Tissue Sparing Posterior Cervical Indirect Decompression and Fusion in Foraminal Stenosis

2016 ◽  
pp. 135-149
Author(s):  
Kris B. Siemionow ◽  
Bruce M. McCormack ◽  
Pier Paolo Maria Menchetti
Keyword(s):  
Foraminal Stenosis ◽  
Indirect Decompression ◽  
Tissue Sparing

scholarly journals Rate of failure of indirect decompression in lateral single-position surgery: clinical results

2020 ◽  
Vol 49 (3) ◽  
pp. E5
Author(s):  
J. Alex Thomas ◽  
Christopher I. M. Thomason ◽  
Brett A. Braly ◽  
Cristiano M. Menezes
Keyword(s):  
Interbody Fusion ◽  
Lateral Decubitus Position ◽  
Foraminal Stenosis ◽  
Lumbar Interbody Fusion ◽  
Number Of Patients ◽  
Indirect Decompression ◽  
Surgical Data ◽  
Lateral Decubitus ◽  
The Mean ◽  
Rate Of Failure

OBJECTIVELateral single-position surgery (LSPS) of the lumbar spine generally involves anterior lumbar interbody fusion (ALIF) performed in the lateral position (LALIF) at L5–S1 with or without lateral lumbar interbody fusion (LLIF) at L4–5 and above, followed by bilateral pedicle screw fixation (PSF) without repositioning the patient. One obstacle to more widespread adoption of LSPS is the perceived need for direct decompression of the neural elements, which typically requires flipping the patient to the prone position. The purpose of this study was to examine the rate of failure of indirect decompression in a cohort of patients undergoing LSPS from L4 to S1.METHODSA multicenter, post hoc analysis was undertaken from prospectively collected data of patients at 3 institutions who underwent LALIF at L5–S1 with or without LLIF at L4–5 with bilateral PSF in the lateral decubitus position between March 2018 and March 2020. Inclusion criteria were symptoms of radiculopathy or neurogenic claudication, central or foraminal stenosis (regardless of degree or etiology), and indication for interbody fusion at L5–S1 or L4–S1. Patients with back pain only; those who were younger than 18 years; those with tumor, trauma, or suspicion of infection; those needing revision surgery; and patients who required greater than 2 levels of fusion were excluded. Baseline patient demographic information and surgical data were collected and analyzed. The number of patients in whom indirect decompression failed was recorded and each individual case of failure was analyzed.RESULTSA total of 178 consecutive patients underwent LSPS during the time period (105 patients underwent LALIF at L5–S1 and 73 patients underwent LALIF at L5–S1 with LLIF at L4–5). The mean follow-up duration was 10.9 ± 6.5 months. Bilateral PSF was placed with the patient in the lateral decubitus position in 149 patients, and there were 29 stand-alone cases. The mean case time was 101.9 ± 41.5 minutes: 79.3 minutes for single-level cases and 134.5 minutes for 2-level cases. Three patients (1.7%) required reoperation for failure of indirect decompression.CONCLUSIONSThe rate of failure of indirect decompression in LSPS from L4 to S1 is exceedingly low. This low risk of failure should be weighed against the risks associated with direct decompression as well as the risks of the extra operative time needed to perform this decompression.

Total uncinectomy of the cervical spine with an osteotome: technical note and intraoperative video

2019 ◽  
Vol 31 (6) ◽  
pp. 831-834 ◽  
Author(s):  
Anand H. Segar ◽  
Alexander Riccio ◽  
Michael Smith ◽  
Themistocles S. Protopsaltis
Keyword(s):  
Vertebral Artery ◽  
High Speed ◽  
Thermal Injury ◽  
Technical Note ◽  
Uncinate Process ◽  
Foraminal Stenosis ◽  
Cervical Kyphosis ◽  
Kyphosis Correction ◽  
Direct Injury ◽  
High Speed Burr

Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.

Patient-reported Quality of Life Following Posterior Lumbar Interbody Fusion or Indirect Decompression Using Lateral Lumbar Interbody Fusion

Spine ◽  
2020 ◽  
Vol 45 (18) ◽  
pp. E1172-E1178
Author(s):  
Hiroaki Nakashima ◽  
Tokumi Kanemura ◽  
Kotaro Satake ◽  
Kenyu Ito ◽  
Satoshi Tanaka ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
Patient Reported ◽  
Indirect Decompression

scholarly journals Translational Research in FLASH Radiotherapy—From Radiobiological Mechanisms to In Vivo Results

Biomedicines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 181
Author(s):  
Loredana G. Marcu ◽  
Eva Bezak ◽  
Dylan D. Peukert ◽  
Puthenparampil Wilson
Keyword(s):  
Dose Rate ◽  
High Dose Rate ◽  
Current Status ◽  
Therapeutic Window ◽  
High Dose ◽  
Linear Accelerators ◽  
Radiation Delivery ◽  
Tissue Sparing

FLASH radiotherapy, or the administration of ultra-high dose rate radiotherapy, is a new radiation delivery method that aims to widen the therapeutic window in radiotherapy. Thus far, most in vitro and in vivo results show a real potential of FLASH to offer superior normal tissue sparing compared to conventionally delivered radiation. While there are several postulations behind the differential behaviour among normal and cancer cells under FLASH, the full spectra of radiobiological mechanisms are yet to be clarified. Currently the number of devices delivering FLASH dose rate is few and is mainly limited to experimental and modified linear accelerators. Nevertheless, FLASH research is increasing with new developments in all the main areas: radiobiology, technology and clinical research. This paper presents the current status of FLASH radiotherapy with the aforementioned aspects in mind, but also to highlight the existing challenges and future prospects to overcome them.

scholarly journals A novel three-dimensional volumetric method to measure indirect decompression after percutaneous cement discoplasty

2021 ◽  
Vol 28 ◽  
pp. 131-139
Author(s):  
Peter Endre Eltes ◽  
Laszlo Kiss ◽  
Ferenc Bereczki ◽  
Zsolt Szoverfi ◽  
Chloé Techens ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Volumetric Method ◽  
Indirect Decompression ◽  
Percutaneous Cement Discoplasty

Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: assessment of target coverage and noninvolved tissue sparing

1998 ◽  
Vol 41 (3) ◽  
pp. 559-568 ◽  
Author(s):  
Avraham Eisbruch ◽  
Lon H Marsh ◽  
Mary K Martel ◽  
Jonathan A Ship ◽  
Randall Ten Haken ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Target Coverage ◽  
Tissue Sparing

Disc displacement patterns in lumbar anterior spondylolisthesis: contribution of foraminal stenosis

2009 ◽  
Vol 33 (5) ◽  
pp. 414
Author(s):  
P.J. MacMahon ◽  
D.H. Taylor ◽  
D. Duke ◽  
D.D. Brennan ◽  
S.J. Eustace
Keyword(s):  
Foraminal Stenosis ◽  
Disc Displacement ◽  
Displacement Patterns
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