Clinical and radiological outcome of stand-alone percutaneous pedicle screw fixation (SAPF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). A propensity-matched cohort study.

In adult patients affected by degenerative disc disease with lumbar instability and chronic low back pain, spine surgery with lumbar fixation aims to reduce segmental instability and pain. Different techniques have been developed, but the optimal surgical technique remains controversial. No studies have compared the clinical and radiological outcomes between stand-alone pedicle screw fixation (SAPF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). This was a retrospective study. All patients who underwent surgery for single-level L4-L5 or L5-S1 lumbar stenosis, associated with minor lumbar instability and treated with SAPF or MI-TLIF techniques were included in the study. Data were collected preoperatively and at 24 monts follow-up. Clinical primary outcomes were Oswestry Disability Index (ODI) and Numerical Rating Scale (NRS). Secondary outcomes were patient satisfaction, walking ability and self reported back and leg pain. In addition, perioperative data and complications were recorded. Segmental lordosis (L4-L5 and L5-S1) and overall lumbar lordosis (L1-S1) were measured on lumbar X-Rays preoperatively and at least 24 months postoperatively. 277 patients were firstly identified. Baseline data and a minimum of two-year follow-up were available for 62 patients. After the propensity score matching, 44 patients (22 patients in the SAPF group and 22 patients in the MI-TLIF group) were matched. At 24 months follow-up, no difference between the two groups of patients in NRS (p = 0.11) and ODI scores (p = 0.21) were observed. Patients' satisfaction at follow-up was also not significantly different between the two groups. In both groups, a significant improvement in the walked distance was observed after surgery (p = 0.05) while no difference was observed regarding the type of surgery performed (p = 1.00). No differences were found in the pre- and post-operative median lumbar lordosis (p = 0.91 and p = 0.67) and the same findings were observed for lumbar segmental lordosis (p = 0.65 and p = 0.41 respectively). Significant improvements in ODI and NRS-scores were recorded after 24 months follow-up with both SAPF and MI-TLIF. No significant differences in postoperative PROMs and patients' satisfaction were observed between the groups. The results of our study indicate no superiority of either surgical technique concerning pain and functional outcomes after 24 months.

Vertebroplasty for symptomatic monostotic Paget disease.

Paget disease (PD) is a chronic metabolically active bone disorder. The spine is the second most commonly involved site; the pathologic changes can cause back pain, myeloradiculopathy, and vertebral fracture. Symptomatic patients are treated medically, and surgery is required when certain complications occur. A case is presented of monostotic vertebral PD treated by percutaneous vertebroplasty (PV) with successful outcome characterized by pain relief and improved disability at 6-month follow-up. PV is proposed as a primary treatment for back pain secondary to PD when unresponsive to conservative therapy and when not associated with other complications.

High frequency extradural motor cortex stimulation transiently improves axial symptoms in a patient with Parkinson's disease.

In a primate model of Parkinson's disease (PD), the benefit of extradural motor cortex stimulation (EMCS) was associated with high-frequency stimulation (130 Hz), whereas no significant motor improvement was achieved at 10 Hz or intermediate frequencies of stimulation. We report the case of a 72-year-old female patient affected by severe PD who underwent bilateral EMCS. In baseline med-off condition the patient was unable to arise from a chair and to stand without assistance. Stimulation at 3 and 60 Hz failed to provide any improvement of symptoms, whereas, when stimulating at 130 Hz, axial akinesia and walking improved consistently: the patient, in med-off condition, was able to arise from chair and to walk without assistance. The patient underwent two brain 99mTc- Ethylcysteinate Dimer-SPECT studies: semiquantitative and Statistical Parametric Mapping revealed that the regional cerebral perfusion was significantly increased in the supplementary motor area during stimulation at 130 Hz. After five months, the benefit of EMCS gradually disappeared.

Ulnar nerve entrapment at the elbow. A surgical series and a systematic review of the literature.

Chronic compression of the ulnar nerve at the elbow is the second most common entrapment neuropathy. Various surgical options have been described. Timing of surgery is also debated. In this study we report the long-term results of a consecutive surgical series of anterior subcutaneous transpositions and review the pertinent literature. Sixty consecutive patients underwent anterior subcutaneous transposition at our Institution to treat ulnar nerve compression at the elbow. McGowan scale was used in the neurological exam before surgery. Bishop rating system was used to assess outcome. Seventy-eight% of patients scored good-excellent. None of the patients worsened. No complications and no recurrences were reported. Young age and good pre-operative neurological status (McGowan grade 1) were predictive of favorable outcome both at univariate and at multivariate analysis. No differences in outcome were observed between patients with intermediate (McGowan grade 2) and severe (McGowan grade 3) neuropathy. Thirty-four studies assessing outcome of different surgical techniques were reviewed. Anterior subcutaneous transposition had the lowest recurrence rate with an excellent effectiveness and safety profile. The favorable predictive role for outcome of preoperative neurological status was confirmed. The good long-term clinical results of the present series and the results of literature analysis confirm the value of anterior subcutaneous transposition of the ulnar nerve at the elbow. This technique has a particular effectiveness in most severe compressions, where outcomes are comparable with intermediate neuropathy cases. Moreover, our results suggest an aggressive attitude towards ulnar nerve compression at the elbow, particularly in younger patients.

Unilateral extradural motor cortex stimulation is safe and improves Parkinson disease at 1 year.

BACKGROUND: The primary motor cortex, which is part of the corticobasal ganglia loops, may be an alternative option for the surgical treatment of Parkinson disease. OBJECTIVE: To report on the 1-year safety and efficacy of unilateral extradural motor cortex stimulation in Parkinson disease. METHODS: A quadripolar electrode strip was extradurally implanted over the motor cortex. Stimulation was continuously delivered through the electrode paddle contralateral to the most affected clinical side. Subjects were prospectively evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson's Disease Quality of Life Questionnaire. In addition, an extensive cognitive and behavioral assessment and electroencephalogram recording were performed. RESULTS: Nine patients were included in this study. No surgical complications or adverse events occurred. Moreover, no cognitive or behavioral changes were observed. Under the off-medication condition, the UPDRS III at baseline was decreased by 14.1%, 23.3%, 19.9%, and 13.2%, at 1, 3, 6, and 12 months, respectively. The motor effects were bilateral, appeared after 3 to 4 weeks of stimulation, and outlasted the stimulation itself for 3 to 4 weeks in 1 case of stimulator accidental switching off. The UPDRS IV was decreased by 40.8%, 42.1%, and 35.5% at 1, 3, and 12 months, respectively. The scores on the Parkinson's Disease Quality of Life Questionnaire were increased at months 3, 6, and 12. CONCLUSION: Extradural motor cortex stimulation is a safe procedure. After 12 months, the patients demonstrated a moderate improvement of motor symptoms (particularly axial symptoms) and quality of life.