scholarly journals Thoracic ossification of the ligamentum flavum causing acute myelopathy in a patient with cervical ossification of the posterior longitudinal ligament: illustrative case

2021 ◽  
Vol 2 (10) ◽  
Author(s):  
Kishan S. Shah ◽  
Christopher M. Uchiyama
Keyword(s):  
Ligamentum Flavum ◽  
Surgical Complication ◽  
East Asian ◽  
Posterior Longitudinal Ligament ◽  
Surgical Approaches ◽  
North American Population ◽  
Illustrative Case ◽  
Complication Rates ◽  
The North ◽  
Csf Leaks

BACKGROUND Ossification of the ligamentum flavum (OLF) has been well characterized as a distinct entity but also in tandem with ossification of the posterior longitudinal ligament (OPLL) in noncontiguous spinal regions. The majority of OLF cases are reported from East Asian countries where prevalent, but such cases are rarely reported in the North American population. OBSERVATIONS The authors present a case of a Thai-Cambodian American who presented with symptomatic thoracic OLF in tandem with asymptomatic cervical OPLL. A “floating” thoracic laminectomy, resection of OLF, and partial dural ossification (DO) resection with circumferential release of ossified dura were performed. Radiographic dural reexpansion and spinal cord decompression occurred despite the immediate intraoperative appearance of persistent thecal sac compression from retained DO. LESSONS Entire spinal axis imaging should be considered for patients with spinal ligamentous ossification disease, particularly in those of East Asian backgrounds. A floating laminectomy is one of several surgical approaches for OLF, but no consensus approach has been clearly established. High surgical complication rates are associated with thoracic OLF, most commonly dural tears/cerebrospinal fluid (CSF) leaks. DO commonly coexists with OLF, is recognizable on computed tomographic scans, and increases the risk of CSF leaks.

Ossification of the ligamentum flavum in a Caucasian man

2008 ◽  
Vol 9 (5) ◽  
pp. 427-437 ◽  
Author(s):  
Risheng Xu ◽  
Daniel M. Sciubba ◽  
Ziya L. Gokaslan ◽  
Ali Bydon
Keyword(s):  
Thoracic Spine ◽  
Clinical Presentation ◽  
Ligamentum Flavum ◽  
East Asian ◽  
Posterior Longitudinal Ligament ◽  
Documented Case ◽  
Asian Populations ◽  
Imaging Characteristics ◽  
Spinal Ligaments

Abnormal ossification of spinal ligaments is a well-known cause of myelopathy in East Asian populations, with ossification of the ligamentum flavum (OLF) and the posterior longitudinal ligament being the most prevalent. In Caucasian populations, OLF is rare, and there has been only 1 documented case of the disease affecting more than 5 spinal levels. In this report, the authors describe the clinical presentation, imaging characteristics, and management of the second published case of a Caucasian man with OLF affecting almost the entire thoracic spine. The literature is then reviewed with regard to OLF epidemiology, pathogenesis, presentation, and treatment.

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.

Surgical Management of Vestibular Schwannoma: Practice Pattern Analysis via NSQIP

2019 ◽  
Vol 129 (3) ◽  
pp. 230-237
Author(s):  
Vijay A. Patel ◽  
Mitchell Dunklebarger ◽  
Kalins Banerjee ◽  
Tom Shokri ◽  
Xiang Zhan ◽  
...  
Keyword(s):  
Surgical Management ◽  
Vestibular Schwannoma ◽  
Surgical Complication ◽  
Treatment Strategies ◽  
Surgical Approaches ◽  
Annual Number ◽  
Complication Rates ◽  
Entire Study ◽  
Acs Nsqip ◽  
Significant Difference

Objective: Characterize current perspectives in the surgical management of vestibular schwannoma (VS) to guide otolaryngologists in understanding United States practice patterns. Methods: A retrospective analysis of ACS-NSQIP database was performed to abstract all patients from 2008 to 2016 who underwent VS resection using ICD-9/10 codes 225.1 and D33.3, respectively. The specific surgical approach employed was identified via CPT codes 61520, 61526/61596, and 61591, which represent retrosigmoid (RS), translabyrinthine (TL) and middle cranial fossa (MCF) approaches, respectively. Analyzed outcomes include general surgical complications, total length of stay, and reoperation. Results: A total of 1671 VS cases were identified, 1266 (75.7%) were RS, 292 (17.5%) were TL, and 114 (6.8%) were MCF. The annual number of cases increased over the study period from 15 to 375, which is chiefly attributed to increased institutional participation in ACS-NSQIP. Perioperative variables including BMI ( P < .001), ASA class ( P = .004), ethnicity ( P = .008), operative time ( P < .001), and reoperation ( P < .001) were found to be statistically significant between cohorts. Increased utilization of RS approach was consistent over the entire study period, with significantly more RS performed than either TL or MCF. Finally, a statistically significant difference with respect to general surgical complication rates was not noted between surgical approaches. Conclusions: There is increased employment of RS approach for the operative management of VS, which likely is the result of increased reliance on both stereotactic radiosurgery and observation as alternative treatment strategies.

The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

2020 ◽  
Vol 32 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Surgical Complication ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Years Of Experience ◽  
Surgeon Experience ◽  
Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

scholarly journals The North Caucasus Region as a Blind Spot in the “European Green Deal”: Energy Supply Security and Energy Superpower Russia

Energies ◽  
2020 ◽  
Vol 14 (1) ◽  
pp. 17
Author(s):  
José Antonio Peña-Ramos ◽  
Philipp Bagus ◽  
Dmitri Amirov-Belova
Keyword(s):  
European Union ◽  
Energy Supply ◽  
Blind Spot ◽  
Illustrative Case ◽  
The European Union ◽  
North Caucasus ◽  
Strong Argument ◽  
The North ◽  
The Impact ◽  
Energy Supply Security

The “European Green Deal” has ambitious aims, such as net-zero greenhouse gas emissions by 2050. While the European Union aims to make its energies greener, Russia pursues power-goals based on its status as a geo-energy superpower. A successful “European Green Deal” would have the up-to-now underestimated geopolitical advantage of making the European Union less dependent on Russian hydrocarbons. In this article, we illustrate Russian power-politics and its geopolitical implications by analyzing the illustrative case of the North Caucasus, which has been traditionally a strategic region for Russia. The present article describes and analyses the impact of Russian intervention in the North Caucasian secessionist conflict since 1991 and its importance in terms of natural resources, especially hydrocarbons. The geopolitical power secured by Russia in the North Caucasian conflict has important implications for European Union’s energy supply security and could be regarded as a strong argument in favor of the “European Green Deal”.

scholarly journals 168 Interprosthetic Fractures of The Femur: A Literature Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Marzano ◽  
V Pace ◽  
F Milazzo ◽  
A Caraffa ◽  
P Antinolfi
Keyword(s):  
Femur Fracture ◽  
Classification Systems ◽  
Surgical Approaches ◽  
High Morbidity ◽  
Complication Rates ◽  
Management Guidelines ◽  
Stress Risers ◽  
Pubmed Database ◽  
Common Diagnosis ◽  
Surgical Options

Abstract Increasing age expectations and number of joint replacement procedures have made interprosthetic femoral fractures (IFF) a progressively more common diagnosis and a challenge for surgeons. A gold standard and universally accepted classifications and guidelines do not exist yet. Customized structured electronic searches performed in PubMed database. Relevant key terms: IFF, classification interprosthetic fracture, peri-implant femoral fracture, biomechanics interprosthetic femur fracture, radiographic femur fracture, risk factor IFF. 42 articles finally included (up to 2019). High morbidity and mortality linked to IFF. Standardised classifications, management guidelines and surgical approaches are not available yet. Periprosthetic classification systems are still utilized even if not entirely appropriate. High rate of failure is related to thinner cortical bone, larger medullary canals and variable stresses depending on the distance among implants. High complication rates in all studies. Stress risers and implant stability based on fracture patterns and stress forces. Several surgical options with no uniformity. Less invasive surgical procedures are associated to reduction of metalwork failure rate, better preservation of vascularization and better functional-clinical outcomes. Lack of specific classification systems and management guidelines. Several surgical options are available with no uniformity of results. Attention to stress risers and preservation of bone stock and vascularization are key aspects for better results.

scholarly journals Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

2021 ◽  
pp. 219256822199478
Author(s):  
Karim Shafi ◽  
Francis Lovecchio ◽  
Maria Sava ◽  
Michael Steinhaus ◽  
Andre Samuel ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Skeletal Dysplasia ◽  
Spinal Surgery ◽  
Cardiovascular Health ◽  
Surgical Complication ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Retrospective Case ◽  
Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

Factors for a Good Surgical Outcome in Posterior Decompression and Dekyphotic Corrective Fusion with Instrumentation for Thoracic Ossification of the Posterior Longitudinal Ligament: Prospective Single-Center Study

2017 ◽  
Vol 13 (6) ◽  
pp. 661-669 ◽  
Author(s):  
Shiro Imagama ◽  
Kei Ando ◽  
Kazuyoshi Kobayashi ◽  
Tetsuro Hida ◽  
Kenyu Ito ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Outcomes ◽  
Ligamentum Flavum ◽  
Posterior Longitudinal Ligament ◽  
Neurophysiological Monitoring ◽  
Posterior Decompression ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Estimated Blood Loss ◽  
Significant Factors

Abstract BACKGROUND Surgery for thoracic ossification of the posterior longitudinal ligament (T-OPLL) is still challenging, and factors for good surgical outcomes are unknown. OBJECTIVE To identify factors for good surgical outcomes with prospective and comparative study. METHODS Seventy-one consecutive patients who underwent posterior decompression and instrumented fusion were divided into good or poor outcome groups based on ≥50% and &lt;50% recovery rates for the Japanese Orthopaedic Association score. Preoperative, intraoperative, and postoperative findings were compared in the 2 groups, and significant factors for a good outcome were analyzed. RESULTS Patients with a good outcome (76%) had significantly lower nonambulatory rate and positive prone and supine position tests preoperatively; lower rates of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level, thoracic spinal cord alignment difference, and spinal canal stenosis on preoperative magnetic resonance imaging; lower estimated blood loss; higher rates of intraoperative spinal cord floating and absence of deterioration of intraoperative neurophysiological monitoring; and lower rates of postoperative complications (P &lt; .0005). In multivariate logistic regression analysis, negative prone and supine position test (odds ratio [OR]: 17.00), preoperative ambulatory status (OR: 6.05), absence of T-OPLL, ossification of the ligamentum flavum, high-intensity area at the same level (OR: 5.84), intraoperative spinal cord floating (OR: 4.98), and lower estimated blood loss (OR: 1.01) were significant factors for a good surgical outcome. CONCLUSION This study demonstrated that early surgery is recommended during these positive factors. Appropriate surgical planning based on preoperative thoracic spinal cord alignment difference, as well as sufficient spinal cord decompression and reduction of complications using intraoperative ultrasonography and intraoperative neurophysiological monitoring, may improve surgical outcomes.

scholarly journals Left-Sided Sigmoid Diverticulitis Presenting as Right-Sided Thigh Abscess

2013 ◽  
Vol 97 (4) ◽  
pp. 285-287 ◽  
Author(s):  
Patrick Bates Murphy ◽  
Paul Belliveau
Keyword(s):  
Diverticular Disease ◽  
Gastrointestinal Symptoms ◽  
Sigmoid Diverticulitis ◽  
North American Population ◽  
American Population ◽  
The North ◽  
Colocutaneous Fistula ◽  
Atypical Presentations ◽  
Thigh Abscess ◽  
Uncommon Complication

Abstract Acquired diverticular disease of the colon is very common in the North American population. Atypical presentations are usually due to complications and rarely the predominant complaint may be related to an associated fistula. Thigh abscesses due to colocutaneous fistula represent an uncommon complication of sigmoid diverticulitis. In rare cases, a thigh abscess may be the only symptom, but gas in the thigh should raise the index of suspicion for bowel pathology. We report the second known case of a left-sided sigmoid diverticulitis leading to an isolated right thigh abscess with no gastrointestinal symptoms.

scholarly journals Assessing Future Changes in the East Asian Summer Monsoon Using CMIP5 Coupled Models

2013 ◽  
Vol 26 (19) ◽  
pp. 7662-7675 ◽  
Author(s):  
Kyong-Hwan Seo ◽  
Jung Ok ◽  
Jun-Hyeok Son ◽  
Dong-Hyun Cha
Keyword(s):  
Summer Monsoon ◽  
East Asian Summer Monsoon ◽  
Asian Summer Monsoon ◽  
East Asian ◽  
Moisture Flux ◽  
Moisture Convergence ◽  
Cmip5 Models ◽  
Moisture Flux Convergence ◽  
The North ◽  
Asian Summer

Abstract Future changes in the East Asian summer monsoon (EASM) are estimated from historical and Representative Concentration Pathway 6.0 (RCP6) experiments of the fifth phase of the Coupled Model Intercomparison Project (CMIP5). The historical runs show that, like the CMIP3 models, the CMIP5 models produce slightly smaller precipitation. A moisture budget analysis illustrates that this precipitation deficit is due to an underestimation in evaporation and ensuing moisture flux convergence. Of the two components of the moisture flux convergence (i.e., moisture convergence and horizontal moist advection), moisture convergence associated with mass convergence is underestimated to a greater degree. Precipitation is anticipated to increase by 10%–15% toward the end of the twenty-first century over the major monsoonal front region. A statistically significant increase is predicted to occur mostly over the Baiu region and to the north and northeast of the Korean Peninsula. This increase is attributed to an increase in evaporation and moist flux convergence (with enhanced moisture convergence contributing the most) induced by the northwestward strengthening of the North Pacific subtropical high (NPSH), a characteristic feature of the future EASM that occurred in CMIP5 simulations. Along the northern and northwestern flank of the strengthened NPSH, intensified southerly or southwesterly winds lead to the increase in moist convergence, enhancing precipitation over these areas. However, future precipitation over the East China Sea is projected to decrease. In the EASM domain, a local mechanism prevails, with increased moisture and moisture convergence leading to a greater increase in moist static energy in the lower troposphere than in the upper troposphere, reducing tropospheric stability.

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