scholarly journals A novel approach to the lumbar sympathetic chain: lateral access

2013 ◽  
Vol 35 (v2supplement) ◽  
pp. Video12
Author(s):  
Shaun D. Rodgers ◽  
John A. Engler ◽  
Noel L. Perin
Keyword(s):  
Interbody Fusion ◽  
Botulinum Toxin Injection ◽  
Treatment Options ◽  
Lateral Approach ◽  
Sympathetic Chain ◽  
Efficacy And Safety ◽  
Social Psychological ◽  
Novel Approach ◽  
Lateral Interbody

Plantar hyperhydrosis is a disabling condition of excessive, symmetric, focal sweating of the feet with social, psychological, and medical implications. Treatment options include topical agents, iontophoresis, botulinum toxin injection, and surgical disruption of the lumbar sympathetic chain.Surgical corridors include transperitoneal and retroperitoneal approaches. We report our technique with a novel minimally invasive lateral retroperitoneal approach commonly used for lateral interbody fusions. The lateral approach for sectioning of the sympathetic chain in the treatment of hyperhydrosis appears safe. The approach may be advantageous for the patient and surgeons familiar with lateral interbody fusion. Further studies may elucidate the long term efficacy and safety of the lateral approach.The video can be found here: http://youtu.be/Q82SGpmAXng.

scholarly journals Stand-Alone Lateral Interbody Fusion for the Treatment of Low-Grade Degenerative Spondylolisthesis

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Luis Marchi ◽  
Nitamar Abdala ◽  
Leonardo Oliveira ◽  
Rodrigo Amaral ◽  
Etevaldo Coutinho ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Lateral Approach ◽  
Low Grade ◽  
Mean Values ◽  
Single Level ◽  
Lateral Interbody Fusion ◽  
Cage Subsidence ◽  
Lateral Interbody

The purpose of this paper was to investigate the stand-alone lateral interbody fusion as a minimally invasive option for the treatment of low-grade degenerative spondylolisthesis with a minimum 24-month followup. Prospective nonrandomized observational single-center study. 52 consecutive patients (67.6±10 y/o; 73.1% female;27.4±3.4 BMI) with single-level grade I/II single-level degenerative spondylolisthesis without significant spine instability were included. Fusion procedures were performed as retroperitoneal lateral transpsoas interbody fusions without screw supplementation. The procedures were performed in average 73.2 minutes and with less than 50cc blood loss. VAS and Oswestry scores showed lasting improvements in clinical outcomes (60% and 54.5% change, resp.). The vertebral slippage was reduced in 90.4% of cases from mean values of 15.1% preoperatively to 7.4% at 6-week followup (P<0.001) and was maintained through 24 months (7.1%,P<0.001). Segmental lordosis (P<0.001) and disc height (P<0.001) were improved in postop evaluations. Cage subsidence occurred in 9/52 cases (17%) and 7/52 cases (13%) spine levels needed revision surgery. At the 24-month evaluation, solid fusion was observed in 86.5% of the levels treated. The minimally invasive lateral approach has been shown to be a safe and reproducible technique to treat low-grade degenerative spondylolisthesis.

scholarly journals Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Doniel Drazin ◽  
Terrence T. Kim ◽  
J. Patrick Johnson
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Posterior Instrumentation ◽  
Lateral Approach ◽  
Control Group ◽  
Percutaneous Instrumentation ◽  
Lateral Interbody Fusion ◽  
Simultaneous Group ◽  
Simultaneous Procedures ◽  
Lateral Interbody

Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes;p=0.009) and lower intraoperative blood loss: 108 mL (versus 93 mL; NS). Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS). There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

Simultaneous Robotic Single-Position Surgery With Oblique Lumbar Interbody Fusion With Software Planning: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Martin H Pham ◽  
Jillian Plonsker ◽  
Luis D Diaz-Aguilar ◽  
Joseph A Osorio ◽  
Ronald A Lehman
Keyword(s):  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Spinal Instrumentation ◽  
Lateral Position ◽  
Lateral Approach ◽  
Lumbar Interbody Fusion ◽  
Robotic Platform ◽  
Patient Consent ◽  
Oblique Lumbar Interbody Fusion ◽  
Lateral Interbody

Abstract The use of robotic guidance for spinal instrumentation is promising for its ability to offer the advantages of precision, accuracy, and reproducibility. This has become even more important in the era of lateral interbody surgery because spinal robotics opens up the possibility of a straightforward workflow for single-position surgery in the lateral position.  We present here a case of a 72-yr-old woman who presented with an L4-5 spondylolisthesis with axial back pain and radiculopathy. She subsequently underwent an L4-5 oblique lumbar interbody fusion with L4-5 bilateral posterior instrumentation in a single lateral position (Mazor X Stealth Edition, Medtronic Sofamor Danek, Medtronic Inc, Dublin, Ireland). Due to the oblique lateral approach and posterior robotic assistance, both surgeons were able to work simultaneously for increased efficiency. To our knowledge, this is the first video demonstrating a two-surgeon simultaneous robotic single-position surgery with oblique lumbar interbody fusion using a spinal robotic platform.  There is no identifying information in this video. Patient consent was obtained for the surgical procedure and for publishing of the material included in the video.

scholarly journals Direct reprogramming of astrocytes to neurons leads to functional recovery after stroke

2020 ◽  
Author(s):  
Jessica Livingston ◽  
Tina Lee ◽  
Emerson Daniele ◽  
Clara Phillips ◽  
Alexandra Krassikova ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Treatment Options ◽  
Brain Repair ◽  
Novel Approach ◽  
Regenerative Approach ◽  
Cortical Stroke ◽  
The Impact

AbstractStroke is the leading cause of adult disability with few treatment options for stroke survivors. Astrocyte reprogramming to neurons enables the targeted in vivo generation of new cells at the site of injury and represents a novel approach for brain repair. A number of studies have demonstrated successful conversion of astrocytes to neurons in various models of brain injury and disease; however, the impact of this strategy on tissue and functional outcome following stroke is not well established. Using AAV delivery of the transcription factor NeuroD1, we reprogrammed astrocytes 7 days after endothelin-1 induced cortical stroke, and studied the long-term cellular and functional outcomes. We found that by 63 days post-stroke, 20% of neurons in the perilesional cortex were reprogrammed. Furthermore, reprogrammed neurons had matured into regionally appropriate neuronal subtypes. Importantly, this treatment was associated with improved functional outcome using the foot fault test and gait analysis. Together, our findings indicate that in vivo reprogramming is a promising regenerative approach for stroke repair.

scholarly journals Minimally invasive lateral interbody fusion for the treatment of rostral adjacent-segment lumbar degenerative stenosis without supplemental pedicle screw fixation

2014 ◽  
Vol 21 (6) ◽  
pp. 861-866 ◽  
Author(s):  
Michael Y. Wang ◽  
Ram Vasudevan ◽  
Stefan A. Mindea
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Ct Scanning ◽  
Lateral Approach ◽  
Leg Pain ◽  
Adjacent Segment ◽  
Lateral Interbody Fusion ◽  
The Mean ◽  
Lateral Interbody

Object Adjacent-segment degeneration and stenosis are common in patients who have undergone previous lumbar fusion. Treatment typically involves a revision posterior approach, which requires management of postoperative scar tissue and previously implanted instrumentation. A minimally invasive lateral approach allows the surgeon to potentially reduce the risk of these hazards. The technique relies on indirect decompression to treat central and foraminal stenosis and placement of a graft with a large surface area to promote robust fusion and stability in concert with the surrounding tensioned ligaments. The goal in this study was to determine if lateral interbody fusion without supplemental pedicle screws is effective in treating adjacent-segment disease. Methods For a 30-month study period at two institutions, the authors obtained all cases of lumbar fusion with new back and leg pain due to adjacent-segment stenosis and spondylosis failing conservative measures. All patients had undergone minimally invasive lateral interbody fusion from the side of greater leg pain without supplemental pedicle screw fixation. Patients were excluded from the study if they had undergone surgery for a nondegenerative etiology such as infection or trauma. They were also excluded if the intervention involved supplemental posterior instrumented fusion with transpedicular screws. Postoperative metrics included numeric pain scale (NPS) scores for leg and back pain. All patients underwent dynamic radiographs and CT scanning to assess stability and fusion after surgery. Results During the 30-month study period, 21 patients (43% female) were successfully treated using minimally invasive lateral interbody fusion without the need for subsequent posterior transpedicular fixation. The mean patient age was 61 years (range 37–87 years). Four patients had two adjacent levels fused, while the remainder had single-level surgery. All patients underwent surgery without conversion to a traditional open technique, and recombinant human bone morphogenetic protein–2 was used in the interbody space in all cases. The mean follow-up was 23.6 months. The mean operative time was 86 minutes, and the mean blood loss was 93 ml. There were no major intraoperative complications, but one patient underwent subsequent direct decompression in a delayed fashion. The leg pain NPS score improved from a mean of 6.3 to 1.9 (p < 0.01), and the back pain NPS score improved from a mean of 7.5 to 2.9 (p < 0.01). Intervertebral settling averaged 1.7 mm. All patients had bridging bone on CT scanning at the last follow-up, indicating solid bony fusion. Conclusions Adjacent-segment stenosis and spondylosis can be treated with a number of different operative techniques. Lateral interbody fusion provides an attractive alternative with reduced blood loss and complications, as there is no need to re-explore a previous laminectomy site. In this limited series a minimally invasive lateral approach provided high fusion rates when performed with osteobiological adjuvants.

Comparative Efficacy and Safety of Nonsurgical Treatment Options for Enthesopathy of the Extensor Carpi Radialis Brevis: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials

2018 ◽  
Vol 47 (12) ◽  
pp. 3019-3029 ◽  
Author(s):  
Jayson Lian ◽  
Amin Mohamadi ◽  
Jimmy J. Chan ◽  
Phillip Hanna ◽  
David Hemmati ◽  
...  
Keyword(s):  
Pain Relief ◽  
Meta Analysis ◽  
Treatment Options ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Short Term ◽  
Long Term Follow Up ◽  
Extensor Carpi Radialis

Background: Numerous treatment options have been proposed for enthesopathy of the extensor carpi radialis brevis (eECRB). Purpose: To (1) compare the efficacy and safety of nonsurgical treatment options for eECRB described in randomized placebo-controlled trials at short-term, midterm, and long-term follow-up and (2) evaluate outcomes in patients receiving placebo. Study Design: Systematic review and meta-analysis. Methods: Following PRISMA guidelines, 4 electronic databases were searched for randomized placebo-controlled trials for eECRB. Studies reporting visual analog scale (VAS) for pain scores and/or grip strength were included. Random- or fixed-effects meta-analysis was employed to compare treatments with at least 2 eligible studies using the standardized mean difference and odds ratio. The study protocol was registered at PROSPERO (ID: CRD42018075009). Results: Thirty-six randomized placebo-controlled trials, evaluating 11 different treatment modalities, with a total of 2746 patients were included. At short-term follow-up, only local corticosteroid injection improved pain; however, it was associated with pain worse than placebo at long-term follow-up. At midterm follow-up, laser therapy and local botulinum toxin injection improved pain. At long-term follow-up, extracorporeal shock wave therapy provided pain relief. With regard to grip strength, only laser therapy showed better outcomes in comparison with placebo. While there was no difference among various treatments in the odds ratio of an adverse event, they all increased adverse events compared with placebo. In placebo-receiving patients, a sharp increase in the percentage of patients reporting mild pain or less was observed from 2% at short-term follow-up to 92% at midterm follow-up. Conclusion: Most patients experienced pain resolution after receiving placebo within 4 weeks of follow-up. At best, all treatments provided only small pain relief while increasing the odds of adverse events. Therefore, if clinicians are inclined to provide a treatment for particular patients, they may consider a pain relief regimen for the first 4 weeks of symptom duration. Patient-specific factors should be considered when deciding on treatment or watchful waiting.

Efficacy and safety of endoscopic ultrasound-guided therapy versus direct endoscopic glue injection therapy for gastric varices: systematic review and meta-analysis

Endoscopy ◽  
2020 ◽  
Vol 52 (04) ◽  
pp. 259-267 ◽  
Author(s):  
Babu P. Mohan ◽  
Saurabh Chandan ◽  
Shahab R. Khan ◽  
Lena L. Kassab ◽  
Sushruth Trakroo ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Treatment Efficacy ◽  
Meta Analysis ◽  
Treatment Options ◽  
Gastric Varices ◽  
Novel Approach ◽  
Comprehensive Search ◽  
Glue Injection ◽  
Guided Therapy

Abstract Background Gastric variceal bleeding carries significant mortality in the setting of portal hypertension. Among the endoscopic treatment options, endoscopic ultrasound (EUS)-guided glue and/or coil injection is a novel approach, but its role in the treatment of gastric varices is not established due to a lack of robust data. Methods We conducted a comprehensive search of several databases (inception to June 2019) to identify studies evaluating EUS in the treatment of gastric varices. Our primary goals were to estimate the pooled rates of treatment efficacy, obliteration and recurrence of gastric varices, early and late rebleeding, and adverse events with EUS-guided therapy in gastric varices. We also searched for studies that evaluated direct endoscopic glue (END-glue) injection for treatment of gastric varices, and used the pooled rates as comparators. Results 23 studies (851 patients) evaluating EUS-guided therapy were included. The pooled treatment efficacy was 93.7 % (95 % confidence interval [CI] 89.5 – 96.3, I 2 = 53.7), gastric varices obliteration was 84.4 % (95 %CI 74.8 – 90.9, I 2 = 77), gastric varices recurrence was 9.1 % (95 %CI 5.2 – 15.7, I 2 = 32), early rebleeding was 7.0 % (95 %CI 4.6 – 10.7, I 2 = 0), and late rebleeding was 11.6 % (95 %CI 8.8 – 15.1, I 2 = 22). The rates were comparable to END-glue therapy (28 studies, 3467 patients) except for obliteration, which was significantly better with EUS-guided therapy. On subgroup analysis, EUS-coil/glue combination showed superior outcomes. Conclusions EUS-guided therapy demonstrated clinical efficacy for treatment of gastric varices in terms of obliteration, recurrence, and long-term rebleeding, and may be superior to END-glue.

scholarly journals Long-Term Efficacy and Safety of the HIV Integrase Inhibitor Raltegravir in Patients With Limited Treatment Options in a Phase II Study

2010 ◽  
Vol 53 (4) ◽  
pp. 456-463 ◽  
Author(s):  
Jose M Gatell ◽  
Christine Katlama ◽  
Beatriz Grinsztejn ◽  
Joseph J Eron ◽  
Adriano Lazzarin ◽  
...  
Keyword(s):  
Phase Ii ◽  
Phase Ii Study ◽  
Treatment Options ◽  
Integrase Inhibitor ◽  
Hiv Integrase ◽  
Efficacy And Safety ◽  
Term Efficacy

scholarly journals Lateral Transpsoas Fusion: Indications and Outcomes

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Vishal C. Patel ◽  
Daniel K. Park ◽  
Harry N. Herkowitz
Keyword(s):  
Interbody Fusion ◽  
Motor Deficits ◽  
Low Grade ◽  
Disc Disease ◽  
Lateral Interbody Fusion ◽  
Transpsoas Approach ◽  
Lower Blood ◽  
Short And Long Term ◽  
Lateral Interbody

Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.

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