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How to perform revision lumbar decompression at the index level through a minimally invasive (MIS) approach
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Aaron Hillis, Christoph Wipplinger, Sertac Kirnaz, Franziska A. Schmidt, Roger Härtl
The rationale and final goal for the MIS revision decompression surgery is similar to that of the primary surgery, which is decompression of the neural structures without extensive bone and muscle disruption. The main difference between revision surgery and primary surgery lies in the altered spinal anatomy due to a significant amount of epidural and/or periradicular fibrosis on the side of primary surgery. Regardless of fibrosis or a reherniated disk, this scarring may trigger radicular pain itself.
Neurosurgery: Minimally invasive neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar
This is another minimally invasive decompression surgery that helps to relieve the pressure on the spinal cord or nerve roots. Compared to open cervical foraminotomy, it is associated with lower blood loss, less pain, and shorter duration of hospital stay. These procedures are usually carried out under general endotracheal anesthesia. The intraoperative evoked potential monitoring requires total intravenous-based anesthesia with omission of muscle relaxants. The anterior cervical foraminotomy helps to treat ventral radiculopathy without the need for discectomy, obviating the need for any arthrodesis or neck collar. Injury may occur to nerve root, blood vessels, or to sympathetic chain, resulting in Horner syndrome. Posterior cervical microforaminotomy is used to treat foraminal stenosis due to degenerative changes such as osteophytes or lateral disc herniation (29). It may be carried out in the prone or sitting position. Injury to dura, nerve root, or blood vessels may occur. Vertebral artery injury is a dreaded complication and requires control with gelfoam packing. In an uneventful case, patients are woken and trachea extubated at the end of surgery.
A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis *
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
Jerry C. Ku, Jefferson R. Wilson
Lumbar spinal stenosis is the most common indication for spinal surgery, and studies have shown that surgical treatment in selected patients is more successful than conservative measures. The aim of this study was to investigate whether fusion surgery as an adjunct to decompression surgery resulted in better clinical outcomes than decompression alone in patients with lumbar spinal stenosis, with or without degenerative spondylolisthesis.
Paracondylar process combined with persistent first intersegmental vertebral artery: an anatomic case report and literature review
Published in British Journal of Neurosurgery, 2023
Haigui Yang, Xiaofei Bai, Xiaoli Huan, Tingzhong Wang
Most of PFIAs in the previous reports were asymptomatic. They were usually discovered incidentally in the patients with odontoid fracture10 or atlantoaxial subluxation.9,11–13 However, for those patients, the PFIAs pose a surgical challenge because the aberrant course of PFIA makes it vulnerable during drilling of facet surfaces, placement of spacers, and the insertion of screws. Therefore, careful review of radiologic studies and consideration of the available surgical options is necessitated before such surgeries are performed. The PFIA can be symptomatic rarely. Buch et al.14 reported a PFIA compressed dynamically by the C1 arch, resulting in rotational vertebrobasilar insufficiency. The patient had a complete resolution of symptoms after decompression surgery.
Management of lumbar spinal stenosis: a systematic review and meta-analysis of rehabilitation, surgical, injection, and medication interventions
Published in Physiotherapy Theory and Practice, 2023
Kaitlin Kirker, Michael F. Masaracchio, Parisa Loghmani, Rosa Elena Torres-Panchame, Michael Mattia, Rebecca States
Symptoms of LSS have a substantial impact on mobility, autonomy, and quality of life (Conway, Tomkins, and Haig, 2011; Tomkins-Lane, Conway, Hepler, and Haig, 2012; Tomkins-Lane, Holz, Yamakawa, Phalke, Quint, Miner, Haig, 2012; Whitehurst, Brown, Eidelson, and D’Angelo, 2001). While debate exists about the most effective management strategies for patients with LSS, most undergo a trial of nonsurgical management (Tomkins et al., 2010; Whitman et al., 2006). Evidence suggests that surgical intervention is more effective after a failed 6-month trial of rehabilitation (Comer, Redmond, Bird, and Conaghan, 2009; Kovacs, Urrutia, and Alarcon, 2011). Therefore, although decompression surgery has been considered the “gold standard,” it is reasonable to consider nonsurgical management as a first line of treatment (Fritz et al., 1997; Simotas, 2001; Surgeon, 2000), despite insufficient evidence to recommend any specific interventions (Ammendolia et al., 2013; Tomkins et al., 2010).
Graded transantral orbital decompression outcomes in stable thyroid eye disease: a series of 47 orbits
Published in Orbit, 2021
Jonathan E. Lu, Margaret L. Pfeiffer, Michael A. Burnstine
There was a 14.9% rate of orbits requiring additional decompression in our study. For orbital decompression performed with anterior approaches (lateral upper eyelid crease, inferior transconjunctival, and transcaruncular), a rate of re-operation at 10 years was observed to be 9% of orbits and 11% of patients.23 Their study differs in several ways, including a preference for fat or lateral wall removal primarily, and their patient population included all orbital decompression for TED. The re-operation rates in our paper with a modified transantral approach are comparable to anterior approaches. Our transantral approach was geared toward total patient satisfaction. Re-operation was performed to achieve ideal aesthetic outcomes for the patient even when the surgeon felt the outcome was acceptable. Unfortunately, there is sparse literature addressing rates of additional decompression surgery. Other papers on this subject do not state an overall reoperation rate24 or instead focus on the re-operative cases and secondary surgery years later due to reactive TED.25 Methods to reduce re-operative rates require further research. Since this modified technique is for rehabilitation and cosmesis, there is a significant component of patient-driven re-operations. Pre-operative counseling and understanding of patient expectations may guide the surgeon during the graded steps of the decompression surgery. In sum, our paper sheds additional light on this under-explored topic of repeat orbital decompression. Future research on orbital decompression surgery may benefit from tracking rates of re-operation.