The lexicon of multirod constructs in adult spinal deformity: a concise description of when, why, and how

The use of multirod constructs in the setting of adult spinal deformity (ASD) began to prevent rod fracture and pseudarthrosis near the site of pedicle subtraction osteotomies (PSOs) and 3-column osteotomies (3COs). However, there has been unclear and inconsistent nomenclature, both clinically and in the literature, for the various techniques of supplemental rod implantation. In this review the authors aim to provide the first succinct lexicon of multirod constructs available for the treatment of ASD, providing a universal nomenclature and definition for each type of supplementary rod. The primary rod of ASD constructs is the longest rod that typically spans from the bottom of the construct to the upper instrumented vertebrae. The secondary rod is shorter than the primary rod, but is connected directly to pedicle screws, albeit fewer of them, and connects to the primary rod via lateral connectors or cross-linkers. Satellite rods are a 4-rod technique in which 2 rods span only the site of a 3CO via pedicle screws at the levels above and below, and are not connected to the primary rod (hence the term “satellite”). Accessory rods are connected to the primary rods via side connectors and buttress the primary rod in areas of high rod strain, such as at a 3CO or the lumbosacral junction. Delta rods span the site of a 3CO, typically a PSO, and are not contoured to the newly restored lordosis of the spine, thus buttressing the primary rod above and below a 3CO. The kickstand rod itself functions as an additional means of restoring coronal balance and is secured to a newly placed iliac screw on the side of truncal shift and connected to the primary rod; distracting against the kickstand then helps to correct the concavity of a coronal curve. The use of multirod constructs has dramatically increased over the last several years in parallel with the increasing prevalence of ASD correction surgery. However, ambiguity persists both clinically and in the literature regarding the nomenclature of each supplemental rod. This nomenclature of supplemental rods should help unify the lexicon of multirod constructs and generalize their usage in a variety of scientific and clinical scenarios.

Pretarsal orbicularis oculi muscle tightening with skin flap excision in the treatment of lower eyelid involutional entropion

Background To evaluate a modified technique for involutional entropion correction in a retrospective cohort study. Methods The patients with involutional entropion eyelid were corrected by tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid. The patients received correction surgery from April 2013 to March 2019 were followed up for more than 6 months postoperatively. The outcome measures included the complications and the recurrence rates. Results Total 152 patients (169 eyes) were included. The mean follow-up period was 29.6 months (range: 6–36 months). Postoperative ectropion (over-correction) was observed in 1 patient with 1 eyelid (0.59%); yet, no further surgery was needed for this patient. Recurrence of entropion was found in 1 patient (0.59%). The patient with recurrent entropion received repeated surgery with the same method and achieved a good eyelid position. Conclusions This study demonstrated that tightening the pretarsal orbicularis oculi muscle and excising the excess skin of the lower eyelid could be an effective surgical method to correct lower eyelid involutional entropion. This method is technically easy with a low recurrence rate and not associated with significant complications in Asians.

Reactivation of herpes simplex labialis following adult spine deformity correction surgery

Background: A depressed host defense is a major contributor to the oral shedding of herpes simplex virus (HSV) type 1. Here, we present an instance in which herpes simplex labialis was reactivated following major spinal deformity surgery. Case Description: A 59-year-old female underwent spinal deformity correction for lumbar degenerative scoliosis. On postoperative days 2–3, she presented with pyrexia (38°C) and tachycardia (94/min); by day 5 she had multiple ulcers around her lips and was HSV IgG positive. She had a remote history of herpes simplex I infection 7 years previously. Once started on oral acyclovir, the lesions improved, and by day 15 postoperative, her pyrexia and all lesions completely resolved. Conclusion: HSV-1 should be suspected in patients with a previous history of HSV and postoperative pyrexia. Adequate prophylactic administration of acyclovir should result in resolution of these outbreaks, in this case, attributed to overly extensive spinal deformity surgery.

The Prevalence of Ocular Demodex folliculorum in 2253 Young Males The Prevalence of Ocular Demodex folliculorum

AimTo determine the prevalence and influencing factors of Demodex folliculorum (DF) in the eyelashes of healthy young males.MethodsAn epidemiological cross-sectional prevalence study was conducted. A total of 2253 healthy young males (aged 17-24 years) were studied for the presence of DF within eyelash follicles. The presence of DF was analyzed according to various factors.ResultsThe total prevalence of DF was 20.73% in our study. Subjects with history of myopia correction surgery had a statistically significant increase in the positive rate of DF (P<0.001). The positive rate was higher in subjects with ocular symptoms than in those without symptoms (P<0.05). Factors such as the educational level, long-term residence, annual household income, sleep time, time of using electronic products, smoke and drinking habits, had no significant correlation with the DF positive rate (all P>0.05). According to the multivariate logistic regression analysis, the history of myopic correction surgery was the risk factors of DF infection (P<0.001). There was no correlation between ocular discomfort and DF infection (P>0.05).ConclusionsThe prevalence of DF in eyelash follicles in healthy young men was relatively high. The history of myopic correction surgery was an important risk factor for the infection.

Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery

Background Intraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen. Results Intraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient. Conclusions Both dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA.

Corporoplasty in Peyronie’s Disease: a Literature Review

Corporoplasty is urological correction surgery for penile deviation that causes copulatory dysfunction or aesthetic discomfort. Penile deviation can be congenital or acquired (Peyronie’s disease, penile fracture). Congenital penile deviation is relatively rare and manifests in the curvature of erect penis ventrally and/or laterally, in most cases. According to many studies, patients with curvatures of 30° or more eventually seek surgical treatment. Congenital curvature may be mistaken for Peyronie’s disease for similar manifestations that, however, differ in aetiology and pathophysiology. Excisional, incisional corporoplasty or plication are commonly engaged to treat congenital curvatures, in various techniques and modifications. Augmentation transplantation (grafting) and penile prosthesis implantation with variant deviation treatment options are the usual practice in Peyronie’s disease. Unequivocal judgment of pros and cons in any particular technique is nevertheless implausible to make. This article aims to review current trends, protocols and their relative advantages in corporoplasty.