mastectomy

2008 ◽  
Vol 11 (12) ◽  
Author(s):  
E. M. Umoh ◽  
N. Arora ◽  
R. M. Simmons
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Clinical Outcome ◽  
Surgical Management ◽  
Surgical Techniques ◽  
Oncologic Outcomes ◽  
Cancer Management ◽  
Breast Cancer Management ◽  
Feasible Option

AbstractSurgical management of breast carcinoma has evolved to include more breast conserving techniques such as skin-, nipple-, and areola-sparing mastectomies, as improved cosmesis becomes an increasing concern. However, the oncologic risk of these procedures must be strongly considered before such techniques can be widely adopted. Here we review available literature on these techniques and their associated clinical outcome. From our own experience, as well as from that reported, we conclude that nipple-, skin-, and areola-sparing mastectomies in carefully selected patients can have safe oncologic outcomes comparable to more traditional surgical techniques and therefore may be a feasible option for breast cancer management.

scholarly journals Blister like aneurysm: a review about its surgical management / Aneurismas blister-like: uma revisão sobre seu manejo cirúrgico

2019 ◽  
Vol 64 (2) ◽  
pp. 131
Author(s):  
Rodrigo Salmeron de Toledo Aguiar ◽  
Guilherme Brasileiro de Aguiar ◽  
Rafael Gomes dos Santos ◽  
André Freitas Nunes ◽  
Renan Maximilian Lovato ◽  
...  
Keyword(s):  
Surgical Management ◽  
Intracranial Aneurysms ◽  
Surgical Techniques ◽  
Vascular Lesion ◽  
High Morbidity ◽  
Good Efficiency ◽  
Treatment Techniques ◽  
Pubmed Database ◽  
Surgical Methods ◽  
Ruptured Intracranial Aneurysms

ABSTRACT Introduction: Blister aneurysms are of uncertain pathogenesis and are a vascular lesion located in the brain. Overall, they represent 0.3% - 1.0% of all intracranial aneurysms and 0.9% - 6.5% of ruptured intracranial aneurysms. They are associated with high morbidity and mortality. Even with the first description being from 1969, there is still debate in the literature about which type of treatment is the best: surgical or endovascular. In this review, we focus on the surgical management. Method: The authors performed a review of available surgical techniques used for blood blister-like aneurysms treatment. Pubmed database was used as search source introducing blister-like aneurysm and blister aneurysms as keywords. The most relevant articles and those that focused on surgical treatment techniques were selected. Discussion: The most used surgical methods are clipping, trapping, wrapping and bypass. As main features of each technique, we can highlight clipping with good efficiency, when there is good neck exposure; trapping being employed in ruptured aneurysm; wrapping for avulsion and bypass that promotes vascularization to the distal territory of the aneurysm. Conclusion: The endovascular method has shown to be promising and efficient. However, different surgical techniques are still being employed based on their efficiency when facing certain surgical scenarios.Keywords: Neurosurgery, Subarachnoid hemorrhage, Intracranial aneurysm, Endovascular proceduresRESUMOIntrodução: Aneurismas cerebrais blister-like são lesões vasculares de patogenia incerta. De modo geral, representam 0.3%-1.0% de todos aneurismas intracranianos e 0.9% - 6.5% dos aneurismas intracranianos que rompem. Estão associados a alta morbimortalidade. Mesmo com a primeira descrição sendo de 1969, ainda há debate na literatura sobre qual tipo de tratamento é o melhor: cirúrgico ou endovascular. Nessa revisão, focamos no tratamento cirúrgico. Métodos: Os autores realizaram uma revisão das técnicas cirúrgicas utilizadas para tratamento de aneurismas blister-like. A plataforma Pubmed foi utilizada para a pesquisa das palavras chaves “blister-like aneurysm” e “blister aneurysm”. Os artigos de maior relevância e aqueles que enfatizam as técnicas cirúrgicas foram selecionados. Discussão: Os métodos cirúrgicos empregados são clipagem, trapping, wrapping e bypass. Quanto às características de cada método, podemos salientar a eficácia da clipagem, quanto melhor for a exposição do aneurisma; o uso do trapping em situações de rompimento do aneurisma; wrapping para casos em que houve avulsão do aneurisma e by-pass que promove a vascularização distal ao aneurisma. Conclusão: O método endovascular tem se mostrado promissor e efetivo. No entanto, as diferentes técnicas cirúrgicas ainda são empregadas e defendidas devido a sua eficiência frente certos cenários cirúrgicos.Descritores: Neurocirurgia, Hemorragia subaracnóidea, Aneurisma intracraniano, Procedimentos endovasculares

scholarly journals Surgical Techniques for Dealing with Intraluminal Thrombus of Great Vessels in Advanced Differentiated Thyroid Carcinoma

2017 ◽  
Vol 9 (3) ◽  
pp. 115-117
Author(s):  
Pooja Ramakant ◽  
Mallika Dhanda ◽  
Akshay Anand ◽  
Devenraj Vijayant ◽  
Abhinav A Sonkar ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Surgical Management ◽  
Tumor Thrombus ◽  
Vena Cava ◽  
Surgical Techniques ◽  
Differentiated Thyroid Carcinoma ◽  
Fogarty Catheter ◽  
Intraluminal Thrombus ◽  
Great Vessels ◽  
Venous Tumor Thrombus

ABSTRACT Aim We aim to define and refine the surgical technique for dealing with intraluminal thrombus of great vessels in advanced differentiated thyroid carcinoma (DTC) to reduce the morbidity. Background Venous tumor thrombus from DTC is a rare occurrence with sequelae that cause increased morbidity and early mortality. Management of such patients poses a challenge to surgeons. Materials and methods We define the surgical planning and road map for surgical management of advanced DTC with tumor thrombus involving the internal jugular vein (IJV) and superior vena cava (SVC) by sacrificing one IJV and retrieving the thrombus from the SVC by Fogarty catheter. This technique has minimal morbidity with good outcome. Conclusion By appropriate planning and meticulous surgical techniques, we can aggressively manage patients of advanced DTC with venous tumor thrombus and reduce the morbidity. Clinical significance By surgical techniques leading to complete surgical resections and saving native vital structures, we can aim for successful aggressive surgical management of advanced DTC with venous tumor thrombus. How to cite this article Dhanda M, Anand A, Vijayant D, Sonkar AA, Singh KR, Ramakant P, Mishra A. Surgical Techniques for Dealing with Intraluminal Thrombus of Great Vessels in Advanced Differentiated Thyroid Carcinoma. World J Endoc Surg 2017;9(3):115-117.

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