Value of N-Terminal Pro-Brain Natriuretic Peptide in Predicting Perioperative Complications Following Spine Surgery.
World Neurosurg. 2020 Jan;133:e784-e788
Authors: Acarbaş A
OBJECTIVE: The utility of preoperative biomarkers for assessing perioperative complications in patients undergoing spine surgery (SS) is unclear, and no study has assessed the ability of preoperative natriuretic peptides to predict adverse events following SS. This study aimed to evaluate the prognostic importance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients undergoing SS.
METHODS: We prospectively followed 154 consecutive adult patients ≥50 years old hospitalized for elective SS. The outcomes of interest were length of stay in hospital and perioperative medical complications during hospitalization, defined as pneumonia, deep or organ space surgical site infection, bacteremia, prolonged mechanical ventilation >48 hours, unplanned reintubation, acute renal failure, sepsis or septic shock, venous thromboembolism (deep vein thrombosis or pulmonary embolism), cardiac arrest, stroke, myocardial infarction, return to operating room, and in-hospital mortality.
RESULTS: In 21 (13.6%) patients, 32 episodes of medical adverse events occurred. Older patients and patients with more comorbid conditions, such as heart failure, diabetes, cerebrovascular disease, coronary artery disease, and chronic obstructive pulmonary disease, tended to have a higher rate of adverse events. Patients with adverse events had higher NT-proBNP and troponin levels on admission compared with patients without adverse events. Multivariate analysis showed that NT-proBNP >242 pg/ml (odds ratio 2.374; 95% confidence interval, 1.000-2.958; P = 0.001) and presence of diabetes (odds ratio 2.16; 95% confidence interval, 1.86-7.89; P = 0.008) were significant and independent predictors of perioperative adverse events.
CONCLUSIONS: This study demonstrates that preoperative NT-proBNP level in patients undergoing SS could be a valuable prognostic marker for several postoperative complications.
PMID: 31605859 [PubMed - indexed for MEDLINE]
Tailored Posterior-Only Approach for C2 Vertebral Body Lesions: Our Surgical Experience in 10 Patients.
World Neurosurg. 2020 Jan;133:e730-e738
Authors: Salunke P, Karthigeyan M, Rekhapalli R, Gupta K
BACKGROUND: C2 vertebral body (axis) lesions are often approached anteriorly and combined with posterior stabilization of the craniovertebral junction (CVJ). The anterior approach has its limitations. A posterolateral corridor is an alternative access to the C2 body lesions, and this alone may suffice in selected cases. We describe our experience with C2 body lesions, dealt primarily through a posterior approach, and propose an algorithm in the management of such cases.
METHODS: Ten patients with axis lesions were operated through a midline posterior approach followed by posterior stabilization of the CVJ in the same sitting. Their preoperative and follow-up clinico-radiologic details were reviewed.
RESULTS: The lesions included aneurysmal bone cysts (n = 2), fibrous dysplasia (n = 2), chordoma (n = 2), Ewing sarcoma (n = 1), metastases (n = 1), post-traumatic malunion (n = 1), and post-inflammatory deformity (n = 1). All patients presented with worsening neck pain. Five also had spastic quadriparesis. There were no perioperative complications. All showed clinical improvement at follow-up. Only 2 patients (chordoma: n = 1; aneurysmal bone cyst: n = 1) required an additional anterior procedure.
CONCLUSIONS: Adequate debulking or total excision of lesion, neural decompression, and stabilization of the CVJ for axis body lesions can be achieved through a single midline posterior approach in most cases. If required, an anterior approach may be later added depending on the final histopathology.
PMID: 31605844 [PubMed - indexed for MEDLINE]
Proximal Adjacent Segment Disease Manifesting as Retroodontoid Pseudotumor After Fusion to C2.
World Neurosurg. 2020 Jan;133:90-96
Authors: Li Y, Levi A
BACKGROUND: Although adjacent segment disease (ASD) following anterior cervical fusion has been well described in the literature, there is relative paucity of data on this pathology after posterior cervical fusion. To our knowledge, there have been no reported cases of proximal ASD following posterior fusion to C2.
CASE DESCRIPTION: We present 2 cases of proximal ASD presenting as retroodontoid pseudotumors following posterior fusion to C2, both in middle-aged females without history of rheumatologic disease. The first occurred in a patient with Klippel-Feil deformity 13 years after C2-6 posterior cervical fusion, the second in a patient 3 and a half years following revisional circumferential C2-T2 fusion. Both were successfully treated with proximal extension of laminectomy and fusion to the occiput, supplemented in the first patient by transdural decompression of retroodontoid mass.
CONCLUSIONS: Proximal ASD can manifest as retroodontoid pseudotumor at variable time intervals following posterior fusion to C2. Clinicians must account for this possibility in their decision making.
PMID: 31568901 [PubMed - indexed for MEDLINE]
Percutaneous Endoscopic Excision and Ablation of Osteoid Osteoma of the Lumbar Spine and Sacrum: A Technical Note and Outcomes.
World Neurosurg. 2020 Jan;133:121-126
Authors: Xie T, Xiu P, Song Y, Zeng J, Huang S
OBJECTIVE: This study aimed to present a new endoscopic technique for osteoid osteoma (OO) of the lumbar spine and sacrum and to evaluate its safety and effectiveness.
METHODS: Eleven consecutive patients with spinal OO underwent percutaneous endoscopic excision and ablation (PEEA) between March 2014 and May 2018. A cannula 0.7 cm in diameter was used for the procedure. According to the size of the nidus, whole-piece removal and piecemeal intralesional resection were used. Afterward, ablation was performed using an endoscopic radiofrequency electrode in the residual osteoma cavities. Clinical outcomes were assessed by Visual Analog Scale (VAS) scores. The efficacy of this technique was assessed using relevant clinical data and postoperative radiographs.
RESULTS: The niduses of the 11 patients were all located in the posterior element of the lumbar spine and sacrum (10 in the lumbar spine and 1 in the sacrum). The preoperative VAS score was 7.18 (range, 6-9), the score on postoperative day 1 was 1 (range, 0-2), and the last follow-up VAS score was 0.27 (range, 0-1). All patients were discharged within 24 hours after surgery. The mean follow-up period was 21.8 months (range, 12-36 months). No serious complications were observed during the follow-up period.
CONCLUSIONS: PEEA is a safe and effective technique for OO in the lumbar spine and sacrum in which the nidus is located in the posterior element. However, it has a steep learning curve. Further research with a larger and more comprehensive sample population is warranted.
PMID: 31562970 [PubMed - indexed for MEDLINE]
Posterior Percutaneous Endoscopic Technique Through Bilateral Translaminar Osseous Channels for Thoracic Spinal Stenosis Caused by Ossification of the Ligamentum Flavum Combined with Disk Herniation at the T10-11 Level: A Technical Note.
World Neurosurg. 2020 Jan;133:135-141
Authors: Liu L, Li Q, Ao J, Du Q, Xin ZJ, Liao WB
BACKGROUND: The occurrence rate of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation is lower than that of ossified ligamentum flavum in the thoracic spine, and the treatment method has rarely been reported. In this paper, we applied an endoscopic technique to a patient with thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation at the T10-11 level.
METHODS: We performed surgical decompression of the thoracic spinal cord for a patient diagnosed with thoracic spinal stenosis at the T10-11 level caused by ossification of the ligamentum flavum combined with disk herniation using percutaneous endoscopic surgery via the bilateral translaminar osseous channel approach. Pre- and postoperative computed tomography (CT) scan and magnetic resonance imaging (MRI) examinations were performed, and pre- and postoperative neurologic status was evaluated using the Modified Japanese Orthopaedic Association and visual analog scale scores.
RESULTS: The ossified ligamentum flavum and herniated disk material were removed through this osseous channel. Postoperative CT and MRI scanning revealed adequate decompression of the spinal cord at the T10-11 level. The patient was discharged home on postoperative day 3. At 6-month postoperative follow-up, the patient experienced complete resolution of T12 dermatomal numbness. The strength in her bilateral lower extremities improved slightly to grade 5.
CONCLUSIONS: We have applied percutaneous endoscopic surgery via bilateral translaminar osseous channels for the treatment of thoracic spinal stenosis caused by ossification of the ligamentum flavum combined with disk herniation. This surgery could provide sufficient decompression for thoracic spinal cord with minimum trauma.
PMID: 31505277 [PubMed - indexed for MEDLINE]
Importance of Spinal Alignment in Primary and Metastatic Spine Tumors.
World Neurosurg. 2019 Dec;132:118-128
Authors: Sankey EW, Park C, Howell EP, Pennington Z, Abd-El-Barr M, Karikari IO, Shaffrey CI, Gokaslan ZL, Sciubba D, Goodwin CR
Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.
PMID: 31476476 [PubMed - indexed for MEDLINE]
Heterotopic Bone Formation 20 Years After Gunshot Wound to the Cervical Spine: A Rare Cause of Progressive Cervical Myelopathy in a Previously Asymptomatic Patient.
World Neurosurg. 2019 Dec;132:197-201
Authors: Womack R, Luther E, Perez-Roman RJ, Manzano GR
BACKGROUND: Gunshot wounds are the most common etiology of penetrating spine injuries and have been increasing in incidence in civilian populations. Although these injuries typically result in severe neurologic deficits, operative intervention remains is controversial and is usually reserved for patients with neurologic deterioration, a persistent externalized cerebrospinal fluid fistula, mechanical instability, metallic toxicity, or a bullet location at high risk of migration.
CASE DESCRIPTION: A previously asymptomatic patient who had sustained a gunshot wound to the cervical spine 20 years previously presented with new-onset progressive myelopathy and radiculopathy secondary to heterotopic ossification (HO) surrounding the retained bullet fragments near the left lateral masses of C5-T1. Computed tomography myelography demonstrated no cranial migration of contrast material past this region of the spine, suggesting severe spinal canal stenosis. Intraoperatively, bullet shrapnel and heterotopic bone fragments were found within the central canal causing compression of the spinal cord. Following decompression and stabilization, the patient had complete resolution of his symptoms and returned to his neurologic baseline. Although HO has been reported as a complication following through and through gunshot wounds, there is a paucity of literature discussing HO formation around retained bullet fragments in the spine.
CONCLUSIONS: HO surrounding retained bullet fragments in the spine is a rare cause of progressive neurologic deterioration following gunshot wounds. Surgical excision of the shrapnel and heterotopic bone can lead to symptomatic relief, and therefore surgery should be considered as a treatment option in carefully selected patients.
PMID: 31450001 [PubMed - indexed for MEDLINE]
Could the Splitting of the Annulus During Percutaneous Endoscopic Lumbar Diskectomy (PELD) Be a Culprit for Recurrent Disk Herniation?: An Analysis of the Reherniation Pattern After PELD.
World Neurosurg. 2019 Dec;132:e623-e629
Authors: Lee JH, Choi KC, Lee JH
OBJECTIVE: To explore which preoperative radiologic variables have propensity for reherniation and to evaluate whether the inherent annulus splitting procedure during percutaneous endoscopic lumbar diskectomy (PELD) could prompt reherniation, we assessed the correlation between the anatomic location of annular penetration and reherniation.
METHODS: Three hundred and fifty patients who underwent PELD for central or subarticular disk herniation through a transforaminal approach were followed-up for at least 24 months. Fifty-four subjects that were reoperated for recurrent herniation were allocated as the reherniation group and the other 296 subjects were allocated as the non-reherniation group. The numerical rating scale score, another lumbosacral disk herniation (LDH) lesion in addition to the PELD level (another LDH), location (central or subarticular) and severity of LDH (protrusion or extrusion), and tear of the posterior longitudinal ligament (PLL) were compared between the 2 groups to identify which variables could be predictive factors for reherniation. To assess the influences of PELD on reherniation, location and severity of reherniation were compared with those of initial herniation.
RESULTS: The location at the subarticular region and the existence of a concomitant PLL tear during initial LDH were significantly related to subsequent reherniation. The location and severity of these reherniations were significantly retained when compared with those of primary herniation.
CONCLUSIONS: PLL tear and subarticular herniation were significantly related to recurrent disk herniation. Reherniation patterns after PELD generally matched those of primary herniation. The annulus penetrating step during PELD did not increase the risk of reherniation.
PMID: 31442646 [PubMed - indexed for MEDLINE]