Percutaneous pedicle screw implantation for refractory low back pain: from manual 2D to fully robotic intraoperative 2D/3D fluoroscopy.

Many surgical treatments for chronic low back pain that is refractory to medical treatments focus on spine stabilization. One of the main surgical procedures consists of placing an interbody cage with bone grafts associated with pedicle screws [2, 25, 30]. This technique can be performed using different approaches: a large open posterior approach, tubular approaches (minimal open) or percutaneously (minimally invasive percutaneous or MIP) [5, 28]. One of the main difficulties is to precisely locate the screws into the pedicle avoiding especially infero-medial pedicle breaches. This difficulty is even great- er when working percutaneously. This paper focuses on percutaneously placed pedicle screws (PPS), reports the use of a robotic multi-axis 2D/3D fluoros- copy to enhance the accuracy of pedicle screw placement and reviews other strategies and results reported in the literature.

[Neurosyphilis revealed by a multiple cranial neuropathy: magnetic resonance imaging findings]. / Neurosyphilis révélée par une atteinte multiple des nerfs crâniens: apport de l'imagerie par résonance magnétique nucléaire.

INTRODUCTION: We report the magnetic resonance imaging (MRI) findings in a case of neurosyphilis revealed by the involvement of two cranial nerves. CASE REPORT: A 41-year-old man developed a right cochleovestibular and left trigeminal neuropathy, associated with high serum titers of VDRL and TPHA, high titers of TPHA in the cerebrospinal fluid (CSF) and several CSF oligoclonal IgG bands. On MRI, hypertrophy and gadolinium contrast enhancement of these cranial nerves were associated with several supratentorial cortical nodules surrounded by marked cerebral edema, corresponding to syphilitic gummas. One of these cortical nodules was biopsied. Microscopic examination showed lesions of meningoencephalitis with necrosis and granulomatous vasculitis. After penicillin therapy, the serum VDRL titers and the MRI abnormalities disappeared, a partial clinical recovery was observed and a significant reduction of the serum TPHA titers was found. DISCUSSION: Such MRI abnormalities are not specific and can be observed in various tumoral, auto-immune and infectious diseases. They can also mimic neurofibromatosis type II. Cranial nerve involvements in neurosyphilis can result from nerve inflammation in basal meningitis, nerve ischemia in meningovasculitis or from compression by an adjacent gumma. In our case, the cranial neuropathy was related to a mixed meningovascular and parenchymatous form of neurosyphilis.