Frontoethmoidal Encephalocele Correction Surgery in Benin: A Case Report.

INTRODUCTION: Primary encephalocele is a rare deformity that is challenging for the neurosurgeon. It requires a multidisciplinary team for adequate reconstructive surgery. CASE PRESENTATION: We report the case of a 6-month-old African boy who presented with a frontoethmoidal encephalocele; we present a technical description of the surgical procedure, using no implant. DISCUSSION/CONCLUSION: The postoperative evolution of the boy was uneventful, with a good clinical result at the follow-up.

Significant Reduction of Radiation Exposure Using Specific Settings of the O-Arm for Percutaneous Cementoplasty in Accordance With the ALARA Principle.

BACKGROUND: Three-dimensional (3D) navigation has become routinely used in spine surgery, allowing more accurate and safe procedures. However, radiation exposure related to the use of imaging is an unresolved issue, and information about it is relatively scarce. The "as low as reasonably achievable" (ALARA) principle aims to reduce the radiation exposure for the patients as low as possible. The objective of this study was to compare the effective dose related to the use of the O-arm in standard settings with adapted features for dose reduction during percutaneous cementoplasty. METHODS: From March 2021 to October 2022, all consecutive patients who underwent navigated percutaneous cementoplasty with the use of the O-arm were prospectively included. Demographic, operative, irradiation, and radiological data were collected. The main outcome was the effective dose (E) in millisievert (mSv). Secondary outcomes were the absolute risk of cancer (AR) in percent equivalent to a whole-body exposition, operative time, and radiological results according to Garnier. In group A, patients were operated on with standard settings of the O-arm, whereas in group B, navigation on the field of view, collimation, and low-dose settings were used. RESULTS: A total of 70 patients were included in the study: 43 in group A and 27 in group B. Also, 109 vertebrae were operated: 59 in group A and 50 in group B. Mean E was significantly higher in group A than in group B (9.94 and 4.34 mSv, respectively; P < 0.01). The 3D-related E followed the same trend (7.82 and 3.97 mSv, respectively), as did 2-dimensional-related E (2.12 and 0.37 mSv, respectively; P < 0.01). Average AR was also significantly higher in group A than in group B (5.10-4% and 2.10-4% respectively; P < 0.01). Operative time was similar in both groups, but the rate of satisfactory radiological results was higher in group A than in group B (95% and 84%, respectively; P = 0.11), and we found similar rates of cement leakage (22% and 24%, respectively; P = 0.71). CONCLUSIONS: The application of settings of the O-arm in accordance with the ALARA principle helped to significantly reduce the radiation exposure and should be routinely used for O-arm-assisted cementoplasty procedures. CLINICAL RELEVANCE: This study details technical aspects and settings that may help users of the O-arm to decrease radiation exposure to patients and surgeons alike, especially in cementoplasty procedures, as well as in other procedures performed under O-arm guidance.

Navigated Cementoplasty With O-Arm and Surgivisio: An Ambispective Comparison With Radiation Exposure.

BACKGROUND: Vertebral compression fractures (VCF) are usually treated by cementoplasty. Computerized navigation allows more accurate surgery without additional imaging acquisition for guidance and related radiation exposure. New technologies trend to optimize the irradiation for patients and surgeons. The objective was to investigate the radiological results and radiation exposure of O-arm navigation compared with the all-in-one 2-dimensional/3-dimensional (2D/3D) Surgivisio device in navigated cementoplasty procedures. METHODS: Patients in the O-arm group comprised an O-arm prospective cohort as well as previous patients. Operations for VCF by navigated cementoplasty took place over 18 months. Patients in the Surgivisio group were the first patients operated on using Surgivisio and were prospectively recruited. Demographic, operative, and irradiation data were collected, as well as the image quality subjectively evaluated by the surgeon. The vertebal filling was evaluated using the Garnier classification and quoted as satisfactory, acceptable, or poor. The effective dose in millisievert (mSv) was calculated for radiation exposure estimation, and the absolute risk of cancer (AR) in percent equivalent to a whole-body irradiation was also calculated. RESULTS: A total of 123 patients were included: 62 in the O-arm group and 61 in the Surgivisio group. A total of 166 vertebrae were analyzed. Compared with the Surgivisio group, the effective dose was significantly higher in the O-arm group, with a mean of 11.47 vs 1.14 mSv, respectively (P < 0.001). The 2D part of the effective dose received by the surgeon was significantly higher in the O-arm group, with an average of 2.25 vs 0.47 mSv, respectively (P < 0.001). Overall AR followed the same trend, with a mean of 4.9 × 10-4% in the O-arm group and 5.7 × 10-5% in the Surgivisio group (P < 0.001). Operative time was significantly higher in the O-arm group (34.52 vs 30.12 minutes respectively, P = 0.03). Image quality was similarly sufficient in 3D, but in 2D, image quality was significantly better in the O-arm group (P = 0.01). Vertebral filling was significantly better in the O-arm group, with 100% of results reported as satisfactory and acceptable versus 85% in the Surgivisio group (P < 0.001). CONCLUSIONS: The O-arm delivered a 10-times higher effective dose during navigated cementoplasty in comparison with the Surgivisio device. The O-arm also had a longer operative time, but it had better image quality and radiological results.

Posterior intraprosthetic dislocation of cervical arthroplasty: illustrative case.

BACKGROUND: Cervical disc herniation is a common condition usually treated with anterior cervical discectomy and fusion (ACDF) or, more recently, with cervical disc arthroplasty (CDA). Both treatments offer similar clinical results. However, CDA has been found to offer fewer medium- to long-term complications as well as potential reduction of long-term adjacent disc degeneration. OBSERVATIONS: A 40-year-old man was treated with cervical discectomy and arthroplasty due to a C6-C7 disc herniation with left C7 radiculopathy. After the treatment, his postoperative follow-up appointments were uneventful for 9 months. However, after 9 months, he reported cervical pain and a right C7 radiculopathy after neck extension. Imaging confirmed a posterior intraprosthetic dislocation, the first case reported to date. The patient was received emergency surgery under neuromonitoring, and the prosthesis was replaced by an ACDF and anterior plate. The insert presented a rupture of the anterior horn. The patient presented no preoperative or postoperative neurological deficit, and his follow-up review revealed no issues. LESSONS: Posterior intraprosthetic dislocation is an extremely rare complication. It may occur with Mobi-C cervical arthroplasty in the case of rupture and oxidation of the polyethylene insert. Spine surgeons should be aware of this potential major complication.

Epidural abscess related to Streptococcus mitis in a 57-year-old immunocompetent patient.

A 57-year-old immunocompetent male patient presented himself to our emergency department with lumbar pain for 10 days, after a lumbar torsion. He was neurologically intact, but showed signs of systemic inflammatory syndrome. A lumbar MRI found a spinal epidural abscess from L3-L4 to L5-S1 levels. The patient was operated early before occurrence of neurological deficit. The abscess cultures found a Streptococcus mitis infection. The patient made a good recovery after surgical decompression, washout with samples taken for cultures and targeted antibiotic therapy for 6 weeks.

Intraoperative disc level marking with needle: a technical note and prospective study on 30 patients.

BACKGROUND: Wrong-level surgery is a rare but unresolved issue in spine surgery. Some proposed protocols with high success rates, but it remains a risk with potential complications for the patient. Surgical navigation offers more accurate surgery, without additional irradiation related to the imaging device, in order to optimize the surgical guidance. METHODS: We describe our institutional technique with a needle placed under fluoroscopy at 3 cm from the incision line at the disc level to be operated, in order to guide the surgical approach; and we report a prospective evaluation of all patients during a six-month period operated by microdiscectomy for symptomatic lumbar discus hernia, whose hernia level was landmarked with this technique. We collected demographic, clinical-such as visual analog scale (VAS) of pain and Oswestry disability index (ODI) scores-operative and irradiation data for effective dose calculation. RESULTS: Thirty patients were included in the study. No wrong-level procedure was performed. Mean time for landmarking was 2.22 [1-5] minutes. Average operative time was 54.5 [30-150] minutes. The effective dose related to the imaging device use was 0.032 (0.007-0.092) mSv. The effective dose was also correlated to body mass index and disc level (P=0.05). The operative duration, complication rate and postoperative VAS and ODI scores were similar to the current literature. CONCLUSIONS: We advocate the use of percutaneous needle guidance, avoiding wrong-level microdiscectomy and helping the surgeon as a "navigation-like" device with minimal additional irradiation for the patient.

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion.

INTRODUCTION: Robotic guidance (RG) and computer-assisted navigation (NV) have seen increased adoption in instrumented spine surgery over the last decade. Although there exists some evidence that these techniques increase radiological pedicle screw accuracy compared with conventional freehand (FH) surgery, this may not directly translate to any tangible clinical benefits, especially considering the relatively high inherent costs. As a non-randomised, expertise-based study, the European Robotic Spinal Instrumentation Study aims to create prospective multicentre evidence on the potential comparative clinical benefits of RG, NV and FH in a real-world setting. METHODS AND ANALYSIS: Patients are allocated in a non-randomised, non-blinded fashion to the RG, NV or FH arms. Adult patients that are to undergo thoracolumbar pedicle screw instrumentation for degenerative pathologies, infections, vertebral tumours or fractures are considered for inclusion. Deformity correction and surgery at more than five levels represent exclusion criteria. Follow-up takes place at 6 weeks, as well as 12 and 24 months. The primary endpoint is defined as the time to revision surgery for a malpositioned or loosened pedicle screw within the first postoperative year. Secondary endpoints include patient-reported back and leg pain, as well as Oswestry Disability Index and EuroQOL 5-dimension questionnaires. Use of analgesic medication and work status are recorded. The primary analysis, conducted on the 12-month data, is carried out according to the intention-to-treat principle. The primary endpoint is analysed using crude and adjusted Cox proportional hazards models. Patient-reported outcomes are analysed using baseline-adjusted linear mixed models. The study is monitored according to a prespecified monitoring plan. ETHICS AND DISSEMINATION: The study protocol is approved by the appropriate national and local authorities. Written informed consent is obtained from all participants. The final results will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER: Clinical Trials.gov registry NCT03398915; Pre-results, recruiting stage.

Spontaneous spinal epidural hematomas in children: can we prevent a negative prognosis?--reflections on 2 cases.

Spontaneous spinal epidural hematomas in children are very rare and, until now, have not been described in infants. Spontaneous spinal epidural hematomas is characterized by a sudden onset of acute back pain followed by acute neurological deterioration within a few hours, but in younger children the initial symptoms are often nonspecific, leading to a delay in diagnosis and treatment. Although some cases have been reported, controversy persists as to its origin, diagnosis, and timing of treatment. We present 2 new cases of this rare condition: a 7-month-old girl who suffered from acute paraplegia and, unfortunately, did not recover after adequate spinal decompression. To our knowledge, this is the first reported case of spontaneous spinal epidural hematomas in an infant. We also report a similar observation in a 13.5-year-old boy who also suffered from acute paraplegia and had only a partial recovery after urgent decompression.

Age-dependent presentation of tectal plate tumors: preliminary observations.

Tectal plate tumors are intrinsic midbrain tumors that behave more like hamartomas than neoplasms. Postulating that the presentation depends on the age of the affected patients, the authors reassessed the presentation of 10 consecutive patients. All patients presented with headache and papilledema. Four children younger than 10 years presented with a short symptom interval, vomiting, and Parinaud's syndrome. The remaining 6 children presented with a long symptom interval, gait abnormalities, cognitive impairment, vision impairment, tremor, macrocephaly, impaired visual acuity, and ataxia and sometimes with pyramidal signs as well. The difference between groups was statistically significant. Tumor size was similar in the groups. It is therefore concluded that the presentation of tectal plate tumors varies with age.