Traction screws to reduce a bilateral pedicle fracture of L5: a case report

Pedicle fractures are rare and usually associated with repetitive stress, high-speed trauma, osteoporosis, unilateral spondylolysis, or instrumentation surgery. A review of the current literature on bilateral pedicle fractures of the lumbar spine revealed only a few cases listed as a complication of instrumentation or excessive decompression surgery. The authors present the clinical case of a 49-year-old man with exacerbating low-back pain and intermittent L5 radicular pain. The known comorbidities were rather remarkable for systemic lupus erythematosus and osteopenia. Radiological investigations revealed an acute bilateral pedicle fracture of L5 without any evidence of preexisting spondylolysis. An off-label minimally invasive fracture reduction and fixation was performed using traction screws and intraoperative navigation. The patient reported instant pain relief and did not show any sensorimotor deficits at discharge. The postoperative CT scan revealed an ossification of the former fracture after 3 months, with great 1-year follow-up outcome. This is the first documented report on the effectiveness of traction screws used in a patient with bilateral pedicle fractures of the L5 vertebra. This minimally invasive technique represents a promising treatment option in selected cases by sparing segmental fusion.

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Microsurgical unilateral laminotomy for bilateral decompression of degenerative lumbar canal stenosis: a comparative study

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0125-4 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Mohamed I. Refaat ◽

Amr K. Elsamman ◽

Adham Rabea ◽

Mohamed I. A. Hewaidy

Keyword(s):

Patient Satisfaction ◽

Blood Loss ◽

Minimally Invasive ◽

Invasive Technique ◽

Decompression Surgery ◽

Microsurgical Decompression ◽

Significant Difference ◽

Duration Of Surgery ◽

Group A ◽

Group B

Abstract Background The quest for better patient outcomes is driving to the development of minimally invasive spine surgical techniques. There are several evidences on the use of microsurgical decompression surgery for degenerative lumbar spine stenosis; however, few of these studies compared their outcomes with the traditional laminectomy technique. Objectives The aim of our study was to compare outcomes following microsurgical decompression via unilateral laminotomy for bilateral decompression (ULBD) of the spinal canal to the standard open laminectomy for cases with lumbar spinal stenosis. Subjects and methods Cases were divided in two groups. Group (A) cases were operated by conventional full laminectomy; Group (B) cases were operated by (ULBD) technique. Results from both groups were compared regarding duration of surgery, blood loss, perioperative complication, and postoperative outcome and patient satisfaction. Results There was no statistically significant difference between both groups regarding the improvement of visual pain analogue, while improvement of neurogenic claudication outcome score was significant in group (B) than group (A). Seventy-three percent of group (A) cases and 80% of group (B) stated that surgery met their expectations and were satisfied from the outcome. Conclusion Comparing ULBD with traditional laminectomy showed the efficacy of the minimally invasive technique in obtaining good surgical outcome and patient satisfaction. There was no statistically significant difference between both groups regarding the occurrence of complications The ULBD technique was found to respect the posterior spinal integrity and musculature, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods than the open laminectomy technique.

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Two-Level Minimally Invasive Lumbar Laminectomy and Foraminotomy: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab134 ◽

2021 ◽

Author(s):

Ethan S Srinivasan ◽

Clifford L Crutcher ◽

Timothy Y Wang ◽

Peter M Grossi ◽

Khoi D Than

Keyword(s):

Minimally Invasive ◽

High Speed ◽

Hospital Length ◽

Spinal Nerve ◽

Hospital Length Of Stay ◽

Foraminal Stenosis ◽

Tubular Retractor ◽

Open Operation ◽

Spinous Processes ◽

Patient Reported

Abstract Minimally invasive lumbar laminectomies utilize tubular retractors to minimize tissue disturbance, blood loss, and hospital length of stay compared to open operations. Here, we highlight the operative treatment of a 68-yr-old male entailing a 2-level minimally invasive lumbar laminectomy and foraminotomy at L2-L3 and L3-L4. The patient initially presented with symptoms of treatment-refractory lower extremity numbness and limited ambulation. His imaging demonstrated coronal scoliosis and severe lumbar central and foraminal stenosis at L2-L3 and L3-L4, with enlarged spinous processes, laminae, and facets. The patient consented to the procedure and publication of their image. The operation proceeded with the patient in a prone position with paramedian dissection to the lamina through a minimally invasive tubular retractor. Laminectomies and foraminotomies were performed at each level with high-speed drill and a Kerrison rongeur, with care to identify and protect the relevant spinal nerve roots. Postoperatively, the patient reported significantly reduced numbness and improved ambulation, with a well-healed surgical incision notably smaller than those produced in an open operation.

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Patient-reported outcomes of ductoscopy procedures for pathologic nipple discharge

Breast Cancer ◽

10.1007/s12282-020-01184-y ◽

2020 ◽

Author(s):

M. D. Filipe ◽

J. M. Simons ◽

L. Moeliker ◽

L. Waaijer ◽

M. R. Vriens ◽

...

Keyword(s):

Minimally Invasive ◽

Nipple Discharge ◽

Invasive Technique ◽

Sf 36 ◽

Patient Reported ◽

Pathologic Nipple Discharge ◽

Duct Excision ◽

Breastfeeding Problems ◽

Over Time

Abstract Background Pathologic nipple discharge (PND) is a common complaint often associated with breast cancer. However, when ultrasound and mammography are negative, the chances of malignancy are lower than 5%. Currently, major duct excision and microdochectomy are often recommended to alleviate symptoms and definitely rule out malignancy, but can cause infections and breastfeeding problems. Ductoscopy is a minimally invasive endoscopy technique that allows visualization of the mammary ducts and may not only obviate surgery but also detect malignancy. The aim of this study was to determine quality of life (QOL) after ductoscopy in patients with PND. Materials and methods All PND patients referred for ductoscopy between 2014 and 2015 to our hospital were included. Ductoscopy procedures were performed under local anaesthesia in the outpatient clinic. Patients were asked to fill out questionnaires (Breast-Q, EQ-5D-5L and SF-36) on the day of ductoscopy, and after 2 weeks, 3 and 6 months. Additionally, we performed reliability analysis to determine if these questionnaires were suitable for PND patients. Results Fifty consecutive patients underwent ductoscopy of whom 47 patients participated in this study. One domain of SF-36 (vitality) varied significantly over time. Breast-Q, SF-36 and EQ-5D-5L showed that QOL after ductoscopy for PND was unaffected by ductoscopy. Success of the ductoscopy procedure was a significant predictor for satisfaction with the result domain. Conclusion Ductoscopy is a minimally invasive technique that does not seem to impact QoL of PND patients over time. Breast-Q, SF-36 and EQ-5D-5L seem to be suitable existing QOL tests for PND patients undergoing ductoscopy, whereas SF-36 would require modifications.

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Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Perspective on Current Evidence and Clinical Knowledge

Minimally Invasive Surgery ◽

10.1155/2012/657342 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Ali Habib ◽

Zachary A. Smith ◽

Cort D. Lawton ◽

Richard G. Fessler

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Modern Method ◽

Current Evidence ◽

Invasive Technique ◽

Published Data ◽

Lumbar Interbody Fusion ◽

Patient Reported ◽

Duration Of Surgery

This paper reviews the current published data regarding open transforaminal lumbar interbody fusion (TLIF) in relation to minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).Introduction. MI-TLIF, a modern method for lumbar interbody arthrodesis, has allowed for a minimally invasive method to treat degenerative spinal pathologies. Currently, there is limited literature that compares TLIF directly to MI-TLIF. Thus, we seek to discuss the current literature on these techniques.Methods. Using a PubMed search, we reviewed recent publications of open and MI-TLIF, dating from 2002 to 2012. We discussed these studies and their findings in this paper, focusing on patient-reported outcomes as well as complications.Results. Data found in 14 articles of the literature was analyzed. Using these reports, we found mean follow-up was 20 months. The mean patient study size was 52. Seven of the articles directly compared outcomes of open TLIF with MI-TLIF, such as mean duration of surgery, length of post-operative stay, blood loss, and complications.Conclusion. Although high-class data comparing these two techniques is lacking, the current evidence supports MI-TLIF with outcomes comparable to that of the traditional, open technique. Further prospective, randomized studies will help to further our understanding of this minimally invasive technique.

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Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus

Foot & Ankle International ◽

10.1177/1071100718803131 ◽

2018 ◽

Vol 40 (2) ◽

pp. 195-201 ◽

Cited By ~ 8

Author(s):

Kar Hao Teoh ◽

Wei Teen Tan ◽

Zeid Atiyah ◽

Aziz Ahmad ◽

Hiro Tanaka ◽

...

Keyword(s):

Minimally Invasive ◽

Clinical Outcomes ◽

Case Series ◽

Hallux Rigidus ◽

Invasive Technique ◽

Open Approach ◽

Level Of Evidence ◽

First Metatarsophalangeal Joint ◽

Patient Reported ◽

The Mean

Background: Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus by a traditional open approach or by a minimally invasive technique. We report our clinical outcomes following minimally invasive dorsal cheilectomy (MIDC). Methods: Eighty-nine patients (98 feet) with symptomatic hallux rigidus treated between 2011 and 2016 were included in this study. The average age was 54 years. Manchester-Oxford Foot Questionnaire (MOxFQ) scores and visual analog scale (VAS) pain scores were collected. The mean follow-up was 50 months. Results: The average VAS score improved from 8.0 preoperatively to 3 postoperatively. The mean MOxFQ summary index score decreased from 58.6 preoperatively to 30.5 postoperatively. All 3 MOxFQ domains also improved. Swelling took an average of 5.3 weeks to settle. There were 2 wound infections and 2 delayed wound healings. Two patients had transient nerve paraesthesia, while 2 patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) underwent reoperation, of which 7 had a first metatarsophalangeal joint arthrodesis for ongoing pain, 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone. Conclusion: Our results suggest that MIDC resulted in improvement in patient-reported outcome measures and was a safe technique with minimal complications. The complications were similar to open cheilectomy. There was an associated learning curve as 5 of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 did well with MIDC as with open cheilectomy as none went onto an arthrodesis. However, 10% (7/65) of our grade 2 and 3 cases went on to an arthrodesis. Level of Evidence: Level IV, retrospective case series.

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A prospective study of functional outcome of closed displaced mid-shaft clavicle fractures treated with intramedullary titanium elastic nail system

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202676 ◽

2020 ◽

Vol 6 (4) ◽

pp. 735

Author(s):

Mallepogu Kiran Kumar ◽

Rajana Siva Prasad

Keyword(s):

Minimally Invasive ◽

Prospective Study ◽

High Speed ◽

Invasive Technique ◽

Time Interval ◽

Titanium Elastic Nail ◽

Elastic Nail ◽

Clavicle Fractures ◽

The Mean ◽

A Prospective Study

Background: Clavicle fractures are most common injuries in young and active individuals, especially those who participate in sports where high-speed falls (e.g., bicycling, motorcycles) or violent collisions (e.g., Football, hockey) are frequent. In contrast, in children and elderly, they are related to falls, and they account for approximately 2.6% of all fractures. The most common site of fracture is a middle-third shaft; it accounts for 80% of all clavicle fractures.Methods: This was a prospective study carried in 20 patients with simple mid third clavicular fractures, who were treated with closed intra-medullary fixation with TENS nailing. Post-operatively range of movements, ability to get back to routine work were assessed and noted. Results: At the end of the study, all the 20 patients in the follow-up group with 14 male and 6 female patients. The mean age was 34.9 years (between 22-55 years) in the group. The mean time interval between injury and surgery was 3.55 days (range 1-6 days). All the patients are achieved clinical and radiological union at a mean of 8.6 weeks (range, 6-12 weeks).Conclusions: Thus, the intramedullary fixation of a displaced midshaft clavicle fracture is a safe minimally invasive technique. The present study advises the use of minimally invasive antegrade titanium elastic nail for fixation of displaced midshaft clavicle fractures. Although, for comminuted fractures plating remains the procedure of choice.

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Transforaminal 360° lumbar endoscopic foraminotomy in postfusion patients: technical note and case series

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine21206 ◽

2021 ◽

pp. 1-7

Author(s):

Albert E. Telfeian ◽

Ashwin Veeramani ◽

Andrew S Zhang ◽

Matthew S. Quinn ◽

Alan H. Daniels

Keyword(s):

Minimally Invasive ◽

High Speed ◽

Lumbar Fusion ◽

Case Series ◽

Visual Analog Scale Score ◽

Technical Note ◽

Leg Pain ◽

Decompression Surgery ◽

Foraminal Stenosis

OBJECTIVE This report describes a minimally invasive lumbar foraminotomy technique that can be applied in patients who underwent complex spine decompression procedures or in patients with severe foraminal stenosis. METHODS Awake, endoscopic decompression surgery was performed in 538 patients over a 5-year period between 2014 and 2019. Transforaminal endoscopic foraminal decompression surgery using a high-speed endoscopic drill was performed in 34 patients who had previously undergone fusions at the treated level. RESULTS At 2-year follow-up, the mean (± SD) preoperative visual analog scale score for leg pain and the Oswestry Disability Index improved from 7.1 (± 1.5) and 40.1% (± 12.1%) to 2.1 (± 1.9) and 13.6% (± 11.1%). CONCLUSIONS A minimally invasive, awake procedure is presented for the treatment of severe lumbar foraminal stenosis in patients with lumbar radiculopathy after lumbar fusion.

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