Is S1 Alar Iliac Screw a Feasible Option for Lumbosacral Fixation?: A Technical Note

Nonunion at the lumbosacral junction is a classic complication of long construct and deformity corrections. Iliac fixations have been extensively studied in the literature and have demonstrated superior biomechanical proprieties and lower complication rates. S2 alar iliac screws address the drawbacks of classical iliac screws but demonstrate similar biomechanical advantage. The main aim of this paper was to describe the S1 alar iliac (S1AI) screw fixation technique while evaluating our early results. S1AI screw fixation technique has the advantage of being able to achieve pelvic fixation without dissection to the S2 pedicle entry and is therefore a viable option for salvage of a failed S1 promontory screw

Single Posterior Approach for Resection and Stabilization for Locally Advanced Pancoast Tumors Involving the Spine: Single Centre Experience

Study DesignMonocentric prospective study.PurposeTo assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors.Overview of LiteratureIn patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for “en-bloc” resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach.MethodsWe included all patients who underwent posterior en-bloc resection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation.ResultsFive patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46–61 years). The tumor involved 2 adjacent levels in 1 patient, 3 levels in 1 patient, and 4 levels in 3 patients. There were no intraoperative complications. The mean operative time was 9 hours (range, 8–12 hours), and the mean estimated blood loss was 3.2 L (range, 1.5–7 L). No patient had a worsened neurological condition at discharge. Four complications occurred in 4 patients. Three complications required reoperation and none was lethal. The mean follow-up was 15.5 months (range, 9–24 months). Four patients harbored microscopically negative margins (R0 resection) and remained disease free. One patient harbored a microscopically positive margin (R1 resection) and exhibited local recurrence at 8 months following radiation treatment.ConclusionsThe posterior approach was a valuable option that avoided the need for a second-stage operation. Induction chemoradiation is highly suitable for limiting the risk of local recurrence

Anterolateral Cervical Kyphoplasty for Metastatic Cervical Spine Lesions

Study Design Retrospective case series. Purpose To evaluate the clinical and radiological efficacy of anterolateral kyphoplasty for cervical spinal metastasis. Overview of Literature Although the spine is the third most common site of tumor metastasis, the cervical spine is the least commonly affected (incidence, 10%–15%). Surgical decompression is highly challenging because of the proximity of neural and vascular elements. Kyphoplasty for cervical spine metastasis has been described in small case reports with promising results. Methods Retrospective analysis of a prospective collected single-center spine metastasis database was done for cervical kyphoplasty cases. Data pertaining to age, sex, primary tumor diagnosis, modified Tokuhashi score, Spinal Instability Neoplastic Score (SINS), preoperative Visual Analog Scale (VAS) score, and analgesic medication were extracted. Postoperative data included VAS score at postoperative day 1, duration of hospitalization, self-reported functional outcome, and VAS score at the last follow-up. Results Eleven patients (mean age, 62.5 years) with cervical spine metastases were treated with 15-level kyphoplasty. Mean Tokuhashi score was 8.1, and mean SINS was 7.85. Mean preoperative pain score was 7.1, and 82% of patients used opioid analgesics. Mean total bleeding volume was 100 mL. Mean complication-free length of stay was 2.6 days with a decrease in postoperative pain (VAS score=2.8, p <0.05). There was a 56% decrease in opioid dosage and the number of consumed analgesics (1.09, p =0.004). Eighty-two percent of the patients reported excellent improvement at the last follow-up self-assessment. Conclusions To our knowledge, this case series represents the largest series of vertebral augmentation using balloon kyphoplasty for cervical spinal metastasis. This technique is associated with low postoperative complications as well as significant decrease in pain, use of opioids, and length of hospital stay. The main indications for vertebral kyphoplasty are lytic lesions of the cervical spine, painful lesions refractory to medical treatment, SINS score of 6–10, and absence of posterior wall defect

sj-tiff-1-sco-10.1177_2050313X221129770 – Supplemental material for Unusual presentation of a common neurosurgical shunt procedure in an adult patient

Supplemental material, sj-tiff-1-sco-10.1177_2050313X221129770 for Unusual presentation of a common neurosurgical shunt procedure in an adult patient by Davaine Joel Ndongo Sonfack, Bilal Tarabay, Daniel Shedid and Sung-Joo Yuh in SAGE Open Medical Case Reports</p

Minimally invasive costotransversectomy for the resection of large thoracic dumbbell tumors

International audienceBackground: Due to their important size and complex localization, the management of thoracic dumbbell tumors is challenging, frequently requiring the need for an anterior approach. Our study aims to first report the feasibility and safety of a single-stage posterior minimally invasive procedure in achieving complete resection of voluminous thoracic dumbbell tumors.Methods: We retrospectively reviewed the medical records of five consecutive patients, who underwent the minimally invasive resection of a type III thoracic dumbbell tumor in our institution between March 2007 and March 2012. There were two men and three women, with a mean age at diagnosis of 57 years (range 41-68 years). After the placement of a non-expandable tubular retractor under fluoroscopic control, a costotransversectomy was achieved. By moving the retractor in all directions, the tumor was largely exposed and resected with the cavitron ultrasonic surgical aspirator. Clinical and radiological monitoring was performed before discharge, at 6 months, 1 year and 2 years.Results: No major intraoperative complication was reported. Gross total resection was achieved in four patients. The mean operative time was 219 mins (range 75-540 mins) and the mean estimated blood loss was 230 ml (range 50-500 ml). No postoperative complication was reported. The mean length of hospital stay was 3.6 days (range 2-6 days) and all patients were discharged home. Histological analysis confirmed the diagnosis of grade 1 schwannoma in four patients and revealed a hemangiopericytoma in one patient. No tumor recurrence was noted with a mean follow up period of 46 months (range 32-54 months).Conclusion: Thoracic dumbbell tumors can be safely and completely resected using a single-stage minimally invasive procedure. The costotransversectomy can be performed through a non-expandable retractor allowing sufficient access to all parts of the tumor

sj-tiff-2-sco-10.1177_2050313X221129770 – Supplemental material for Unusual presentation of a common neurosurgical shunt procedure in an adult patient

Supplemental material, sj-tiff-2-sco-10.1177_2050313X221129770 for Unusual presentation of a common neurosurgical shunt procedure in an adult patient by Davaine Joel Ndongo Sonfack, Bilal Tarabay, Daniel Shedid and Sung-Joo Yuh in SAGE Open Medical Case Reports</p

Safety of performing craniotomy in the elderly: The utility of co-morbidity indices

Objectives: With the current trend of aging of the population, neurosurgeons will be more and more confronted to surgical decision-making involving the elderly. Faced with this increasing demand and frailty of aged patients, a better understanding on the post-operative outcome of this growing population is warranted. The objective of the present study is to assess the post-operative outcome in regard of complications of elderly patients undergoing a craniotomy. Patients and methods: The files of consecutive patients aged 80 years old and more who underwent a craniotomy at a single institution were retrospectively reviewed. Data on demographics, surgical indication, length of surgery, operative blood loss, urgency of surgery, comorbidities using the Elixhauser comorbidity index and post-operative complications were gathered. We performed a multivariate analysis in search of risk factors for post-operative complications. Results: A total of 53 patients were included in the study. The mean age of all patients was 84 years old with the main indication for surgery being subdural hematoma. The overall complication rate was 62%, with 34% of patients suffering from a major complication and 47% from a minor complication. The mean Elixhauser comorbidity index, operative time and operative blood loss were similar to those reported in adult craniotomy series. None of the studied variables were statistically associated with the occurrence of complications in the multivariate analysis. Conclusion: Patients 80 years-old and more were found to harbour a high complication rate following craniotomy when compared to literature. Our study suggests increasing age itself remains an important risk factor for postoperative complications. Keywords: Comorbidity, Complication, Craniotomy, Elderly, Outcom