Background and purposeInter-hospital transfer for mechanical thrombectomy (MT) might result in the transfer of patients who finally will not undergo MT (ie, futile transfers [FT]). This study evaluated FT frequency in a primary stroke center (PSC) in a semi-rural area and at 156 km from the comprehensive stroke center (CSC).MethodologyRetrospective analysis of data collected in a 6-year prospective registry concerning patients admitted to our PSC within 4.5 hours of acute ischemic stroke (AIS) symptom onset, with MR angiography indicating the presence of large vessel occlusion (LVO) without large cerebral infarction (DWI-ASPECT ≥5), and selected for transfer to the CSC to undergo MT. Futile transfer rate and reasons were determined, and the relevant time measures recorded.ResultsAmong the 529 patients screened for MT, 278 (52.6%) were transferred to the CSC. Futile transfer rate was 45% (n=125/278) and the three main reasons for FT were: clinical improvement and reperfusion on MRI on arrival at the CSC (58.4% of FT); clinical worsening and/or infarct growth (16.8%); and longer than expected inter-hospital transfer time (11.2%). Predictive factors of FT due to clinical improvement/reperfusion on MRI could not be identified. Baseline higher NIHSS (21 vs 17; P=0.01) and lower DWI-ASPECT score (5 vs 7; P=0.001) were associated with FT due to clinical worsening/infarct growth on MRI.ConclusionsIn our setting, 45% of transfers for MT were futile. None of the baseline factors could predict FT, but the initial symptom severity was associated with FT caused byclinical worsening/infarct growth.

IntroductionVideosurgery is widely used in gynecology, abdominal and general surgery. The main success with this technique has been obtained in surgery of the gall bladder, where it provides better results than the classic procedure [14]. In addition to laparoscopy, the technique of retroperitoneoscopy has been developed and has been used in several diagnostic and therapeutic procedures. In vascular surgery retroperitoneoscopy has been employed for lumbar sympathectomy [3], allowing dissection close to the lumbar spine. In orthopedic surgery, videoscopic procedures have been used mainly in arthroscopy, but videoscopic techniques have also been successfully applied to surgery of the spine, first via laparoscopy at the lumbosacral level [9,12], then via thoracoscopy at the thoracic level [7,12,13]. With the development of lumbar retroperitoneal, thoracolumbar retroperitoneal, and retropleural approaches, all segments of the thoracic and lumbar spine can now be reached by the videoscopic method. Retroperitoneal surgery on lumbosacral segments has also been developed on lumbosacral segments and has several advantages [10]. Various techniques are used, but the aim is always to diminish the parietal lesion and increase the tolerability of the anterior surgery. In this paper we present techniques for lumbar and thoracolumbar retroperitoneal approaches and report on our 5 years' clinical experience. Materials and patients Lumbar approachWe use a left-side video-assisted retroperitoneal approach. The patient is placed in a right lateral position. This technique is used to Abstract Retroperitoneal videoscopic spine surgery has been developed in our department since 1994. It has been used not only at the lumbar, but also at the thoracolumbar and lumbosacral level. Thirty-eight patients have been operated on. We have performed 12 thoracolumbar approaches, 23 lumbar approaches, and 3 retroperitoneal lumbosacral approaches. In every case, a video-assisted technique has been employed. These techniques have been used for anterior grafting in 18 cases of fracture, for corporectomy and grafting with or without anterior osteosynthesis in 6 cases of malunion, for cage implantation or isolated grafting in 10 cases of degenerative disc disease, and for the treatment of 4 cases of spondylodiscitis. Results were satisfactory for every type of pathology. The complications related to the approach were the same as those seen with open surgery; however, the videoscopic approach seems to us less invasive, with cosmetic benefit, less blood loss, and more rapid recovery. A video-assisted technique appears to be a good compromise between videoscopic technique and open surgery. With the development of these techniques, few indications remain for open anterior surgery on the lumbar spine in our opinion.

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