Minimally invasive lateral single-position surgery for multilevel degenerative lumbar spine disease: feasibility and perioperative results in a single Latin-American spine center.

INTRODUCTION: Within advances in minimally invasive spine surgery, the implementation of lateral single position (LSP) increases efficiency while limiting complications, avoiding intraoperative repositioning and diminishing surgical time. Most literature describes one-level instrumentation of the lumbar spine; this study includes the use of LSP for multilevel degenerative disease. OBJECTIVE: The objective of the article is to analyze initial clinical results and complications in the use of LSP for multiple level instrumentation in adults with lumbar degenerative disease. METHODS: A retrospective early clinical series was performed for patients who had multiple level instrumentation in LSP between August 2019 and September 2022 at the Hospital Universitario San Ignacio in Bogota, Colombia. Inclusion criteria were patients older than 18 years with symptomatic lumbar degenerative disease, undergoing any combination of multilevel anterior lumbar interbody fusion, lateral lumbar interbody fusion (LLIF) and pedicle screw fixation. RESULTS: Forty patients with an average age of 61.3 years were included, with diagnosis of multilevel degenerative spondylotic changes. Four-, three- and two-level interventions were performed in 52.5, 35 and 12.5%, respectively. Average time per level was 68.9 min, and length of hospital stay had an average of 2.4 days, with all patients starting ambulation within the first postoperative day. CONCLUSION: Procedural time and blood loss were similar to those reported in literature. No severe lesions, postoperative infections or reinterventions took place. Although it was a small number of patients and further clinical trials are needed, LSP for multiple levels is apparently safe with adequate outcomes which may improve efficiency in the operating room.

Minimally Invasive Posterior Trans-muscular C1-C2 Screw Fixation Through an Anatomical Corridor to Preserve Occipitocervical Tension Band: Surgical Anatomy and Clinical Experience.

The C1-C2 joint is affected by multiple entities that may produce biomechanical instability. Optimal management for atlantoaxial instability has been searched by ways of different surgical techniques with different results, generating discussion between second effects of a particular treatment. Lateral dissections can place the axial neck musculature and ligaments at risk of neural denervations or vascular compromise. Either of these entities may result in significant postoperative atrophy, pain, and instability. Minimally invasive techniques for the treatment of spinal disorders allow to our patients less morbid procedures with equal or better results compared to conventional surgery. In the following paper, we review the anatomy of the atlantoaxial joint and propose a minimally invasive trans-muscular C1-C2 fusion technique using C1 lateral-mass screws and C2 pedicular screws. We describe cases with surgical, clinical, and radiographic follow-up.

A history of Colombian neurosurgery: events, persons, and outcomes that have shaped the specialty in the country.

The history of Colombian neurosurgery is a collective legacy of neurosurgeon-scientists, scholars, teachers, innovators, and researchers. Anchored in the country's foundational values of self-determination and adaptability, these pioneers emerged from the Spanish colonial medical tradition and forged surgical alliances abroad. From the time of Colombian independence until the end of World War I, exchanges with the French medical tradition produced an emphasis on anatomical and systematic approaches to the emerging field of neurosurgery. The onset of American neurosurgical expertise in the 1930s led to a new period of exchange, wherein technological innovations were added to the Colombian neurosurgical repertoire. This diversity of influences culminated in the 1950s with the establishment of Colombia's first in-country neurosurgery residency program. A select group of avant-garde neurosurgeons from this period expanded the domestic opportunities for patients and practitioners alike. Today, the system counts 10 recognized neurosurgery residency programs and over 500 neurosurgeons within Colombia. Although the successes of specific individuals and innovations were considered, the primary purpose of this historical survey was to glean relevant lessons from the past that can inform present challenges, inspire new opportunities, and identify professional and societal goals for the future of neurosurgical practice and specialization.

Intraoperative Complications of Anterior Lumbar Interbody Fusion: A 5-Year Experience of a Group of Spine Surgeons Performing Their Own Approaches.

BACKGROUND: Spine surgery has evolved at an accelerated pace, allowing the development of more efficient surgical techniques while providing a decreasing rate of morbimortality. One example of these approaches is the anterior lumbar interbody fusion (ALIF). The aim of this study was to evaluate the surgical complication rate when performing ALIF without the help of a vascular "access" surgeon. METHODS: A retrospective descriptive study was conducted at the Hospital Universitario San Ignacio between 2014 and 2018 and included all patients who underwent ALIF during this time. A nonsystematic review was performed assessing approach-related complications in ALIF and the impact of "access" surgeons in surgical outcomes. RESULTS: A total of 337 patients were included and 508 levels were fused. ALIF was performed as ALIF-360° (27%), ALIF-lateral lumbar interbody fusion (LLIF) (8.9%), and stand-alone ALIF (62%). Most procedures were single-level fusions (51.9%), 45.4% involved 2 levels, and 2.6% were 3-level fusions. The mortality rate was 0%, and only 9 cases of vascular injury were observed and described. Left and common iliac veins were the predominant affected structures. Only a single case required blood transfusion without any other treatment or intensive care unit surveillance. CONCLUSIONS: Our study is consistent with literature reports about ALIF complications, finding an incidence of 1.7%. Therefore, ALIF is an excellent alternative for spine procedures, especially for the levels L5-S1 that require sagittal balance restoration. The approaches were performed without a vascular "access" surgeon and presented complication rates similar to those described in the literature.

The Berbeo-Sardi Angle (BSA): An Innovative Method to Effectively Estimate Pelvic Retroversion in Anteroposterior Radiographs-A Correlation With Traditional Parameters.

STUDY: Design: Diagnostic studies-concordance between diagnostic tests. OBJECTIVES: The purpose of this study was to develop a novel spinopelvic parameter (Berbeo-Sardi angle [BSA], the angle formed at the intersection of a line that connects the inferior margin of the sacroiliac joint to the midpoint of a horizontal line joining both femoral heads) measurable in anteroposterior radiographs that indirectly estimates pelvic retroversion and correlates with traditional measurements like pelvic tilt (PT). SUMMARY: Sagittal balance appraisal and surgical planning rely on the interpretation of spinopelvic parameters. An increased PT reflects pelvic retroversion as a compensatory mechanism to limit sagittal imbalance and correlates with increased pain and disability. However, poor imaging techniques and incorrect patient positioning frequently hamper landmark identification in lateral radiographs, and with no measurable angles in anteroposterior radiographs, it is often impossible to determine PT and pelvic retroversion. METHODS: Whole-spine radiographs from 105 consecutive patients were used to retrospectively measure conventional spinopelvic parameters and the BSA. Intraclass correlation coefficient was used to assess a quantitative correlation between the PT and BSA as indirect measures of pelvic retroversion. RESULTS: Average values for pelvic incidence, lumbar lordosis, sacral slope, PT, and BSA were 46.5° (±10.23), 48.56° (±12.30), 29.97° (±9.77), 16.94° (±8.03), and 54.47° (±4.05), respectively. We encountered a moderately strong correlation (r = -0.66) between PT and BSA. Receiver operating characteristic plot analysis revealed that a BSA threshold of 46° has a sensitivity of 90% to identify pathologic PT values (>20°), whereas a BSA ≥60° has a specificity of 90% to rule out pelvic retroversion using anteroposterior radiographs. CONCLUSIONS: There is a moderately strong correlation between the BSA, an innovative spinopelvic parameter measurable in anteroposterior radiographs, and PT. BSA seems to show great promise in simplifying spinopelvic appraisal by easily estimating pelvic retroversion associated with sagittal imbalance, while avoiding image-quality issues often encountered in lateral radiographs. LEVEL OF EVIDENCE: Level III.

Craniocervical junction diseases treatment with a minimally invasive approach / Abordagem minimamente invasiva para tratamento de lesões da união craniocervical / Abordaje minimamente invasivo para tratamiento de lesiones de la union craneocervical

Objective: To introduce a new minimally invasive surgical approach to anterior and lateral craniocervical junction diseases, preserving the midline posterior cervical spine stabilizing elements and reducing the inherent morbidity risk associated with traditional approaches. Methods: We describe a novel surgical technique in four cases of extra-medullary anterolateral compressive lesions located in the occipito-cervical junction, including infections and intra- and/or extradural tumor lesions. We used a paramedian trasmuscular approach through an anatomical muscle corridor using a micro MaXcess® surgical expandable retractor, with the purpose of reducing morbidity and preserving the posterior muscle and ligamentous tension band. Results: This type of surgical approach provides adequate visualization and microsurgical resection of lesions and reduces muscle manipulation and devascularisation, preserving the tension of the ligament complex. There was minimal blood loss and a decrease in postoperative pain, with rapid start of rehabilitation and shorter hospitalization times. There were no intraoperative complications, and all patients recovered from their pre-operative symptoms. Conclusions: This novel surgical technique is feasible and adequate for the occipito-atlanto-axial complex, with better results than traditional procedures.

Objetivo: Realizamos esforços para desenvolver novas técnicas cirúrgicas para reduzir a morbidade e a mortalidade. Métodos: Descrevemos uma técnica cirúrgica nova em quatro casos de lesões extramedulares compressivas anterolaterais da junção occipitocervical, que incluem infecções e lesões tumorais intra e extradurais. As lesões foram excisadas por uma nova técnica cirúrgica minimamente invasiva, por meio de um corredor anatômico muscular, utilizando-se o afastador expansível MaXcess® (Nuvasive Inc., San Diego, CA, EUA) visando reduzir a morbidade e preservar a banda de tensão músculo-ligamentar. Resultados: Esse tipo de abordagem proporcionou visualização e excisão microcirúrgica adequada das lesões, com redução da manipulação muscular, preservando a tensão do complexo ligamentar nucal. Houve perda de sangue mínima, além da redução da dor pós-operatória, início rápido da reabilitação e pequena estadia hospitalar. Não foram observadas complicações intraoperatórias e os pacientes não tiveram mais os sintomas apresentados no pré-operatório. Conclusões: Essa nova técnica cirúrgica é uma opção de tratamento na região do complexo occipito-atlanto-axial anterolateral, com resultados superiores aos dos procedimentos tradicionais.

Objetivo: Se han realizado esfuerzos por desarrollar nuevas técnicas quirúrgicas que reduzcan morbimortalidad. Métodos: Describimos una novedosa técnica quirúrgica de tratamiento en cuatro casos de lesiones extramedulares compresivas anterolaterales de la unión occipitocervical que incluyen infecciones y lesiones tumorales intra y extradurales. Las lesiones fueron extirpadas por una nueva técnica quirúrgica mínimamente invasiva a través de un corredor anatómico muscular, utilizándose el retractor expansible MaXcess® (Nuvasive Inc., San Diego, CA, EEUU) con el objetivo de reducir la morbilidad y preservar la banda de tensión músculo-ligamentaria. Resultados: Este tipo de abordaje aportó adecuada visualización y resección microquirúrgica de las lesiones, con reducción de la manipulación muscular, preservando la tensión del complejo ligamentario nucal. Hubo mínima pérdida sanguínea además de disminución de dolor post-operatorio, rápido inicio de rehabilitación y corta estancia hospitalaria. No se presentaron complicaciones intraoperatorias y los pacientes se recuperaron de la sintomatología preoperatoria. Conclusiones: Esta nueva técnica quirúrgica se perfila como una opción de tratamiento a nivel del complejo occipito-atlanto-axial anterolateral con resultados superiores a los procedimientos tradicionales.

Procedimientos neuroquirúrgicoscerebrales guiados por estereotaxiarealizados en el Hospital Universitario de San Ignacio (HUSI): evolución a corto y mediano plazo / Neurosurgical Brain Estereotactic- Guided Procedures Performed at Hospital Universitario San Ignacio (HUSI): Development in the Short and Medium Term

Objetivo: Describir los resultados postoperatorios de los pacientes a los que se lesrealizaron procedimientos neuroquirúrgicos cerebrales guiados por estereotaxia enel Hospital Universitario de San Ignacio durante el periodo julio del 2009-julio del2011. Materiales y métodos: Se revisaron las historias clínicas de 78 pacientes,sus características clínicas, la localización de las lesiones en las neuroimágenes,el tipo de procedimiento, los resultados funcionales y los desenlaces a corto ymediano plazo. Resultados: 78 pacientes tuvieron procedimientos neuroquirúrgicosguiados por estereotaxia entre julio del 2009 y julio del 2011. El 64,1 % (n = 50)eran hombres. La localización de las lesiones fue en orden de frecuencia: gangliossubtalámicos, lóbulo frontal, lóbulo temporal, tálamo, unión córtico-subcortical, tallocerebral, ubicación frontotemporal, lóbulo occipital, ubicación parieto-occipital ybase del cráneo. Discusión: La implementación de procedimientos neuroquirúrgicosguiados por estereotaxia sigue siendo una de las mejores opciones en el abordaje depatologías cerebrales profundas o de difícil acceso. Tanto en Colombia como en elresto del mundo son procedimientos con una baja tasa de morbilidad y mortalidad.Conclusiones: Independientemente del tipo de procedimiento guiado por estereotaxiala tasa de complicaciones no excede el 5 %, tasas similares a las obtenidas en laliteratura mundial...

Objective: Retrospective description of postoperativeoutcomes of patients who underwentneurosurgical brain stereotactic guided proceduresat the Hospital Universitario San Ignacioduring the period July 2009-July 2011. Materialsand Methods: A review of medical recordsof 78 patients who were taken to neurosurgicalstereotactic guided procedures at the HospitalUniversitario San Ignaci. We reviewed the clinicalcharacteristics of patients, the location of thelesions on neuroimaging, management, type ofprocedure of each patient, functional results andoutcomes in the short and medium term. Results:78 patients who underwent neurosurgical brainstereotactic guided procedures between July2009 to July 2011 at the Hospital UniversitarioSan Ignacio. The 64.1 % (n = 50) were men. Thelocation of the lesions were in order of frequencysub-thalamic ganglia, frontal lobe, temporallobe, thalamus, cortico-subcortical junction, brainstem,fronto-temporal location, occipital lobe,parieto-occipital location, and at the skull’s base.Discussion: Implementing guided stereotacticneurosurgical procedures remains one of the bestoptions in dealing with deep brain pathologies ordifficult access. In both Colombia and the rest ofthe world, these are procedures with low morbidityand mortality. It must, however, developmulticenter studies that allow us to observe thedevelopment of stereotactic neurosurgery in ourcountry, also develop studies with a larger continuityto assess the long-term outcomes. Conclusions:Whatever type of stereotactic guidedprocedure the rate of complications does not exceed5 %, similar rates to those obtained from theglobal literature...

Técnica mínimamente invasiva para descompresión y estabilización dinámica con sistema pedicular en enfermedad degenerativa de la columna lumbar. Reporte preliminar de casos y revisión de la literatura / Minimally invasive technique for decompression and dynamic stabilization with pedicle system in degenerative lumbar spine. Preliminary report of cases and literature review

El dolor lumbar constituye una patología de alta incidencia y costos, transformándose en un problema de salud pública. Cuando la causa es secundaria a compresión de estructuras neurales la indicación quirúrgica es clara; sin embargo, cuando a ésta se asocian características biomecánicas del dolor no es claro el manejo que se debe seguir y las medidas terapéuticas no siempre tienen buenos resultados. Durante mucho tiempo se ha manejado el concepto de inestabilidad como causal del componente biomecánico de la lumbalgia crónica; de tal manera, la fusión del segmento espinal se ha convertido en la medida terapéutica de elección. Sin embargo, a pesar de una depuración de la técnica, y de tasas de fusión cercanas al 100%, el resultado clínico no se correlaciona y, por el contrario, aparecen complicaciones como la enfermedad del segmento adyacente a la fusión. Se han propuesto entonces formas de estabilización que conserven el movimiento, prefiriéndose los sistemas basados en tornillos transpediculares por su larga durabilidad y mejor control del movimiento. Reportamos tres casos de enfermedad degenerativa lumbar asociada a compresión de estructuras nerviosas que requerían estabilización adicional y en los que se prefirió, por la edad de los pacientes y otros factores a favor, la colocación del sistema dinámico de estabilización posterior COSMIC. Presentamos un reporte preliminar de casos con resultados alentadores de una técnica de fijación transpedicular dinámica como una opción al tratamiento tradicional de fusión estático y rígido, para el manejo de la enfermedad degenerativa de la columna lumbar y el dolor lumbar crónico.

Absceso Selar / Intrasellar abscess

Se presenta el caso de una mujer con un tumor hipotisiario intervenido dos años antes por vía transesfenoidal, quien posteriormente presenta un cuadro clínico de recidiva la cual se documenta imagenológicamente. En cirugía se encontró un absceso selar. Se presentan los hallazgos imagenológicos e histológicos de la lesión

Monitoreo y manejo del trauma craneoencefalico severo / Severe Head injury: Monitoring and treatmet

Uno de los objetivos del tratamiento del TCE severo es optimizar la PPC así sea a través de llevar al paciente a una hipertensión hipervolémica. La base de este manejo es la cascada de la vasoconstricción donde una PPC adecuada disminuye el VSC y por consiguiente la PIC, mostrando que la autorregulación sigue funcionando en estos pacientes. Los pacientes con TCE severo necesitan un monitoreo completo que idealmente debe incluir línea arterial, PVC o PCP, SVjO, o PtiO, ETCO, SaO, y PPC. El drenaje de LCR se constituye como la primera medida para disminuir rápidamente las elevaciones espontáneas de la PIC. Los bolos de manitol tienen efectos hemodinámicos y reológicos beneficiosos en mejorar la PPC al disminuir la PIC. La posición de la cabecera, el uso de barbitúricos y la hipotermia siguen siendo controvertidos. El uso de estos métodos debe limitarse a la experiencia del grupo tratante del paciente