scholarly journals Segmental Artery Injury During Anterior Column Realignment: A Case Report and Review of the Literature

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Elliot Pressman ◽  
Ryan Screven ◽  
Brooks Osburn ◽  
Sara Hartnett ◽  
Puya Alikhani
Keyword(s):  
Lumbar Lordosis ◽  
Endovascular Embolization ◽  
Anterior Column ◽  
Invasive Technique ◽  
Anterior Longitudinal Ligament ◽  
Review Of The Literature ◽  
Segmental Artery ◽  
Artery Injury ◽  
Vessel Injury ◽  
Great Vessels

Background: Anterior column realignment (ACR) is a minimally invasive technique used to restore lumbar lordosis and improve sagittal balance. The most feared complication from ACR includes injury to the great vessels. Segmental artery injuries are also a possible complication though sparsely reported. We report such a case. Case Description: During anterior longitudinal ligament release at L3-4, the L3 segmental artery was injured. Intraoperative angiogram and coiling was performed. Our patient remained hemodynamically stable though during the postoperative period his hemoglobin fell five points. Discussion: This patient was at risk for this complication due to the tortuosity of his vessels and his osteophytes. This injury can be treated concurrently with endovascular embolization if equipment and personnel are readily available. Ultimately, segmental artery injury does not appear to be as morbid as great vessel injury if addressed emergently.

Release of Anterior Longitudinal Ligament in Setting of Unfavorable Vascular Anatomy for Anterior Column Realignment—Technical Note: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E189-E189
Author(s):  
Jakub Godzik ◽  
Corey T Walker ◽  
Alexander C Whiting ◽  
Randall J Hlubek ◽  
Juan S Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Techniques ◽  
Technical Note ◽  
Anterior Column ◽  
Preoperative Imaging ◽  
Invasive Technique ◽  
Anterior Longitudinal Ligament ◽  
Transpsoas Approach ◽  
Patient Consent ◽  
Flat Back

Abstract Anterior column realignment (ACR) with anterior longitudinal ligament (ALL) release from a lateral transpsoas approach is increasingly being used as a minimally invasive technique to restore lordosis. Safe execution requires a plane between the ALL and the anterior vasculature. An unfavorable plane on preoperative imaging is a contraindication to using the technique. We describe a patient undergoing multistage minimally invasive correction of a flat-back deformity who had an unfavorable plane between the ALL and vasculature at L4-5. Patient consent was provided, and Institutional Review Board approval was not required. To safely complete the ALL release and ACR, we elected to sharply incise the lateral aspect of the ligament at L4-5 with direct control of the vessels during the anterior approach for an L5-S1 anterior lumbar interbody fusion. We then moved to the lateral transpsoas approach and used controlled distraction techniques to complete the ALL release and then to complete the ACR in a standard fashion. We ultimately achieved excellent realignment with correction of the patient's flat-back deformity using minimally invasive surgical techniques while minimizing vascular risk. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Minimally Invasive Anterior Longitudinal Ligament Release for Anterior Column Realignment

2020 ◽  
Vol 10 (2_suppl) ◽  
pp. 101S-110S
Author(s):  
Jakub Godzik ◽  
Bernardo de Andrada Pereira ◽  
Courtney Hemphill ◽  
Corey T. Walker ◽  
Joshua T. Wewel ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Anterior Column ◽  
Future Research ◽  
Invasive Technique ◽  
Review Of The Literature ◽  
Surgical Options ◽  
Segmental Lordosis

Study Design: Review of the literature. Objectives: Anterior column realignment (ACR) is a powerful but relatively new minimally invasive technique for deformity correction. The purpose of this study is to provide a literature review of the ACR surgical technique, reported outcomes, and future directions. Methods: A review of the literature was performed regarding the ACR technique. A review of patients at our single center who underwent ACR was performed, with illustrative cases selected to demonstrate basic and nuanced aspects of the technique. Results: Clinical and cadaveric studies report increases in segmental lordosis in the lumbar spine by 73%, approximately 10° to 33°, depending on the degree of posterior osteotomy and lordosis of the hyperlordosis interbody spacer. These corrections have been found to be associated with a similar risk profile compared with traditional surgical options, including a 30% to 43% risk of proximal junctional kyphosis in early studies. Conclusions: ACR represents a powerful technique in the minimally invasive spinal surgeon’s toolbox for treatment of complex adult spinal deformity. The technique is capable of significant sagittal plane correction; however, future research is necessary to ascertain the safety profile and long-term durability of ACR.

Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

2021 ◽  
Author(s):  
Jenny Christine Kienzler ◽  
Salome Schoepf ◽  
Serge Marbacher ◽  
Michael Diepers ◽  
Luca Remonda ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Prone Position ◽  
Popliteal Artery ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Safe Procedure ◽  
Spinal Dural Arteriovenous Fistula ◽  
Segmental Artery ◽  
Small Branch

Abstract Background Spinal dural arteriovenous fistula (SDAVF) is a rare cause of progressive myelopathy in predominantly middle-aged men. Treatment modalities include surgical obliteration and endovascular embolization. In surgically treated cases, failure of obliteration is reported in up to 5%. The aim of this technical note is to present a safe procedure with complete SDAVF occlusion, verified by intraoperative digital subtraction angiography (DSA). Methods We describe four patients with progressive leg weakness who underwent surgical obliteration of SDAVF with spinal intraoperative DSA in the prone position after cannulation of the popliteal artery. All surgeries took place in our hybrid operating room (OR) and were accompanied by electrophysiologic monitoring. Surgeries and cannulation of the popliteal artery were performed in the prone position. Ultrasound was used to guide the popliteal artery puncture. A 5-Fr sheath was inserted and the fistula was displayed using a 5-Fr spinal catheter. Spinal intraoperative DSA was performed prior to and after temporary clipping of the fistula point as well after the final SDAVF occlusion. Results The main feeder of the SDAVF fistula in the first patient arose from the right T11 segmental artery, which also supplied the artery of Adamkiewicz. The second patient initially underwent endovascular treatment and deteriorated 5 months later due to recanalization of the SDAVF via a small branch of the T12 segmental artery. The third and fourth cases were primarily scheduled for surgical occlusion. Access through the popliteal artery for spinal intraoperative DSA proved to be beneficial and safe in the hybrid OR setting, allowing the sheath to be left in place during the procedure. During exposure and after temporary and permanent occlusion of the fistulous point, intraoperative indocyanine green (ICG) video angiography was also performed. In one case, the addition of intraoperative DSA showed failure of fistula occlusion, which was not visible with ICG angiography, leading to repositioning of the clip. Complete fistula occlusion was documented in all cases. Conclusion Spinal intraoperative DSA in the prone position is a feasible and safe intervention for rapid localization and confirmation of surgical SDAVF occlusion.

Endovascular embolization of cervical hemangiopericytoma with Onyx-18: case report and review of the literature

2010 ◽  
Vol 3 (3) ◽  
pp. 304-307 ◽  
Author(s):  
A. Santillan ◽  
W. Zink ◽  
E. Lavi ◽  
J. Boockvar ◽  
Y. P. Gobin ◽  
...  
Keyword(s):  
Case Report ◽  
Endovascular Embolization ◽  
Review Of The Literature

scholarly journals Koebner phenomenon in leukocytoclastic vasculitis: A case report and an updated review of the literature

2019 ◽  
Vol 7 ◽  
pp. 2050313X1985035
Author(s):  
Farah Kassam ◽  
Sabrina Nurmohamed ◽  
Richard M Haber
Keyword(s):  
Case Report ◽  
Leukocytoclastic Vasculitis ◽  
Immunoglobulin A ◽  
Small Vessel Vasculitis ◽  
Review Of The Literature ◽  
Henoch Schonlein Purpura ◽  
Koebner Phenomenon ◽  
Vessel Injury ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

Leukocytoclastic vasculitis is the most common form of cutaneous vasculitis. It is a neutrophilic small vessel vasculitis resulting from the deposition of circulating immune complexes. Henoch-Schonlein purpura is a systemic type of leukocytoclastic vasculitis, characterized by immunoglobulin A-mediated blood vessel injury. We present a case of Henoch-Schonlein purpura in an adult female manifesting with a vasculitic rash with Koebner phenomenon.

scholarly journals Treatment of severe accidental hypothermia with intermittent hemodialysis

CJEM ◽  
2009 ◽  
Vol 11 (02) ◽  
pp. 174-177 ◽  
Author(s):  
Nabil Sultan ◽  
Karl D. Theakston ◽  
Ron Butler ◽  
Rita S. Suri
Keyword(s):  
Potential Role ◽  
Circulatory Arrest ◽  
Hemodynamic Instability ◽  
Invasive Technique ◽  
Intermittent Hemodialysis ◽  
Optimal Management ◽  
Rapid Rate ◽  
Review Of The Literature ◽  
Severe Hypothermia ◽  
Conventional Hemodialysis

ABSTRACTThe optimal management of moderate-to-severe hypothermia with hemodynamic instability remains unclear. Although cardiopulmonary bypass offers the most rapid rate of rewarming and has been suggested as the method of choice in the presence of circulatory arrest, there is no evidence to support the use of this highly invasive technique over other rewarming modalities in the absence of circulatory collapse. We report the successful treatment of hemodynamically unstable hypothermia with conventional hemodialysis in a patient with normal renal function, after initial efforts of rewarming using conventional strategies had failed. This case report and review of the literature highlights the advantages and the challenges of using hemodialysis in this setting, and suggests a potential role for hemodialysis in the routine management of moderate-to-severe hypothermia in the absence of circulatory arrest.

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