Bilateral Acute Osteoporotic Lumbar Pedicle Fracture Presenting with Associated Neurological Deficit: A Case Report and Review of Literature.

Osteoporosis is a common cause of vertebral compression fractures. Often times affecting post-menopausal women, these fractures may occur spontaneously or following minor trauma and are typically managed non-surgically. Here we present a case of a 67-year-old patient who presented with acute compression fracture of the lumbar 5 vertebra and bilateral pedicle fractures of the fourth and fifth lumbar vertebrae following an episode of coughing secondary to tracheitis. She underwent a lumbar 3 to sacral 1/ilium instrumentation/arthrodesis, with screw augmentation via hydroxyapatite, followed by lumbar 4/5 laminectomy and foraminotomy.

T10-L3 Cystic Lesion of the Ventriculus Terminalis Presenting as Conus Medullaris Syndrome.

BACKGROUND: Intramedullary spinal cord cysts are benign, rare, fluid-filled lesions that can present anywhere along the craniospinal axis. However, when present at the level of the ventriculus terminalis, conus medullaris syndrome may occur. Radical resection of the cyst wall and evacuation of the cyst content are the 2 surgical procedures of choice. CASE DESCRIPTION: We present the case of a 54-year-old woman with a long-lasting history of left lower-extremity weakness and recent onset of bladder dysfunction. On further assessment, magnetic resonance imaging of the thoracic and lumbar spine showed a T10-L3 intramedullary cystic lesion. Surgical fenestration of the cyst was rendered, but no biopsy was taken due to the highly functional tissue along the full extension of lesion. CONCLUSIONS: Cystic lesions of the ventriculus terminalis are rare entities with a common presentation of severe, progressive neurologic impairment. Our case matches the classic presentation of conus medullaris syndrome. We describe and demonstrate through an operative video novel surgical techniques used to achieve successful fenestration of the cyst wall with remarkable neurologic symptom improvement. Moreover, the present case does not correlate with the classic radiographic characteristics available in current literature, such as involvement of 5 spinal segments.

Guillain-Barre Syndrome After Minimally Invasive Transforaminal Interbody Fusion: A Case Report.

Guillain-Barre syndrome (GBS) is an autoimmune disorder in which an individual's immune system attacks the peripheral nerve myelin. Although rare, but serious, the syndrome typically starts with numbness, tingling, or weakness in the lower extremities and progresses in an ascending fashion. Severe weakness can transmit into paralysis and respiratory compromise. Although rare, GBS has been reported as a complication of multiple surgeries including orthopedic, cardiovascular, transplant, and general surgeries. To our knowledge, we here present the first case report of GBS after minimally invasive transforaminal interbody fusion. Furthermore, we highlight the importance of understanding the presenting symptoms and identifying proper examination findings, particularly in the setting of confounding factors, for prompt diagnosis, treatment, and reduction of morbidity.

The Reliability of YouTube Videos Describing Stereotactic Radiosurgery: A Call for Action.

BACKGROUND: Gamma Knife radiosurgery was introduced in the 1960s and is currently used worldwide. The internet has become a foremost source of information used by patients and their families. In this study, we aim to evaluate the accuracy and reliability of the Gamma Knife radiosurgery-related YouTube videos. METHODS: We searched YouTube and the first 3 pages sorted according to "Relevance-Based Ranking" were included for analysis. Four independent health care workers from different disciplines evaluated the videos using the validated DISCERN tool. RESULTS: Our search resulted in 65,774 videos, and 14 videos met inclusion criteria. Our study found that 50% (7 of 14) of the videos were uploaded by university-affiliated hospitals; 14% of videos scored 3. The search term "Radiosurgery for intraaxial brain lesions" had the highest percentage of moderate videos (DISCERN = 3) (50%). CONCLUSIONS: Patients and caregivers turn to online sources to gather information about the disease. However, the available YouTube published videos are published without proper academic monitoring, as in such a free platform, published videos tend to catch a general audience for different purposes, which leads to diminishing quality control. Academic medical institutions should consider a proper monitoring process for videos to improve the accuracy of the published information for the patients.

Neurochemical characterization of tyrosine hydroxylase-immunoreactive interneurons in the developing rat cerebral cortex.

Understanding the development of cortical interneuron phenotypic diversity is critical because interneuron dysfunction has been implicated in several neurodevelopmental disorders. Here, tyrosine hydroxylase (TH)-immunoreactive neurons in the developing and adult rat cortex were characterized in light of findings regarding interneuron neurochemistry and development. Cortical TH-immunoreactive neurons were first observed 2 weeks postnatally and peaked in number 3 weeks after birth. At subsequent ages, the number of these cell profiles was gradually reduced, and they were seen less frequently in adults. No DNA fragmentation or active caspase 3 was observed in cortical TH cells at any age examined, eliminating cell death as an explanation for the decrease in cell number. Although cortical TH cells reportedly fail to produce subsequent catecholaminergic enzymes, we found that the majority of these cells at all ages contained phosphorylated TH, suggesting that the enzyme may be active and producing L-DOPA as an end-product. Morphological criteria and colocalization of some TH cells with glutamic acid decarboxylase suggest that these cells are interneurons. Previously, parvalbumin, somatostatin, and calretinin were demonstrated in non-overlapping subsets of interneurons. Cortical TH neurons colocalized with calretinin but not with parvalbumin or somatostatin. These findings suggest that the transitory increase in TH cell number is not due to cell death but possibly due to alterations in the amount of detectable TH present in these cells, and that at least some cortical TH-producing interneurons belong to the calretinin-containing subset of interneurons that originate developmentally in the caudal ganglionic eminence.

The Role of Minimally Invasive Techniques in Scoliosis Correction Surgery.

OBJECTIVE: Recently, minimally invasive surgery (MIS) has been included among the treatment modalities for scoliosis. However, literature comparing MIS to open surgery for scoliosis correction is limited. The objective of this study was to compare outcomes for scoliosis correction patients undergoing MIS versus open approach. METHODS: We retrospectively collected data on demographics, procedure characteristics, and outcomes for 207 consecutive scoliosis correction surgeries at our institution between 2009 and 2015. RESULTS: MIS patients had lower number of levels fused (p < 0.0001), shorter surgeries (p = 0.0023), and shorter overall lengths of stay (p < 0.0001), were less likely to be admitted to the ICU (p < 0.0001), and had shorter ICU stays (p = 0.0015). On multivariable regression, number of levels fused predicted selection for MIS procedure (p = 0.004), and multiple other variables showed trends toward significance. Age predicted ICU admission and VTE. BMI predicted any VTE, and DVT specifically. Comorbid disease burden predicted readmission, need for transfusion, and ICU admission. Number of levels fused predicted prolonged surgery, need for transfusion, and ICU admission. CONCLUSIONS: Patients undergoing MIS correction had shorter surgeries, shorter lengths of stay, and shorter and fewer ICU stays, but there was a significant selection effect. Accounting for other variables, MIS did not independently predict any of the outcomes.