Herniated Disc Causing Foraminal Stenosis and Compression of the Unilateral Exiting Nerve Root at C5-C6: A Case Report.

This case report describes the use of unilateral biportal endoscopy (UBE) for treating a 40-year-old female patient with cervical radiculopathy caused by a herniated disc at C5-C6, which had led to foraminal stenosis and nerve root compression. The patient presented with a one-year history of neck pain radiating to the right upper limb, accompanied by tingling sensations. Imaging revealed loss of cervical lordosis, disc dehydration, and a right-sided foraminal disc protrusion. The patient underwent a right-sided cervical UBE with C5-C6 discectomy and foraminotomy. Postoperatively, the pain was significantly reduced, with improvement in MacNab's grade and visual analog scale scores for neck pain and radiating pain of the upper limb at one- and three-month follow-ups. The procedure demonstrated the effectiveness of UBE in achieving good clinical outcomes with minimal complications, such as reduced soft tissue damage, minimal blood loss, and preserved spinal stability.

Patients with achondroplasia have increased risk of 90-day adverse events following laminectomy: A matched comparison using a national database.

PURPOSE: Performing laminectomies in patients with achondroplasia-a common skeletal dysplasia-can present unique challenges. There are a limited number of studies that have reported on the adverse effects of laminectomies in patients with achondroplasia. To compare the 90-day postoperative adverse events following laminectomy in patients with and without achondroplasia. METHODS: Retrospective cohort study using the 2010-2020 PearlDiver Mariner 91 administrative database was used to identify patients who underwent thoracic, thoracolumbar, or lumbar laminectomy. Patients with achondroplasia were matched 1:4 to patients without achondroplasia based on age, sex, insurance, and ECI. Univariate and multivariate logistic regression analyses assessed and compared 90-day adverse events. Odds ratios (OR), 95% confidence intervals (CI), and p-values were reported with significance set at p < 0.05. RESULTS: A multivariate analysis revealed that when laminectomy was performed, patients with achondroplasia were 2.82 times more likely to have 90-day AE compared to those without achondroplasia (p < 0.001). When comparing individual subtypes of adverse events, patients with achondroplasia were found to have significantly greater odds of a transfusion (OR 6.40, p < 0.001), UTI (OR 3.79, p < 0.001), disruption of wound (OR 3.71, p < 0.001), and hematoma (OR 2.94, p = 0.032). Pneumonia, cardiac arrest, AKI, other perioperative events, durotomy, and VTE were not significantly different between the two cohorts. CONCLUSION: This study uses one of the largest cohorts to compare patients with and without achondroplasia undergoing laminectomy. Patients with achondroplasia were found to have a significantly greater risk of 90-day adverse events following laminectomy compared to their matched cohort of patients without achondroplasia.

L3-L4/L4-L5 Type II-A spondylolisthesis: A case report.

INTRODUCTION AND IMPORTANCE: Double level isthmic spondylolisthesis at L3-L4/L4-L5 is exceedingly rare with only a few documented cases in the literature, but to our knowledge no detailed case reports have been written. CASE PRESENTATION: 49 year old male with L3-4, L4-5 isthmic spondylolisthesis with neurologic symptoms and failed conservative management treated with L3-4, L4-5 Gill laminectomy, transforaminal interbody fusion with bone grafting and L3-5 posterior instrumented fusion. CLINICAL DISCUSSION: While rare, this condition can be successfully treated with posterior decompression and instrumented interbody fusion similar to single level spondylolisthesis. Surgeons should feel confident that they can achieve a good outcome for patients and feel comfortable offering this procedure. CONCLUSION: This case report may offer guidance for surgeons in the future as it explores the successful treatment of double level isthmic spondylolisthesis at L3-L4/L4-5 from initial presentation to final post-operative follow-up where the patient had complete resolution of symptoms.

Treatment strategies for cervical spondylotic myelopathy-is laminectomy alone a safe and effective option?

Background: Cervical laminectomy may be underutilized in the treatment of cervical spondylotic myelopathy (CSM) due to concerns regarding potential for post-operative instability and/or kyphosis. The purpose of this retrospective, observational study is to assess the short-term clinical and radiological outcomes as well as complications associated with a group of carefully selected patients who underwent laminectomy alone for CSM and compared them to a cohort of patients who underwent laminectomy with fusion. Methods: Patients with CSM were identified via review of a single surgeon's cases. All patients underwent preoperative clinical evaluation, lateral flexion-extension cervical radiographs, and documentation of neck and/or extremity pain via Nurick Scale and modified Japanese Orthopedic Association (JOA) scores. Postoperative follow-up occurred at 1, 3 and 6 months for all patients. Statistical analysis was performed via Student's t-test for parametric values and Wilcoxon (Mann-Whitney) rank sum test for ordinal scores. Multi-variable linear regression was used to correct for co-variance. Results: Forty-one patients who underwent laminectomy alone and 13 patients who underwent laminectomy with fusion were identified who met inclusion criteria. Both groups demonstrated significant improvement on Nurick and JOA scores postoperatively. Two patients in the laminectomy alone group required a subsequent one-level anterior cervical discectomy and fusion for onset of postoperative neck pain, without neurological symptoms or new deficits in the follow up period. There was no difference in rates of post-operative kyphosis between the groups. Conclusions: In appropriately selected patients without pre-operative kyphosis or abnormal motion on flexion-extension films, cervical laminectomy remains a safe and effective treatment option.

Health care disparities in complication and mortality rates following surgical management of cauda equina syndrome in New York State.

CONTEXT: While healthcare disparities related to race and ethnicity are well reported for non-emergent conditions, the literature on disparities in outcomes of emergent spinal conditions such as cauda equina syndrome (CES) remains sparse. OBJECTIVE: To evaluate racial disparities in complication, mortality, and readmission rates following surgical intervention for CES. METHODS: This retrospective analysis of The Statewide Planning and Research Cooperative System (SPARCS) database demonstrates that among patients surgically treated for CES in New York between 2015 and 2020. Bivariate and multivariate logistic regression analysis was performed to analyze the association of race and outcome variables after controlling for age, sex, comorbidities, length of stay, insurance, and hospital characteristics. RESULTS: Overall, 2,114 patients who underwent lumbar surgery for CES were identified. The study population was comprised of Black patients (177, 8%), White patients (79%, 1680), and Asian patients (257, 12%). Options for surgery included lumbar decompression (821, 38.8%), fusion (746, 35.3%), or both (547, 25.9%). On multivariate analysis, the odds of 30-day mortality were 2.98-fold greater in Black patients than in other patients (P = 0.029). By 180 and 360 days, the odds of mortality were 4.27 and 3.05-fold greater in Black patients than in other patients, respectively (P < 0.001 each). Thirty-day readmissions were 1.87-fold greater in Black patients than others (P = 0.004). No difference in overall complication rate was found between Black patients and all other race groups (P = 0.306). CONCLUSIONS: Black patients surgically treated for CES face significantly higher rates of mortality and readmission than their non-Black counterparts.

Outcomes and Cost-Effectiveness of Hospital Outpatient Versus Ambulatory Surgery Center Lumbar Decompression Surgery.

STUDY DESIGN: Retrospective Chart Review. OBJECTIVES: Outpatient spinal surgeries in Ambulatory Surgery Centers (ASCs) have gained traction due to their potential cost efficiencies and improved perioperative processes. This study aims to compare the cost-effectiveness and patient outcomes of lumbar laminectomies performed in hospital settings vs ASCs. METHODS: A retrospective analysis was conducted on 771 patients who underwent 1 or 2-level outpatient laminectomy between 2019 and 2023. Patient demographics, 90-day and one-year clinical and patient-reported outcomes (PROs), and one-year episode of care costs were evaluated. A one-year cost-effectiveness analysis was performed using the EQ-5D to measure quality-adjusted life years (QALYs). RESULTS: ASC patients demonstrated lower body mass index and American Society of Anesthesiologists (ASA) scores, with a higher prevalence of 1-level laminectomies compared to hospital patients. ASC-based laminectomy was associated with lower initial surgery cost and one-year episode of care costs ($5662 ± 4748 vs $10229 ± 9202, P < 0.001), with similar rates of complications and postoperative resource utilization. These trends remained after controlling for patient demographics, comorbidities, and number of levels treated. In patients completing baseline and 1-year EQ-5D scores, ASC-based laminectomy was over twice as cost-effective as hospital procedures ($64873/QALY gained vs $152630). CONCLUSIONS: The findings support the safety and one-year cost effectiveness of ASCs for appropriately selected patient populations undergoing lumbar laminectomy. Additional studies are needed to replicate these findings across institutions, and to assess the cost effectiveness of ASC-based laminectomy beyond one-year postoperatively.

Evaluation of the Effectiveness of Cervical One-Hole Split Endoscopic Keyhole Surgery for Cervical Radiculopathy.

Purpose: One-hole Split Endoscopy (OSE) is a newer surgical modality that can be applied to posterior cervical foraminotomy (PCF), lumbar discectomy, laminectomy, and decompression. It incorporates intervertebral foraminotomy, open surgery, and other lumboendoscopic techniques with a wide observation field, free space, and compatibility with various spinal surgical techniques and instruments. This study investigated the clinical efficacy of minimally invasive posterior cervical nucleus pulposus removal for cervical spondylotic radiculopathy (CSR) by OSE-Keyhole technique. Patients and Methods: This was a retrospective study of 63 patients treated with OSE keyhole treatment for CSR between May 2021 and September 2023 at Qilu Hospital of Shandong University, Qilu Hospital of Shandong University (Qingdao, China), and Second Hospital of Shandong University, respectively. Clinical outcomes included patients' preoperative and postoperative visual analogue scale (VAS) - arm and neck, Japanese Orthopaedic Association Assessment Treatment Score (JOA) - cervical spine, which were collected at baseline, two days postoperatively, one month postoperatively, and three months postoperatively after the last follow-up visit for evaluation, and perioperative indicators, including intraoperative bleeding, length of hospital stay, postoperative complications, and reoperations, which were also collected. Results: Statistical analyses were performed for the baseline data and follow-up results of 63 patients. Compared to the preoperative baseline values, the follow-up results two days, one month and three months after surgery showed significant improvements in vas-arm, neck and JOA scores in the operated patients (P<0.05) as well as a reduction in all perioperative-related indices. Conclusion: In the treatment of cervical pain and disability due to radiculopathy, OSE keyhole removal of the posterior cervical nucleus pulposus is a better clinical option as it is less invasive and recovers better postoperatively.

Lumbar Endoscopic Unilateral Laminectomy for Bilateral Decompression in Degenerative Spondylolisthesis.

BACKGROUND: Degenerative spondylolisthesis is an important cause of chronic low back pain and radiculopathy in the adult U.S. POPULATION: Open decompression with or without fusion is considered the standard for management, yet optimal treatment remains controversial. Full endoscopic spine surgery offers an alternative surgical approach with possible advantages. There is a paucity of data on the use of full endoscopic spinal surgery in degenerative spondylolisthesis. Therefore, we present the clinical and radiographic outcomes of 73 patients with low-grade degenerative spondylolisthesis with severe stenosis, who underwent lumbar endoscopic unilateral laminectomy for bilateral decompression. METHODS: Patients with low-grade degenerative spondylolisthesis who underwent a lumbar endoscopic ULBD at 6 spine centers in North America were included in this study. Patients were followed up at 3, 9, and 12 months. Static and dynamic imaging was performed and evaluated routinely before surgery to identify the pathology and grade of spondylolisthesis. Patient-reported outcomes were prospectively collected. RESULTS: This study included 73 patients from 6 spine centers. Sixty-two patients were diagnosed with grade I spondylolisthesis, whereas 11 were diagnosed with grade II spondylolisthesis. Postoperatively, 70 patients reported improved symptoms and pain resolution, whereas 3 patients reported worse pain. Mean visual analog scale back and visual analog scale leg scores and Oswestry Disability Index showed a statistically significant improvement at 3, 9, and 12 months compared with the preoperative period. Radiographically, no patient in our study had progression of the grade of spondylolisthesis. CONCLUSIONS: Patients with low-grade degenerative spondylolisthesis causing severe stenosis can safely be treated with lumbar endoscopic unilateral laminectomy for bilateral decompression. A head-to-head trial should be undertaken to provide a higher level of clinical evidence.

Efficacy and Safety of Biportal Endoscopic Decompressive Laminectomy in Octogenarians With Severe Lumbar Spinal Stenosis.

BACKGROUND: Lumbar spinal stenosis (LSS) is prevalent among octogenarians, causing significant pain and disability. Surgical intervention is often required because of the ineffectiveness of conservative treatments. This study investigates the efficacy and safety of biportal endoscopic decompressive laminectomy (BED) in octogenarians with severe LSS, evaluating its potential as a minimally invasive surgical option. METHODS: This retrospective study included 107 patients aged 80 years or older who underwent BED for LSS between March 2017 and December 2022. Data were collected from electronic medical records, including demographic information, clinical outcomes, and surgical details. Patients with fractures, infectious spondylitis, herniated discs, and follow-up less than 12 months were excluded. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT at baseline and at 3, 6, and 12 months after surgery. RESULTS: The mean age of the 107 patients was 84.1 years, with 59% being women. Significant improvements were observed in visual analog scale scores for lower back and lower extremities pain, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT scores, indicating reduced pain, decreased disability, and enhanced quality of life. There were no significant differences in outcomes between patients aged 80 to 84 and those 85 or older. Surgery-related outcomes such as operation time, blood loss, and complications were similar in both age groups. CONCLUSIONS: BED is a safe and effective treatment for LSS in octogenarians, providing significant pain relief and functional improvement. This minimally invasive technique is also viable for patients older than 85 years, without increased risk of complications, supporting its broader indications in managing LSS in the elderly. CLINICAL RELEVANCE: This study highlights the efficacy and safety of BED for LSS in octogenarians, demonstrating its potential to improve quality of life and function with low risks, making it a feasible option for elderly patients.

AB007. Intramedullary schwannoma: a rare case report.

BACKGROUND: Intramedullary schwannomas are a rare case, accounting for only 0.3% of all intraspinal neoplasms and 1.1% of spinal schwannomas. These tumors have most often been reported to involve a single lesion affecting the cervical spinal cord (63%), the thoracic spinal cord (26%), and the lumbar spinal cord (11%). Here we report a very rare case thoracic intramedullary schwannoma. CASE DESCRIPTION: A 24-year-old female patient was admitted with gradual onset weakness of both lower limbs for last 2 years with retention of urine. Neurological examination revealed the motor strengths on both legs were 2. There was a sensibility dissociation below Th8 dermatomal level. Magnetic resonance imaging shows an ill-demarcated intramedullary lesion extending from Th8 to Th9 accompanied by spinal cord edema along Th4 to Th11. The surgery was performed with standard posterior middle approach. Laminectomy decompression was performed and dura opened in the midline. Infiltrative nature of the mass made the total resection impossible. Histopathological result followed by immunohistochemistry confirmed the diagnosis of schwannoma. In the postoperative follow-up, the motor strengths of both legs are absent and no clinical improvement at all until now. Prior to surgery, intramedullary schwannoma is often misdiagnosed as other types of tumour, including ependymoma, astrocytoma and hemangioblastoma, due to its atypical imaging appearance and low incidence. Surgery for spinal intramedullary tumors remains one of the major challenges for surgeons, due to their relative infrequency, and surgical difficulty technique. Worse preoperative McCormick Scale, thoracic tumor location, partial resection, and lack of availability of intraoperative neurophysiology monitoring (IONM) were significant factors for poor prognosis. CONCLUSIONS: Intramedullary schwannomas are slow-growing rare tumors and should be considered as one of the differential diagnoses for the intramedullary spinal lesions. Magnetic resonance imaging may be helpful for diagnosis however clear distinction cannot be made between the intramedullary spinal lesions. Total surgical resection is the treatment choice for this patient but infiltrative lesions cannot be resected completely for which radiotherapy has been suggested.

The Impact of Preoperative Sagittal Imbalance on Long-term Postoperative Outcomes Following Minimally Invasive Laminectomy.

Background: Postoperative sagittal alignment has been shown to be associated with patient-reported outcome measures (PROMs) following open lumbar decompression procedures, although it is unknown whether preoperative sagittal imbalance affects clinical outcomes of minimally invasive surgical (MIS) decompression only surgery. Purpose: We sought to evaluate the impact of preoperative pelvic incidence-lumbar lordosis (PI-LL) imbalance on PROMs after MIS laminectomy for the treatment of neurogenic claudication symptoms. Methods: We conducted a retrospective cohort study of adult patients undergoing MIS laminectomy for degenerative lumbar spinal stenosis between April 2017 and April 2021 at a single institution. Of the 52 patients included (mean follow-up, 17 months) radiographs were taken prior to surgery and assessed for sagittal alignment parameters. Patients were grouped based on the preoperative PI-LL (balanced vs unbalanced). Changes in PROMs were compared between unbalanced PI-LL and balanced PI-LL groups. Minimal clinically important difference (MCID) for Oswestry Disability Index (ODI) was also assessed. Results: Of the 52 patients, 17 (32.7%) had unbalanced age-adjusted preoperative PI-LL. There was no significant difference found in PROMs between unbalanced and balanced PI-LL groups preoperatively or at final follow-up. Compared with those with unbalanced PI-LL, patients with balanced PI-LL were shown to have no added benefit in achieving MCID for ODI at long-term follow-up and no added benefit in the time to achieving MCID. Conclusion: These retrospective findings suggest that patients with unbalanced preoperative PI-LL may experience significant benefit in long-term clinical outcomes following MIS laminectomy, similarly to those with balanced PI-LL at baseline. The findings also suggest that the presence of sagittal imbalance preoperatively may not appreciably influence the long-term clinical outcomes following MIS laminectomy. Prospective study involving a larger population is warranted.

Pediatric spinal arachnoid cysts with compressive myelopathy: single-center experience and update on surgical management.

PURPOSE: This study describes the surgical outcome of pediatric primary spinal arachnoid cysts (SACs) presenting with compressive myelopathy and gives an update on the classification and management of these rare lesions. METHODS: We performed a single-center retrospective analysis of pediatric patients operated for primary spinal arachnoid cysts. The clinical and radiologic profiles and surgical outcomes of these children were analyzed. Subgroup analysis was done in the laminoplasty vs laminectomy groups to see for the development of spinal deformity. RESULTS: There were 10 males and seven females with a mean age of 10.4 years (range:6-14 years). The cysts extended to an average of 5.2 levels (range:2-8). They were extradural in seven (41%) and intradural in 10 (59%). Six intradural and four extradural cysts underwent laminectomy (n = 10) while four intradural and three extradural cysts underwent laminoplasty (n = 7). Although three out of 10 cases in the laminectomy group and none in the laminoplasty group had post-operative spinal deformity, this result was not statistically significant (p = 0.110). There was a moderate negative correlation between post-operative cord occupancy ratio (COR) and post-operative McCormick grade (Pearson correlation coefficient = -0.453, p = 0.068), suggesting that higher CORs are associated with lower McCormick grades. CONCLUSION: Symptomatic pediatric primary spinal arachnoid cysts are safely and effectively managed by marsupialization or microsurgical excision. Considering the growing age group, laminoplasty rather than laminectomy should be the standard surgical procedure to prevent late postoperative spinal deformity. Clinically significant recurrences are rare in the setting of adequate cord expansion and restored subarachnoid CSF flow following surgery.

Navigating Anesthetic Challenges in Multiple Spinal Hydatid Cysts.

Spinal hydatid disease is a rare form of hydatid disease caused by the larval stage of Echinococcus granulosus. It refers to a range of conditions that affect the spinal cord, the spine, or both. The prevalence of spinal hydatid disease is highest in the thoracic spine; however, it can also occur in other regions of the spine. In this case report, we present an unusual occurrence of numerous hydatid cysts in a 42-year-old male living in a remote region. The patient has been experiencing a progressive loss of power in his lower limbs, urine incontinence, and back pain for the past four months. The patient was found to have many distinct cystic lesions with spinal cord compression syndrome. Spinal hydatidosis is an uncommon illness that causes significant suffering and has a bleak outlook. When evaluating a patient with spinal compression syndrome, it is important to evaluate this as one of the potential causes.

Patient-Reported Outcomes and Complications of Simultaneous versus Staged Surgical Decompression for Tandem Spinal Stenosis.

Introduction Tandem spinal stenosis (TSS) refers to the narrowing of the spinal canal at two distinct anatomic areas. Symptoms can present due to either cervical myelopathy or lumbar stenosis. Consequently, determining the symptomatic anatomical levels requiring surgery can pose a challenge. We sought to identify the surgical approach associated with better patient-reported outcomes. Materials and Methods The Information Management System was queried using the International Classification of Diseases Ninth and Tenth Edition codes to identify patients who underwent simultaneous or staged decompression surgery for TSS between 2011 and 2020. Patient records were reviewed to collect data on age, sex, comorbidities, surgical approach, modified Japanese Orthopedic Association (mJOA) score, and complications. The mJOA is a validated composite assessment used to quantify postoperative neurological status. Multivariable regression models were utilized to identify factors associated with better postoperative neurological recovery. Results Among 42 patients included in the analytical cohort, 33 (78.6%) underwent simultaneous cervical and lumbar decompression, while 9 (21.4%) underwent staged decompression (cervical followed by lumbar). The patient's age, sex, comorbid conditions, and American Society of Anesthesiologists level were similar between the two groups. Furthermore, simultaneous decompression was associated with higher blood loss (676.97 vs. 584.44 mL) and an increased need for transfusion (259.09 vs. 111.11 mL) compared with staged decompression. Moreover, patients who underwent simultaneous decompression experienced a higher number of postoperative complications (10 vs. 1; p = 0.024). Notably, postoperative mJOA scores improved in both groups; however, the improvement was more pronounced in the staged group (mJOA score: 15.16% [ ± 2.18] vs. 16.56% [ ± 1.59]). On follow-up visits, patients who underwent staged decompression showed better recovery rates (mJOA score: 78.20% [ ± 24.45] vs. 59.75% [ ± 25.05]). Conclusion The patient's clinical history and examination findings should be the main determinants of surgical decision-making. Our study showed a slightly higher postoperative mJOA score and a recovery rate with fewer complications in staged decompression of TSS.

Exploring the atlantic part of the vertebral artery in the South Indian population and its implications in spine surgery.

STUDY DESIGN: A descriptive, quantitative cross-sectional study of the atlantic part (V3) of the vertebral artery (VA). PURPOSE: This study aimed to bridge the research gap in the morphometry of the V3 segment of the VA in the South Indian population. OVERVIEW OF LITERATURE: The microsurgical anatomy of this segment of the VA has been explored in various populations, and a thorough understanding of the anatomy and course of the VA, particularly the V3 segment, is essential to prevent iatrogenic complications. Several computed tomography studies but a few cadaveric studies have explored the V3 segment of the VA in the South Indian population. METHODS: This study examined 40 VAs from 20 embalmed cadavers that were obtained from the voluntary donation program, and Institutional Ethical Clearance was obtained before the study. The length, diameter, and angle of the vertical, horizontal, and exit parts of the V3 segment of the VA were documented after its exposure. RESULTS: The mean lengths of the right and left VAs on each part were nearly similar, except for the mean length of the horizontal part (right: 38.937 mm, left: 40.237 mm) and total length of the V3 segment (right: 66.870 mm, left: 70.350 mm). CONCLUSIONS: These morphometric parameters are essential to spine surgeons who intend to operate on a small part (vertical, horizontal, or exit part) of the V3 segment of the VA. The mean values of the parameters obtained in this study give average measurements or safe limits to surgeons for safe surgical procedures such as the occipital condyle screw technique and C1 laminectomy.

A challenge diagnosis of lumbar synovial facet cyst. A case report.

INTRODUCTION AND IMPORTANCE: Synovial cysts occur more frequently in the lumbar spine, especially at L4-5 level. Traditional open surgical management with posterolateral arthrodesis is the currently recommended treatment. CASE PRESENTATION: This is a 64-year-old woman with no prior pathological history. Initial clinical and radiological assessment concluded that there was advanced right coxarthrosis with a degenerative lumbar spine. The patient therefore had a total hip arthroplasty secondarily presented an intermittent neurogenic claudication without sphincter disorders. The MRI concluded at a compressive synovial facet cyst at the L4-L5 level. The patient underwent surgical treatment. At two years postoperatively, the walking distance was significantly improved while maintaining moderate lower back pain. CLINICAL DISCUSSION: The diagnosis of synovial facet cysts of spine is a challenge that depends heavily on history, physical examination, and MRI. MRI will demonstrate not only the nature of the cystic lesion, but also its relationship to the root, the cord or the thecal sac. The L4-L5 level of the lumbar spine is the most common location of the synovial cyst of the facet joints. As in our case, surgical treatment combining posterolateral arthrodesis is currently recommended for these types of lesions. Surgical treatment, as in our case, is sometimes delayed when this pathology is associated with advanced osteoarthritis of the hips. CONCLUSION: Improved imaging capabilities such as magnetic resonance imaging (MRI) have resulted in increased reporting, diagnostic yield and treatment of spinal synovial cysts. Surgical treatment combining posterolateral arthrodesis is the treatment for this lesion.

How I do it: Exoscope assisted microsurgical ligation of type 1 spinal dural arteriovenous fistula.

BACKGROUND: Type 1 Spinal dural arteriovenous fistula (dAVF) is a rare but curable vascular cause of myelopathy. Microneurosurgery is a very efficacious modality in treating them. METHOD: A 26 year old gentleman with progressive flaccid paraparesis (LMN type) and urinary incontinence underwent surgery using exoscope for a right side T9-10 dAVF. A dilated vein was seen accompanying the exiting nerve root intraoperatively, consistent with the preoperative angiographic findings. The vein was ligated and divided leading to restitution of spinal cord vasculature on table and excellent postoperative outcome. CONCLUSION: Surgical resection is a straightforward and highly effective treatment in spinal dAVF.

Comparison of the effectiveness of diclofenac sodium and tenoxicam in the prevention of epidural fibrosis by topical application with an absorbable gelatin sponge on the dura in an experimental laminectomy model.

INTRODUCTION: There has been an increasing trend in spinal surgery interventions in recent years. Low back pain is a disorder that is seen at least once in the lifetime of approximately 80% of the general population. Today, neurosurgeons perform operations including laminectomy for various reasons. Epidural fibrosis is a scar tissue that develops after posterior spinal surgery. Various synthetic and organic materials have been used in experimental studies to prevent epidural fibrosis in laminectomy defects. In this study we aimed to investigate and observe histopathologically the effectiveness of cyclooxygenase inhibitor drugs; tenoxicam and diclofenac sodium in the experimental rat laminectomy model in preventing the postoperative spinal epidural fibrosis. MATERIAL AND METHODS: In this study, 32 Wistar-Albino female rats were used. 8 mg/kg tenoxicam and 1.5 mg/kg diclofenac sodium were applied on the dura with an absorbable gelatin sponge. After decapitation, L1-L4 laminectomy area was totally removed and histopathological examination was performed. RESULTS AND CONCLUSIONS: It has been shown that the topical application of diclofenac sodium and tenoxicam, which are selective Cox inhibitor drugs, prevents fibroblast migration by forming a local barrier and Cox inhibitors are caused by the inhibition of prostanoids, which are inflammatory mediators.

Functional outcome after introduction of hemilaminectomy in management of spinal schwannomas and meningiomas.

Background: Schwannomas and meningiomas are intradural extramedullary spinal tumors which are regularly encountered in the neurosurgical clinic. These tumors cause neurological deficit by compression on the spinal cord and commonly pain when affecting the cauda equina. The traditional treatment with standard laminectomy (SL) can cause instability to the dorsal segments of the spinal column, and the less invasive option of hemilaminectomy (HL) has therefore been developed. We aim in this study to investigate transition from SL to HL in a population-based cohort. Methods: Adult patients (18 years and older) undergoing primary surgery due to spinal meningioma or schwannoma between 2007 and 2022 at the neurosurgical clinic were included. Data related to clinical, surgical and outcome variables were retrospectively collected. Results: A total of 187 patients were identified: 155 in the SL group, 26 in the HL group and in 6 patients a combination of SL and HL. The mean age of the SL group was 62.7 years (SD14.2) compared to 58.0 (SD15.7) in the HL group (p = 0.16). Preoperative motor deficit was more common in SL group compared to HL group (76.8 % and 61.5 %, respectively, p = 0.14). Thoracal location was most common for both groups (SL 65.8 % and HL 61.5 %). Postoperative change in McCormick grades and early complications were similar between groups. Conclusion: Outcome after hemilaminectomy due to intradural extramedullary schwannoma or meningioma is comparable to standard laminectomy with regards to postoperative complications and neurological improvement. Our findings support the transition to hemilaminectomy in selected cases.

Efficiency of Long Lateral Mass Screw in Posterior Cervical Fusion.

INTRODUCTION: Long lateral mass screw (LLMS) technique for posterior cervical fusion has been performed in our hospital since 2019. In this study, the LLMS insertion technique, deviation rate, and insertion torque have been described. Moreover, several major concerns associated with LLMS have been adequately addressed. METHODS: This study included 58 patients (43 men and 15 women) who had undergone LLMS surgery at our hospital during the four-year period from December 2019 to December 2023, and were evaluated using postoperative CT. The evaluation parameters included the screw length at each vertebral segment, screw angle in the sagittal section, distance between the screw heads, and complications. RESULTS: The median screw length at C3 was 23.0 mm (22.0-24.0 mm), the screw angle was 36.1° (31.6-41.8°), and the distance between screw heads was 13.8 mm (11.6-17.2 mm). The median screw length at C4 was 22.0 mm (21.0-24.0 mm), the screw angle was 36.2° (28.7-40.7°), and the distance between screw heads was 15.9 mm (13.0-19.0 mm). The median screw length at C5 was 21.0 mm (20.0-22.0 mm), the screw angle was 35.6° (28.0-39.7°), and the distance between screw heads was 17.6 mm (15.1-20.4 mm). The median screw length for C6 was 20.0 mm (19.0-22.0 mm), the screw angle was 29.2° (25.2-36.8°), and the distance between screw heads was 20.4 mm (16.1-24.4 mm). CONCLUSION: The major limitations of the LLMS technique were inadequate screw angle, difficulty inserting long screws, inadequate decompression, and the inability to perform cervical laminoplasty. However, these limitations did not substantially affect the efficiency of LLMS. LLMS has fewer complications and can insert longer screws than LMS.