Spinal cord compression in thoracolumbar burst fractures: application of high-definition three-dimensional exoscope in minimally invasive lateral surgery.

STUDY DESIGN: Spinal cord decompression in thoracolumbar burst fractures is challenging. Development of minimally invasive approaches and the improvement in new magnification technologies allowed a better and safer surgical treatment for these complex spinal injuries. We reported our experience in the minimally invasive surgical treatment of thoracolumbar burst fractures with spinal cord compression supported by high-definition (HD) three-dimensional (3D) Video-assisted telescope operating monitor (VITOM) or exoscope. OBJECTIVES: To assess the role and potential advantages of exoscope in the minimally invasive surgery of traumatic thoracolumbar spinal cord compression comparing traditional magnification systems. SETTING: The study was conducted in a Northern Italy Spinal Trauma Center. METHODS: We reported 10 consecutive thoracolumbar (T11-L2) burst fractures associated with spinal cord compression treated with minimally invasive corpectomy and exoscope-assisted spinal decompression. Three main indicators were retrospectively analyzed: surgical time, blood loss, and intraoperative complications. The data were compared with those obtained from an equal sample of 10 procedures performed by the same surgeon with the same technique, but traditional microscope assisted. User impressions in terms of ergonomics, magnification, and image quality were rated differently. RESULTS: A small reduction of surgical time and blood loss were observed in the exoscope assisted group. There were no intraoperative complications attributed to visualization mode or conversion to the traditional microscope in any procedure. In our experience the exoscope allowed a better magnification and image definition with better ergonomics and user-friendliness. CONCLUSIONS: In our preliminary experience the exoscope new technology is a safe and effective tool for spinal cord minimally invasive decompression in thoracolumbar burst fractures. The stereoscopic vision provided by 3D images seems to be crucial in hand eye coordination. There are clear advantages in terms of maneuverability, wide field of view, deep focus, and more comfortable posture for the spinal surgeon.

Spinal cord stimulator medullary compression-a very rare SCS complication and surgical treatment.

INTRODUCTION: The risk of spinal cord damage after Spinal Cord Stimulator (SCS) implant is a very rare event. In our case report, the patient was affected by a progressively worsening spinal stenosis due to SCS compression. CASE REPORT: The authors describe a progressive paraparesis in a 58-year-old woman with a long history of back pain and multiple spine surgeries. Computed tomography (CT) outlined vertebral canal stenosis corresponding to an electrode array implanted in T9. A posterior T8-T10 spinal cord decompression with explanation of the SCS device was performed and a partial neurological improvement was observed immediately postoperative. DISCUSSION: Spinal cord stimulation has been used since 1967 for the treatment of refractory chronic pain, particularly failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). Still, the mechanism underlying its function is not completely clear. Moreover, complications are mainly related to implant dysfunction and the risk of direct and indirect spinal cord compression is described as exceptional in the literature. Our aim is to describe the case SCS device spinal cord direct compression and its surgical treatment.

Spinal cord compression in dialysis-related upper cervical amyloidoma - a case report.

INTRODUCTION: Dialysis-related amyloidosis (DRA) can lead to various degenerative conditions but rarely involves the spine with a spinal cord compression. CASE REPORT: The authors describe a progressive tetraparesis (AIS-B) in a 57-year-old woman with upper cervical dialysis-related amyloidoma. Magnetic resonance imaging (MRI) showed a solid focal mass lesion at the C2-odotoid level with severe spinal cord compression. Computed tomography (CT) outlined multiple lytic lesions in C1 lateral masses and odontoid process. The patient underwent urgent surgical treatment. A posterior C1-C2 spinal cord decompression with biopsy followed by occipito-cervical posterior fixation was performed. Histopathological examination revealed amyloid deposits representing DRA. An immediately postoperative neurological improvement was observed. DISCUSSION: Even if the spinal amyloidoma is extremely rare, this condition has to be suspected in a long-term hemodialysis patient suffering from progressive neurological deficits. Differential diagnosis is mandatory between infections, rheumatologic and neoplastic lesions. Imaging evaluation with CT and MRI is recommended in order to assess the characteristics of the pathological mass, the extension of lytic lesions and the entity of neurological compression. Surgical treatment is mandatory if clinical evidence of root or spinal cord compression is present.

Donor-Site Morbidity After Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Gait Performance.

PURPOSE: The purpose was to evaluate donor-site clinical morbidity and changes in kinematic gait parameters after the harvest of a vascularized free fibula flap for facial reconstruction. MATERIALS AND METHODS: We enrolled 14 patients (aged 50 ± 15 years) in a longitudinal study. Every patient underwent a double evaluation in which a presurgical assessment and 6-month postsurgical assessment were performed. Subjective donor-site evaluation was carried out through unstructured clinical questioning about pain, paresthesia, walking ability, and restrictions in activity. Further subjective evaluations were assessed through the Western Ontario and McMaster Universities Osteoarthritis Index and the Point Evaluation System for Lower Extremity Fibulectomy. A clinical evaluation of the donor site assessed muscular deficits, sensibility disturbance, and wound healing. Temporal and spatial kinematic parameters were measured through gait analysis during overground walking at a comfortable speed. RESULTS: Postsurgical clinical examinations detected 1 patient affected by a neurologic disorder and 3 patients with donor-site pain, whereas 10 patients (71%) declared no residual alterations in the operated leg. On average, the Western Ontario and McMaster Universities Osteoarthritis Index score was 367 of 2,400, and the Point Evaluation System for Lower Extremity Fibulectomy score was 19 of 24. Presurgical versus postsurgical gait analysis comparison showed no significant differences in gait parameters except for a 6% reduction in the double-support phase. Stance values were higher for the operated limb in both evaluations (+1.3% before surgery, +1.8% after surgery). No alterations were detected in the range of motion of the lower-limb joints. CONCLUSIONS: Considering the slight modification of the gait pattern, which is not usually perceived by patients, vascularized free fibula flap harvest was generally associated with successful functional and subjective outcomes of the donor site.