Spine

2016 ◽  
pp. 103-118
Keyword(s):  
New Technologies ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Metastatic Lesion ◽  
Board Examination ◽  
Cord Injury ◽  
The Common ◽  
Cervical Plating ◽  
Invasive Techniques ◽  
Cervical Facet

Spine cases form a significant component of the neurosurgery Oral Board Examination. A familiarity with the common cases is essential in preparing for the boards. Spine includes cases that span from the skull base to the sacrum. Another component of spine includes an understanding of spine stability as well as the use of spinal instrumentation such as cervical plating and pedicle screws. These techniques are now a standard part of the neurosurgical armamentariun. Current new technologies or approaches to the spine, whether minimally invasive techniques or surgery for deformity, are actively used and will continue to form a larger part of the oral examination. The following cases are discussed in this chapter: bilateral cervical facet dislocation with spinal cord injury, central calcified thoracic disk herniation, L5 congenital spondylolysis with spondylolisthesis, metastatic lesion, and intramedullary ependymoma.

Spine

2020 ◽  
pp. 103-120
Author(s):  
Allan D. Levi
Keyword(s):  
New Technologies ◽  
Thoracolumbar Spine ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Metastatic Lesion ◽  
Oral Exam ◽  
Spine Deformity ◽  
Thoracic Disc ◽  
Cervical Plating ◽  
Invasive Techniques

Spine cases form a significant component of the neurosurgery Oral Board Examinations. A familiarity with the common cases is essential in preparing for the boards. Spine includes cases that span from the skull base to the sacrum. Another component of spine includes an understanding of spine stability as well as the use of spinal instrumentation such as cervical plating and pedicle screws. These techniques are now a standard part of the neurosurgical armamentarium. Current new technologies or approaches to the spine whether minimally invasive techniques or surgery for deformity are actively used and will continue to form a larger part of the oral exam. The following cases are discussed in this chapter: bilateral cervical facet dislocation with spinal cord injury, central calcified thoracic disc herniation, L5 congenital spondylolysis with spondylolisthesis, metastatic lesion, and a thoracolumbar spine deformity.

scholarly journals Minimally invasive spine technology and minimally invasive spine surgery: a historical review

2009 ◽  
Vol 27 (3) ◽  
pp. E9 ◽  
Author(s):  
Jeffrey H. Oppenheimer ◽  
Igor DeCastro ◽  
Dennis E. McDonnell
Keyword(s):  
Minimally Invasive ◽  
Spine Surgery ◽  
New Technologies ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Historical Review ◽  
Outpatient Basis ◽  
Minimal Access ◽  
Hybrid Procedures ◽  
Minimally Invasive Spine

The trend of using smaller operative corridors is seen in various surgical specialties. Neurosurgery has also recently embraced minimal access spine technique, and it has rapidly evolved over the past 2 decades. There has been a progression from needle access, small incisions with adaptation of the microscope, and automated percutaneous procedures to endoscopically and laparoscopically assisted procedures. More recently, new muscle-sparing technology has come into use with tubular access. This has now been adapted to the percutaneous placement of spinal instrumentation, including intervertebral spacers, rods, pedicle screws, facet screws, nucleus replacement devices, and artificial discs. New technologies involving hybrid procedures for the treatment of complex spine trauma are now on the horizon. Surgical corridors have been developed utilizing the interspinous space for X-STOP placement to treat lumbar stenosis in a minimally invasive fashion. The direct lateral retroperitoneal corridor has allowed for minimally invasive access to the anterior spine. In this report the authors present a chronological, historical perspective of minimal access spine technique and minimally invasive technologies in the lumbar, thoracic, and cervical spine from 1967 through 2009. Due to a low rate of complications, minimal soft tissue trauma, and reduced blood loss, more spine procedures are being performed in this manner. Spine surgery now entails shorter hospital stays and often is carried out on an outpatient basis. With education, training, and further research, more of our traditional open surgical management will be augmented or replaced by these technologies and approaches in the future.

scholarly journals Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Sinan Kahraman ◽  
Meriç Enercan ◽  
Özkan Demirhan ◽  
Türker Şengül ◽  
Levent Dalar ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Postoperative Period ◽  
Spinal Canal ◽  
Posterior Instrumentation ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Early Postoperative Period ◽  
Screw Length ◽  
Cord Injury ◽  
Tracheal Tear

Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20–25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period.

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

Diversity of organisms

2018 ◽  
Author(s):  
Philip James
Keyword(s):  
Life Cycle ◽  
Urban Areas ◽  
Native Species ◽  
New Technologies ◽  
Urban Environments ◽  
Green Spaces ◽  
The Common ◽  
Living Organisms ◽  
Micro Organisms ◽  
Diversity Of Life

The focus of this chapter is an examination of the diversity of living organisms found within urban environments, both inside and outside buildings. The discussion commences with prions and viruses before moving on to consider micro-organisms, plants, and animals. Prions and viruses cause disease in plants and animals, including humans. Micro-organisms are ubiquitous and are found in great numbers throughout urban environments. New technologies are providing new insights into their diversity. Plants may be found inside buildings as well as in gardens and other green spaces. The final sections of the chapter offer a discussion of the diversity of animals that live in urban areas for part or all of their life cycle. Examples of the diversity of life in urban environments are presented throughout, including native and non-native species, those that are benign and deadly, and the common and the rare.

scholarly journals A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Courtney Celian ◽  
Veronica Swanson ◽  
Maahi Shah ◽  
Caitlin Newman ◽  
Bridget Fowler-King ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Relative Advantage ◽  
Personal Attributes ◽  
Design Work ◽  
Cognitive Limitations ◽  
Knowledge And Beliefs ◽  
Cord Injury

Abstract Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.

scholarly journals Minimally Invasive Techniques for Iliac Bolt Placement: 2-Dimensional Operative Video

2021 ◽  
Vol 20 (4) ◽  
pp. E292-E292
Author(s):  
Travis Hamilton ◽  
Mohamed Macki ◽  
Thomas M Zervos ◽  
Victor Chang
Keyword(s):  
Minimally Invasive ◽  
Imaging System ◽  
Pedicle Screws ◽  
Vertical Axis ◽  
Spinal Diseases ◽  
Open Approach ◽  
Sagittal Vertical Axis ◽  
Pelvic Fixation ◽  
Iliac Screws ◽  
Invasive Techniques

Abstract As the popularity of minimally invasive surgery (MIS) continues to grow, novel techniques are needed to meet the demands of multisegment fixation for advanced spinal diseases. In one such example, iliac bolts are often required to anchor large fusion constructs, but MIS technical notes are missing from the literature.  A 67-yr-old female presented with a symptomatic coronal deformity: preoperative pelvic incidence = 47°, pelvic tilt = 19°, and lumbar lordosis = 29°, sagittal vertical axis = +5.4 cm with 30° of scoliosis. The operative plan included T10-ilium fusion with transforaminal interbody grafts at L2-3, L3-4, L4-5, and L5-S1. The intraoperative video is of minimally invasive placement of iliac bolts using the O-Arm Surgical Imaging System (Medtronic®). The patient consented to the procedure.  A mini-open exposure that remains above the fascial planes allows for multilevel instrumentation with appropriate decompression at the interbody segments. After the placement of the pedicle screws under image-guidance, the direction is turned to the minimally invasive iliac bolts. Following the trajectory described in the standard open approach,1 the posterior superior iliac spine (PSIS) is identified with the navigation probe, which will guide the Bovie cautery through the fascia. This opening assists in the trajectory of the navigated-awl tap toward the anterior superior iliac spine (ASIS). Next, 8.5 mm x 90 mm iliac screws were placed in the cannulated bone under navigation. After intraoperative image confirmation of screw placement, the contoured rods are threaded under the fascia. The setscrews lock the rod in position. MIS approaches obviate cross-linking the rods, rendering pelvic fixation more facile.  This technique allows for minimal dissection of the posterior pelvic soft tissue while maintaining adequate fixation.

scholarly journals The Biological Effects of Combining Metals in a Posterior Spinal Implant: In Vivo Model Development Report of the First Two Cases

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Christine L. Farnsworth ◽  
Peter O. Newton ◽  
Eric Breisch ◽  
Michael T. Rohmiller ◽  
Jung Ryul Kim ◽  
...  
Keyword(s):  
Galvanic Corrosion ◽  
Biological Effects ◽  
Model Development ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Tissue Response ◽  
In Vivo Model ◽  
Particle Count ◽  
Spinal Implant

Study Design. Combinations of metal implants (stainless steel (SS), titanium (Ti), and cobalt chrome (CC)) were placed in porcine spines. After 12 months, tissue response and implant corrosion were compared between mixed and single metal junctions. Objective. Model development and an attempt to determine any detriment of combining different metals in posterior spinal instrumentation. Methods. Yucatan mini-pigs underwent instrumentation over five unfused lumbar levels. A SS rod and a Ti rod were secured with Ti and SS pedicle screws, SS and Ti crosslinks, SS and CC sublaminar wires, and Ti sublaminar cable. The resulting 4 SS/SS, 3 Ti/Ti, and 11 connections between dissimilar metals per animal were studied after 12 months using radiographs, gross observation, and histology (foreign body reaction (FBR), metal particle count, and inflammation analyzed). Results. Two animals had constructs in place for 12 months with no complications. Histology of tissue over SS/SS connections demonstrated 11.1 ± 7.6 FBR cells, 2.1 ± 1.7 metal particles, and moderate to extensive inflammation. Ti/Ti tissue showed 6.3 ± 3.8 FBR cells, 5.2 ± 6.7 particles, and no to extensive inflammation (83% extensive). Tissue over mixed components had 14.1 ± 12.6 FBR cells and 13.4 ± 27.8 particles. Samples surrounding wires/cables versus other combinations demonstrated FBR (12.4 ± 13.5 versus 12.0 ± 9.6 cells, P = 0.96), particles (19.8 ± 32.6 versus 4.3 ± 12.7, P = 0.24), and inflammation (50% versus 75% extensive, P = 0.12). Conclusions. A nonfusion model was developed to study corrosion and analyze biological responses. Although no statistical differences were found in overlying tissue response to single versus mixed metal combinations, galvanic corrosion between differing metals is not ruled out. This pilot study supports further investigation to answer concerns when mixing metals in spinal constructs.

Concepts of Risk in Nanomedicine Research

2012 ◽  
Vol 40 (4) ◽  
pp. 809-822 ◽  
Author(s):  
Linda F. Hogle
Keyword(s):  
New Technologies ◽  
Human Subjects ◽  
Medical Science ◽  
Ethical Concern ◽  
Mitigation Measures ◽  
Ethical Review ◽  
Benefit Analysis ◽  
The Common ◽  
Risk Benefit Analysis ◽  
Ethical Oversight

Risk is the most often cited reason for ethical concern about any medical science or technology, particularly those new technologies that are not yet well understood, or create unfamiliar conditions. In fact, while risk and risk-benefit analyses are but one aspect of ethical oversight, ethical review and risk assessment are sometimes taken to mean the same thing. This is not surprising, since both the Common Rule and Food and Drug Administration (FDA) foreground procedures for minimizing risk for human subjects and require local IRBs to engage in some sort of risk-benefit analysis in decisions to approve or deny proposed research. Existing ethical review and oversight practices are based on the presumption that risk can be clearly identified within the planned activities of the protocol, that metrics can reasonably accurately predict potential hazards, and that mitigation measures can be taken to deal with unintended, harmful, or catastrophic events.

scholarly journals The use of intraoperative navigation for complex upper cervical spine surgery

2014 ◽  
Vol 36 (3) ◽  
pp. E5 ◽  
Author(s):  
Kern H. Guppy ◽  
Indro Chakrabarti ◽  
Amit Banerjee
Keyword(s):  
Cervical Spine ◽  
Navigation System ◽  
Surgical Navigation ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Upper Cervical Spine ◽  
Cervical Canal ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws

Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2–3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1–2 with distortion of the anatomy and overgrowth of the bony structure at C-2.

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