Simple Microsurgical Extirpation as a Method of Choice in Treating Symptomatic Spinal Facet Joint Cysts: A Retrospective Case Series.

BACKGROUND: Facet joint cysts (FJCs) are a cause of radiculopathy, back pain, cauda equina syndrome, and/or claudication. They mostly affect the lumbar spine in the elderly, prevailing in women, and are connected to spinal degeneration and instability. We aimed to evaluate the safety and efficacy of open surgical decompression and cyst excision without a subsequent fusion. METHODS: We evaluated neurologic symptoms and potential signs of spinal instability on preoperative versus postoperative radiological examination. We performed a histological assessment of the extirpated cysts. Statistical analysis was then performed. RESULTS: Of a total of 66 patients, 44 were included in the present study. The average age was 61.2 years. Female patients prevailed (61.4%). The mean follow-up was 5.3 years. The segment most frequently affected by a FJC was L4-L5 (65.9%). Cyst resection led to significant relief from neurologic symptoms for most patients. Thus, 95.5% of our patients reported their postoperative outcome as excellent. Preoperatively, 43.2% and 47.4% of patients had had radiographic signs of instability on magnetic resonance imaging and signs of spondylolisthesis on dynamic radiographs in the operated segment, respectively, with 54.5% manifesting signs of spondylolisthesis in the same segment on a postoperative dynamic radiograph. Despite spondylolisthesis progression, no patient required reoperation. Histologically, pseudocysts without synovium were more frequent than were synovial cysts. CONCLUSIONS: Simple FJC extirpation is a safe and effective method for resolving radicular symptoms, with excellent long-term outcomes. It does not lead to the development of clinically significant spondylolisthesis in the operated segment; thus, no supplementary fusion with instrumented stabilization is required.

Long-Term Outcome After Midline Lumbar Fusion for the Treatment of Lumbar Spine Instability Due to Degenerative Disease.

BACKGROUND: Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF. METHODS: This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant. RESULTS: The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P < 0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P < 0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded. CONCLUSIONS: MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.

Trends and outcomes for non-elective neurosurgical procedures in Central Europe during the COVID-19 pandemic.

The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th-April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017-2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.

Successful surgical excision of cerebral abscess caused by Fonsecaea monophora in an immunocompetent patient and review of literature.

Cerebral abscesses caused by dark-pigmented Fonsecaea fungi are rare, especially in otherwise healthy individuals. In this case report, we present a 61-year-old man from Moldova, living in the Czech Republic, who had worked as a locksmith on oil platforms in Turkmenistan, Kazakhstan, Sudan, and Iraq since 1999, and was admitted to a neurology ward for a sudden motion disorder of the right leg, dysarthria, and hypomimia. Imaging revealed presence of expansive focus around the left lateral ventricle of the brain and a pronounced peripheral edema. The intracranial infectious focus was excised under intraoperative SonoWand guidance. Tissue samples were histologically positive for dark-pigmented hyphae, suggesting dematiaceous fungi. Therefore, liposomal amphotericin B therapy was initiated immediately. Fonsecaea monophora was provisionally identified using ITS rDNA region sequencing directly from brain tissue. The identification was subsequently confirmed by cultivation and DNA sequencing from culture. The strain exhibited in vitro sensitive to voriconazole (MIC = 0.016 µg/mL) and resistance to amphotericin B (MIC = 4 µg/mL); therefore, the amphotericin B was replaced with voriconazole. Postoperatively, a significant clinical improvement was observed and no additional surgery was required. Based on the literature review, this is the third documented case of cerebral infection due to this pathogen in patients without underlying conditions and the first such case in Europe.

Comparison of biochemical response between the minimally invasive and standard open posterior lumbar interbody fusion.

BACKGROUND: The mini-invasive open posterior lumbar fusion procedure (mini PLIF) procedure is an alternative to standard open procedure (open PLIF) and is intended to reduce surgery-related trauma. The measuring of suitable biochemical factors enables objective comparison of the invasiveness of spinal surgery procedures. METHODS: Prospectively collected data on myoglobin, creatine kinase, interleukin-6, C-reactive protein levels and intensity of low back pain and radicular pain in one-level mini PLIF and open PLIF procedures were analysed. The mini PLIF and the open PLIF groups included 27 and 23 patients, respectively. The collection of blood samples and clinical data were performed preoperatively and on postoperative days 1, 3 and 7. The non-paired t-test was used for statistical evaluation. RESULTS: We did not found any statistically significant differences of myoglobin and creatine kinase levels between the groups. In the open PLIF group the IL-6 levels were significantly higher than in the mini PLIF group on postoperative day 3. CRP levels showed significant lower stress response in favour of the mini PLIF group on postoperative days 3 and 7. Levels of post-op low back pain on day 3 were significantly lower in mini PLIF group. Also intensity of radicular pain on day 1 and 3 were lower also mini PLIF group. CONCLUSION: The extent of myonecrosis was comparable in both techniques. The analysis of the IL-6 and CRP levels showed significantly lower systemic inflammatory response in mini PLIF technique. The mini PLIF technique provides transiently lower postoperative pain levels.

Comparison of Biochemical Markers of Muscle Damage and Inflammatory Response Between the Open Discectomy, Microsurgical Discectomy, and Microsurgical Discectomy Using Tubular Retractor.

BACKGROUND: One of the methods to compare the invasiveness of different surgical techniques objectively is to measure the levels of biochemical markers of systemic inflammatory response and muscle damage. METHODS: A total of 120 patients undergoing surgery for symptomatic disc herniation at L4-L5 and L5-S1 were enrolled in the study. Patients were operated on using open discectomy (OD), microsurgical discectomy (MD), or microsurgical discectomy with tubular retractor (MD-TUB). Myoglobin (MYO) and creatine kinase (CK) levels were used as indicators of muscle damage, and interleukin-6 (IL-6) and C-reactive protein (CRP) levels were used as indicators of systemic inflammatory response. Sampling and analysis of samples were performed preoperatively and on postoperative days 1, 3, and 7. Levels of postoperative low back pain and radicular pain were recorded on a 10-grade visual analog scale. Statistical evaluation was performed using the analysis of variance test. RESULTS: MYO concentrations in the MD-TUB group on postoperative day 1 were significantly lower than in the MD and OD groups. CK values on postoperative day 1 were significantly lower in microsurgical techniques (MD and MD-TUB) than in the OD group. The lowest IL-6 levels were found in the MD-TUB group, followed by the MD and OD groups. Differences in the IL-6 levels were significant between the groups on postoperative day 1. On all postoperative days that were monitored, values of CRP in the MD-TUB group were significantly lower compared with the MD and OD groups. Lower values in the MD group versus OD group were not statistically significant. CONCLUSION: All studied techniques showed similar efficacy in reducing radicular pain. The microsurgical diskectomy using a retractor in comparison with MD and OD is friendlier toward the paraspinal muscles, but the difference is significant only for the MYO levels. The total stress inflammatory response exhibited by patients undergoing the MD-TUB technique is significantly lower compared with the MD and OD techniques.

Application of transcranial color-coded sonography in severe brain injury.

Transcranial color-coded sonography (TCCS) monitoring of severe brain injury patients may reveal various pathological hemodynamic changes. According to changes in flow velocities in basal brain arteries, the presence of brain hyperemia, vasospasms, and oligemia can be detected. The study included a group of 20 patients with severe brain injury. TCCS measured flow velocities and ICP values were monitored on a daily basis in the course of a week after injury. In nearly 50 % of patients significant hemodynamic changes occurred. The most frequent pathological finding was hyperemia (31.8 %), followed by vasospasm (10.9 %) and oligemia (9.1 %). In 42.7 % of patients increased flow velocities were registered and only 9.1 % of records were within the normal range of values. The most substantial elevation in time-averaged mean velocity occurred from the second to the sixth day after injury. In a subgroup of patients with raised intracranial pressure 41.6 % of flow velocity (FV) measuring met the TCCS criteria for hyperemia compared with 26 % in a subgroup of patients without intracranial pressure (ICP) elevation. The study showed that hemodynamic changes after severe brain injury are relatively common findings and that TCCS is a useful bed-side tool for the monitoring of intracranial hemodynamic changes.

Medical consultations and the sharing of medical images involving spinal injury over mobile phone networks.

BACKGROUND: The transmission of medical images and other data over mobile phone networks may facilitate remote medical consultations between neurosurgeons and regional hospitals treating spinal injury patients. The aim of this study was to compare the efficacy of mobile phone consultations with standard hospital workstation consultations in spinal injury patients. METHODS: The images were exported over the Internet from surrounding local hospitals through the Picture Archiving and Communication System, in DICOM III format, to the central hospital server. The xVision browser was used to view the acquired images on a standard workstation. The data were also exported to the secured hospital Web server IIS60 and converted to JPEG format to enable remote physician access and consultation. The remote consulting physician connected to this server by mobile phone using the phone's Internet browser. A second physician, blind to the mobile phone results, evaluated the same images at a workstation in the hospital. The results of the mobile phone consultations were compared with the results from standard workstation consultations. RESULTS: There was no difference in the quality of spinal computed tomographic/magnetic resonance images viewed on the phone screen compared with on the workstation. More importantly, the final diagnoses made by mobile phone did not differ from those made by workstation consultations. A transfer to the department of neurosurgery was required after consultation in 11 patients. CONCLUSION: Mobile phone consultations for patients with spinal injuries was as effective as workstation consultations. Mobile phone consultations can increase the expertise available to regional hospitals, which are often the first responders to medical emergencies.

18 months of experiences with the biotitanium replacement (Implaspin) used in treatment of degenerative lumbar spine diseases.

Between 2007-2008 forty two patients neurosurgery department of the KNTB (Regional Hospital of T. Bat'a) Zlin underwent surgery using the bioactive replacement Implaspin. The group of 21 patient of the total of number of 42 patients was operated first time for diagnosis degenerative instability or spondylolisthesis gr I-II. In this group was the follow-up period of 18 months, the mean baseline Oswestry score was 57%. A value of 37% was achieved after 18 months during the evaluation of the clinical status using the Oswestry questionnaire. This result represented a improvement of the condition. No change of the position of the instruments occurred during the X-ray and CT, MRI controls. Therefore, the Implaspin replacement appeared to be a perfect alternative to other lumbar spine replacements combining the osteoconductive properties of the bioactive material with the rigidity of titanium.

Bioactive titan cage Implaspin in treatment of degenerative disease of the cervcal spine--the results from 2007 till 2008.

The authors present results of surgical treatment of cervical spine degenerative disease via Implaspin biotitanium replacement. Surgery was indicated for a group of 24 patients with symptoms of cervical spondylogenic myelopathy or the irritation decay root syndrome non-reacting to conservative treatment. Pre-surgery X-ray and MRI examinations showed spinal canal stenosis caused by the intervertebral disk osteochondrosis combined with prolapse or dorsal osteophytes. Clinical problems of the group of patients were evaluated through the JOA classification before surgery and during the 2nd, the 6th and month 12th after surgery. The surgery rate of success was evaluated in percentages during post-surgery examinations that took place in the 12th month. Based on the JOA classification, that rate of success falls into the good surgery results zone. The post-surgery X-ray examinations showed two sank replacements by 1/3 of its height into the surrounding vertebral bodies. In these cases we performed the control MRI. No signs of the new spinal compression were found and the spinal canal was free in the operated site. Based on our short-term experiences, the Implaspin bioactive replacement seems to be a suitable alternative to the other types of replacements designed for intervertebral fusion in the lower cervical spine area.

Injuries of the central nervous system - mobile phone consultations.

Transmission of visual documentation between a neurosurgery center and a regional hospital, with a mobile phone, significantly improves consultation on a craniocerebral injury. This is one of the methods of fast consultation on image documentation (CT). We reported on one year of experience (September 2007 to September 2008) of our department with this method of image transmission in 16 patients with craniocerebral injury. The images were exported, via the Internet, from local hospitals through the PACS system [Picture Archiving and Communication System], in DICOM III format, to the server of the Regional Hospital of T. Ba̕a, (KNTB). Browsing of the acquired image documentation at particular stations was possible with the xVision browser. The data were exported to a secure hospital Web server, IIS60, to enable consultation on the images, which were changed to JPEG format. The consulting physician was connected to this server with his/her mobile phone by means of the Internet browser. After establishing the connection, it downloads and gradually displays the images on the screen of the mobile phone. The whole process takes approximately 10 minutes. After comparing the images on the screen of the mobile phone and on the workstation using the xVision browser, we verified that there was no difference in the quality of imaging of the pathological lesions recorded with CT.