scholarly journals Hemivertebrectomy of L5 in Grade 2 Chondrosarcoma: Is a Single Posterior Approach with No Nerve Root Sacrifice Possible? A Case Report

2021 ◽  
pp. 1-4
Author(s):  
S. Colangeli ◽  
A. D. Ruinato ◽  
E. Ipponi ◽  
S. Colangeli ◽  
R. Capanna
Keyword(s):  
Surgical Approach ◽  
Posterior Approach ◽  
Iliac Crest ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
High Rate ◽  
Surgical Approaches ◽  
En Bloc ◽  
Current Case ◽  
Single Posterior Approach

En-bloc resection of spine tumors is difficult to achieve compared to extremities tumors for anatomical reason. Several surgical techniques have been described, such as combined multiple surgical approaches or an enlarged single posterior approach. These demanding strategies correlate with high rate of intraoperative/postoperative complications. The current case is about a patient treated with a single posterior-lateral surgical approach to perform hemivertebrectomy of L5 for a single grade 2 chondrosarcoma metastasis (WBB 2-5/b-c). Usually, L5 hemivertebrectomy requires a combined surgical approach to preserve L5 root. The final solution was to perform a T-shape skin incision: a longitudinal branch centered on the vertebral spine and a transverse branch on the iliac crest. This approach allowed osteotomy of the ipsilateral iliac crest, achieving sufficient view to preserve L5 root and vessels anteriorly; the same osteotomy was used to create a bone autograft to reconstruct the residual part of L5. Finally, cryotherapy was used in order to increase the adequacy of surgical margins. A L3-S1 arthrodesis is assembled to achieve stability of the system. Surgical time was 5 hours, no nerve roots have been sacrificed nor any other intraoperative complications occurred. This surgical technique had never been described before in literature.

scholarly journals Surgical approach for fracture of distal humerus: Posterior vs lateral

2020 ◽  
Author(s):  
Michela Saracco ◽  
Alessandro Smimmo ◽  
Davide De Marco ◽  
Osvaldo Palmacci ◽  
Giuseppe Malerba ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Radial Nerve ◽  
Posterior Approach ◽  
Age Distribution ◽  
Young Patients ◽  
Lateral Approach ◽  
Humeral Fractures ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Complication Rates

Humeral fractures have an incidence of 3-5% and a bimodal age distribution. They may occur in young patients after highenergy traumas or in elderly osteoporotic patients after low-energy injuries. In nondisplaced fractures or in elderly patients, humeral fractures are treated by conservative methods. Open reduction and internal fixation (ORIF) should be the treatment of choice in case of multi-fragmentary fractures associated with radial nerve palsy or not. ORIF is usually regarded as the gold standard treatment, but, depending on the different types of fracture, the surgical approach can change. In this review, we compare results and complication rates between lateral and posterior surgical approaches in the management of extraarticular distal humeral shaft fractures. An internet-based literature research was performed on Pubmed, Google Scholars and Cochrane Library. 265 patients were enrolled: 148 were treated by lateral or antero-lateral approach, while 117 by posterior or postero-lateral approach. The literature shows that no differences between the posterior and lateral approach exist. Certainly, the posterior approach offers undoubted advantages in terms of exposure of the fracture and visualization of the radial nerve. In our opinion, the posterior approach may also allow better management of complex and multi-fragmentary fractures.

Novel Surgical Treatment Strategies for Unstable Lumbar Osteodiscitis: A 3-Patient Case Series

2017 ◽  
Vol 14 (6) ◽  
pp. 639-646 ◽  
Author(s):  
Michael A Bohl ◽  
Randall J Hlubek ◽  
Jay D Turner ◽  
Edward M Reece ◽  
U Kumar Kakarla ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Iliac Crest ◽  
Surgical Techniques ◽  
Case Series ◽  
Recurrent Infection ◽  
Surgical Approaches ◽  
Spinal Instability ◽  
Iliac Crest Graft ◽  
Imaging Results ◽  
Novel Methods

Abstract BACKGROUND Lumbar osteomyelitis frequently affects patients with medical comorbidities and poor preoperative health. Surgery is indicated when medical management fails or patients present with spinal instability or neural compromise. Successful arthrodesis can be difficult and sometimes requires alternative surgical techniques. OBJECTIVE To report 3 novel methods, each illustrated by a case, for achieving arthrodesis for lumbar osteomyelitis. METHODS A retrospective review was performed of 3 cases of surgical treatment of lumbar osteomyelitis. Novel aspects of the surgical techniques are reported, as are perioperative clinical details and imaging results. RESULTS In the first patient, a vascularized iliac crest graft on a quadratus lumborum pedicle was rotated into the posterolateral fusion bed of the affected level. In the second, an anterior approach with debridement of affected lumbar levels was followed by rotation of a vascularized iliac crest graft on an iliacus muscle pedicle into the anterior lumbar defect. In the third, a structural, nonvascularized iliac crest graft was harvested via a lateral approach to provide better surgical access, and an autologous tricortical bone graft was obtained for placement in the debridement defect. Follow-up imaging suggested successful early incorporation of all the grafts in the fusion beds. CONCLUSION Patients with multiple risk factors for pseudarthrosis and recurrent infection often require alternative surgical strategies to augment fusion. These 3 novel methods for lumbar debridement, fixation, and fusion using vascularized or nonvascularized autograft accommodate posterior, anterior, and lateral surgical approaches. Further experience with these techniques is required to compare outcomes with those of traditional techniques.

Surgical approach significantly affects the complication rates associated with total hip arthroplasty

2019 ◽  
Vol 101-B (6) ◽  
pp. 646-651 ◽  
Author(s):  
V. K. Aggarwal ◽  
A. Elbuluk ◽  
J. Dundon ◽  
C. Herrero ◽  
C. Hernandez ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Periprosthetic Fracture ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Deep Infection ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Wound Drainage

Aims A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common complications can occur following THA regardless of the approach used. The purpose of this study was to compare five commonly used surgical approaches with respect to the incidence of surgery-related complications. Patients and Methods The electronic medical records of all patients who underwent primary elective THA at a single large-volume arthroplasty centre, between 2011 and 2016, with at least two years of follow-up, were reviewed. After exclusion, 3574 consecutive patients were included in the study. There were 1571 men (44.0%) and 2003 women (56.0%). Their mean age and body mass index (BMI) was 63.0 years (sd 11.8) and 29.1 kg/m2 (sd 6.1), respectively. Data gathered included the age of the patient, BMI, the American Society of Anesthesiologists (ASA) score, estimated blood loss (EBL), length of stay (LOS), operating time, the presence of intra- or postoperative complications, type of complication, and the surgical approach. The approaches used during the study were posterior, anterior, direct lateral, anterolateral, and the northern approach. The complications that were recorded included prolonged wound drainage without infection, superficial infection, deep infection, dislocation, aseptic loosening, and periprosthetic fracture. Finally, the need for re-operation was recorded. Means were compared using analysis of variance (ANOVA) and Student’s t-tests where appropriate and proportions were compared using the chi-squared test. Results A total of 248 patients had 263 complications related to the surgery, with an incidence of 6.94%. The anterior approach had the highest incidence of complications (8.5% (113/1329)) and the posterior approach had the lowest, at 5.85% (97/1657; p = 0.006). Most complications were due to deep infection (22.8%), periprosthetic fracture (22.4%), and prolonged wound drainage (21.3%). The rate of dislocation was 0.84% (14/1657) with the posterior approach and 1.28% (17/1329) with the anterior approach (p = 0.32). Conclusion Overall, THA has a relatively low complication rate. However, the surgical approach plays a role in the incidence of complications. We found that the posterior approach had a significantly lower overall complication rate compared with the anterior approach, with an equal dislocation rate. Periprosthetic fracture and surgical site infection contributed most to the early complication rates. Cite this article: Bone Joint J 2019;101-B:646–651

scholarly journals Modified total en bloc spondylectomy for thoracolumbar spinal tumors via a single posterior approach

2012 ◽  
Vol 22 (3) ◽  
pp. 556-564 ◽  
Author(s):  
Lin Huang ◽  
Keng Chen ◽  
Ji-chao Ye ◽  
Yong Tang ◽  
Rui Yang ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Spinal Tumors ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Single Posterior Approach

scholarly journals Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization

2019 ◽  
Vol 30 (3) ◽  
pp. 308-313 ◽  
Author(s):  
Julia Onken ◽  
Kathrin Obermüller ◽  
Franziska Staub-Bartelt ◽  
Bernhard Meyer ◽  
Peter Vajkoczy ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Complication Rate ◽  
Posterior Approach ◽  
Surgical Complication ◽  
Extent Of Resection ◽  
Surgical Approaches ◽  
Special Focus ◽  
Complication Rates ◽  
Duration Of Surgery ◽  
Spinal Meningiomas

OBJECTIVESpinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA).METHODSBetween 2005 and 2017, 207 patients underwent resection of sMNGs at one of two institutions. The following characteristics were assessed: tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rates, and neurological outcome. Data were compared between the subgroups of patients according to the lesion’s relationship to the denticulate ligament and to surgical approach.RESULTSThe authors identified 48 patients with aMNGs, 86 patients with lateral MNGs, and 76 patients with posterior MNGs (pMNGs). Overall, 66.6% of aMNGs and 64% of pMNGs were reached via a ULPA. aMNGs that were approached via a ULPA showed reduced duration of surgery (131 vs 224 minutes, p < 0.0001) and had surgical complication rates and neurological outcomes comparable to those of lesions that were approached via a bilateral approach. No significant differences in complication rate, outcomes, and extent of resection were seen between aMNGs and pMNGs.CONCLUSIONSThe duration of surgery, extent of resection, and outcomes are comparable between aMNGs and pMNGs when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG.

scholarly journals Surgical Approaches to First Branchial Cleft Anomaly Excision: A Case Series

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Lourdes Quintanilla-Dieck ◽  
Frank Virgin ◽  
Chistopher Wootten ◽  
Steven Goudy ◽  
Edward Penn
Keyword(s):  
Surgical Treatment ◽  
Facial Nerve ◽  
Surgical Approach ◽  
Case Series ◽  
High Rate ◽  
Preoperative Imaging ◽  
Surgical Approaches ◽  
Complete Surgical Excision ◽  
Clinical Presentations ◽  
Branchial Cleft

Objectives. First branchial cleft anomalies (BCAs) constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one.Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs.Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This requireden blocexcision that included the lateral cortex of the mandible.Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential.

scholarly journals Maximal surgical resection and adjuvant surgical technique to prolong the survival of adult patients with thalamic glioblastoma

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0244325
Author(s):  
Jaejoon Lim ◽  
YoungJoon Park ◽  
Ju Won Ahn ◽  
So Jung Hwang ◽  
Hyouksang Kwon ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Technique ◽  
Surgical Resection ◽  
Surgical Approach ◽  
Dna Methyltransferase ◽  
Surgical Techniques ◽  
Motor Evoked Potential ◽  
High Rate ◽  
Surgical Morbidity ◽  
Neurophysiologic Monitoring

The importance of maximal resection in the treatment of glioblastoma (GBM) has been reported in many studies, but maximal resection of thalamic GBM is rarely attempted due to high rate of morbidity and mortality. The purpose of this study was to investigate the role of surgical resection in adult thalamic glioblastoma (GBM) treatment and to identify the surgical technique of maximal safety resection. In case of suspected thalamic GBM, surgical resection is the treatment of choice in our hospital. Biopsy was considered when there was ventricle wall enhancement or multiple enhancement lesion in a distant location. Navigation magnetic resonance imaging, diffuse tensor tractography imaging, tailed bullets, and intraoperative computed tomography and neurophysiologic monitoring (transcranial motor evoked potential and direct subcortical stimulation) were used in all surgical resection cases. The surgical approach was selected on the basis of the location of the tumor epicenter and the adjacent corticospinal tract. Among the 42 patients, 19 and 23 patients underwent surgical resection and biopsy, respectively, according to treatment strategy criteria. As a result, the surgical resection group exhibited a good response with overall survival (OS) (median: 676 days, p < 0.001) and progression-free survival (PFS) (median: 328 days, p < 0.001) compared with each biopsy groups (doctor selecting biopsy group, median OS: 240 days and median PFS: 134 days; patient selecting biopsy group, median OS: 212 days and median PFS: 118 days). The surgical resection groups displayed a better prognosis compared to that of the biopsy groups for both the O6-methylguanine-DNA methyltransferase unmethylated (log-rank p = 0.0035) or methylated groups (log-rank p = 0.021). Surgical resection was significantly associated with better prognosis (hazard ratio: 0.214, p = 0.006). In case of thalamic GBM without ventricle wall-enhancing lesion or multiple lesions, maximal surgical resection above 80% showed good clinical outcomes with prolonged the overall survival compared to biopsy. It is helpful to use adjuvant surgical techniques of checking intraoperative changes and select the appropriate surgical approach for reducing the surgical morbidity.

scholarly journals Surgical Approach to the Adrenal Glands

2015 ◽  
Vol 11 (02) ◽  
pp. 119
Author(s):  
David Scott-Coombes ◽  
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Adrenal Glands ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Great Care ◽  
Adrenal Incidentalomas ◽  
Adrenal Surgery ◽  
Multi Disciplinary Team ◽  
Adrenal Disease

Any surgeon treating a patient with adrenal disease should be a member of a multi-disciplinary team involving dedicated specialists, including an endocrinologist, anaesthetist, radiologist, intensivist and geneticist. In an era of epidemic numbers of adrenal incidentalomas, great care must be taken to determine not only the endocrine diagnosis, but also the benefits (if any) of adrenal surgery. Finally, the surgeon must be competent in both minimally invasive and gross resectional surgical techniques and know when to adopt these two very different surgical approaches.

Extensive total spondylectomy for recurrent giant cell tumor in the thoracic spine

2007 ◽  
Vol 6 (6) ◽  
pp. 600-605 ◽  
Author(s):  
Morio Matsumoto ◽  
Ken Ishii ◽  
Hironari Takaishi ◽  
Masaya Nakamura ◽  
Hideo Morioka ◽  
...  
Keyword(s):  
Giant Cell Tumor ◽  
Giant Cell ◽  
Posterior Approach ◽  
Pathological Condition ◽  
Cell Tumor ◽  
En Bloc ◽  
Spinal Reconstruction ◽  
Paravertebral Muscles ◽  
Recurrent Giant Cell Tumor ◽  
Single Posterior Approach

✓The authors report the case of a 47-year-old woman who harbored a giant cell tumor at the T-5 level. She had undergone curettage of the tumor via a combined anterior and posterior approach at a regional hospital and was later referred to the authors' institution for treatment after the tumor recurred. On examination she exhibited progressive paraparesis and was nonambulatory due to cord compression caused by the tumor, which had invaded the spinal canal and extended to the right paravertebral muscles and right thoracic cavity. A spondylectomy was performed through a single posterior approach. The tumor, together with a portion of the dura mater, pleura, and muscles, was resected en bloc from T-4 to T-6. After resection, spinal reconstruction was performed by placement of an anterior titanium mesh cage as well as posterior pedicle screw and rod instrumentation. The patient's postoperative course was uneventful, and she exhibited substantial neurological recovery and became ambulatory. Two and a half years after surgery, the patient was tumor free. En bloc resection of a recurrent giant cell tumor was successfully achieved through a single posterior approach. This surgical technique can be an effective option for this pathological condition, which is difficult to manage using other conventional treatment options including repeated curettage and radiotherapy.

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