Complications of Percutaneous Vertebroplasty: A Pictorial Review.

Percutaneous vertebroplasty is a minimally invasive treatment technique for vertebral body compression fractures. The complications associated with this technique can be categorized into mild, moderate, and severe. Among these, the most prevalent complication is cement leakage, which may insert into the epidural, intradiscal, foraminal, and paravertebral regions, and even the venous system. The occurrence of a postprocedural infection carries a notable risk which is inherent to any percutaneous procedure. While the majority of these complications manifest without symptoms, they can potentially lead to severe outcomes. This review aims to consolidate the various complications linked to vertebroplasty, drawing from the experiences of a single medical center.

Biomechanical stability analysis of transpedicular screws combined with sublaminar hook-rod system using the finite element method.

AIM: To develop and test a new posterior stabilization system by augmenting the posterior hook-rod system with screws and rods. METHODS: A biomechanical analysis was performed using the finite element method. The anatomical structures were modeled based on computed tomography data. Instrumentation (hooks, rods, and screws) was modeled based on the data obtained by 3D scanning. The discretized model was verified by converging solutions and validated against data from a previously published experiment. A Th12-L1 spinal segment was modeled and modified by removing the body of the L1 vertebra (corpectomy) and the entire L1 vertebra (spondylectomy). The model was additionally modified by incorporating stabilization systems: i) posterior stabilization (transpedicular screws and rods); ii) combined posterior stabilization with sublaminar hooks; and iii) combined anterior (titanium cage) and posterior (sublaminar hooks) stabilization. The rotation angles in each group, and the strains on each part of the three stabilization constructs, were analyzed separately. RESULTS: The combined anterior and posterior stabilization system was the stiffest, except in the case of lateral bending, where combined posterior stabilization was superior. Stress analysis showed that the posterior stabilization system was significantly unloaded when augmented with a hook-rod system. A significant strain concentration was calculated in the cranially placed hooks. CONCLUSION: Stiffness analysis showed comparable stiffness between the tested and proposed stabilization construct. Stress analysis showed luxation tendency of the cranially placed hooks, which would most likely lead to system failure.

Spinal dural arteriovenous fistulas: a report on outcomes in a single-center retrospective cohort treated surgically and/or endovascularly.

AIM: To report on the outcomes of spinal dural arteriovenous fistulas (sDAVFs) treatment in a single-center retrospective cohort. METHODS: Data were retrieved on sDAVF cases treated surgically and endovascularly between January 2009 and January 2020. Sociodemographic, clinical, imaging data, and outcomes were analyzed. RESULTS: Thirty-four patients were identified: 11 female, mean age 64.1 ± 11.5 years; mean time of symptom duration 12 (range 1-149) months. The sDAVF locations were the following: 18 (62.1%) thoracic, 4 (13.8%) lumbar, 4 (13.8%) sacral, and 3 (10%) with multiple location feeders. All patients had a motor deficit and affected walking, and the majority had a sensory deficit, bowel, and bladder dysfunction. Fifteen (44.1%) patients underwent surgical treatment, 7 (20.6%) underwent endovascular treatment, and 12 (35.3%) underwent both (crossover). Radiological myelopathy showed regression in 19 (55.9%) patients. Overall, clinical improvement (decrease in modified Rankin score) following treatment was observed in 14 patients (41.2%), worsening in 1 (2.9%), while other had unchanged status. The proportion of patients with initial treatment failure markedly differed between the before-2014 and after-2014 period. Patients who failed to improve had more extensive myelopathy. CONCLUSION: Patients who underwent surgery or endovascular treatment had on average significant clinical recovery, while those who underwent treatment crossover had negligible improvement. The extent of myelopathy seems to be associated with clinical improvement.

Polymethylmethacrylate cranioplasty using low-cost customised 3D printed moulds for cranial defects - a single Centre experience: technical note.

We report our experience with 3D customised cranioplasties for large cranial defects. They were made by casting bone cement in custom made moulds at the time of surgery. Between October 2015 and January 2018, 29 patients underwent the procedure; 25 underwent elective cranioplasties for large cranial defects and four were bone tumour resection and reconstruction cases. The majority of patients (96.5%) reported a satisfactory aesthetic outcome. No infections related to the surgical procedure were observed in the follow-up period. The method proved to be effective and affordable.

Validation of the Croatian version of the Oswestry Disability Index.

PURPOSE: To translate, cross-culturally adapt, and validate the Croatian version of the Oswestry Disability Index (ODI). METHODS: The original English-language ODI was cross-culturally adapted into Croatian and then evaluated in a group of 114 patients with chronic low back pain (LBP) at the Department of Neurosurgery, Zagreb University School of Medicine. Confirmatory factor analysis (CFA) was conducted with three models: two were theory driven (unidimensional and two dimensional-static and dynamic factors); the other was based on our exploratory factor analysis (EFA). Internal consistency and test-retest reliability were evaluated using Cronbach's α and the intraclass correlation coefficient (ICC), respectively. Construct validity was assessed by evaluating the correlation between the ODI and Visual Analogue Scale (VAS), and between the ODI and 36-item short form survey (SF-36) scores. RESULTS: The EFA-derived two-dimensional structure explained 82.7% of the total variance and was significantly better than the other models (P < 0.001); however, none of the models had acceptable fit. Internal consistency (Cronbach α = 0.84) and test-retest reliability (ICC = 0.94) were satisfactory. The ODI was positively correlated with VAS (rs = 0.54, P < 0.001) and negatively correlated with all of the SF-36 sections (rs = - 0.35 to - 0.64, P < 0.001, all), apart from the role-physical (rs = - 0.02, P = 0.767). CONCLUSIONS: The Croatian version of the ODI has acceptable psychometric properties. It appears to be suitable for assessment of LBP and treatment outcomes in Croatian-speaking patients. Overall, there was no evidence to reject the original unidimensional structure in favor of a two-factor solution. As such, the unidimensional structure should continue to be used in future studies. These slides can be retrieved under Electronic Supplementary Material.

Middle cerebral artery fusiform aneurysm presented with stroke and delayed subarachnoid hemorrhage trapping, thrombectomy, and bypass.

BACKGROUND: Ischemic stroke is a well-described but less frequent consequence of ruptured or unruptured intracranial aneurysms. To date, the optimal form of treatment for patients with a thrombosed cerebral aneurysm has not yet been well-defined. CASE DESCRIPTION: Here, we report a case of a 68-year-old female patient presenting with cerebral stroke. Five days poststroke multislice computed tomography (MSCT) and MSCT angiography were performed for the evaluation of clinical deterioration, showing a left M2 middle cerebral artery (MCA) bifurcation aneurysm and subarachnoid hemorrhage. Having in mind the high mortality and morbidity rates after a re-rupture, as well as the digital subtraction angiography features of the aneurysm, urgent surgery was performed consisting of aneurysm trapping and superficial temporal artery (STA) to M3 MCA segment end-to-side anastomosis. The surgery and early postoperative period proceeded uneventfully and the patient gradually recovered from the previously diagnosed expressive dysphasia and cranial and extremity motor deficit. CONCLUSION: Our case describes a complex aneurysm treatment that consisted of aneurysm trapping, thrombus removal and an STA-M3 MCA branch bypass creation for the protection of the patent M3 insular MCA branch and prevention of further ischemia. This procedure rewarded us with an excellent clinical result.