The inflatable bone tamp was efficacious in the treatment of osteoporotic vertebral compression fractures. Kyphoplasty is associated with early clinical improvement of pain and function as well as restoration of vertebral body height in the treatment of painful osteoporotic compression fractures.

Object. Despite a history of safety and efficacy, spinal anesthesia is rarely used in lumbar surgery. Application of regional anesthetics is widely preferred for lower-extremity surgery, but general anesthesia is used almost exclusively in spine surgery, despite evidence that spinal anesthesia is as safe and may offer some advantages. Methods. In this case-controlled study the authors analyzed outcomes obtained in 400 patients in whom either spinal anesthesia or general anesthesia was induced to perform a lumbar decompression. Patients were matched for anesthesia-related class, preoperative diagnosis, surgical procedure, and perioperative protocols. All aspects of surgery, recovery, postanesthesia care, and pain management were uniform irrespective of the anesthetic type. Case complexity was equivalent. An independent observer performed analysis of the data. Data from the intraoperative period through hospital discharge were collected and compared. Two hundred consecutive patients meeting inclusion criteria were included in each group. Patients were treated for either lumbar stenosis or herniated nucleus pulposus. Demographically, both groups were well matched. Anesthetic and operative times were longer for patients receiving a general anesthetic (p < 0.05), in whom more nausea and greater requirements for antiemetics and pain medication were also present during recovery (p < 0.05). Overall complication rates and, specifically, the incidences of urinary retention were significantly lower in spinal anesthesia—induced patients (p < 0.05). There were no neural injuries in either group, and the incidence of spinal headache was lower in patients receiving a spinal anesthetic (1.5% compared with 3%). Conclusions. Spinal anesthesia was as safe and effective as general anethesia for patients undergoing lumbar laminectomy. Potential advantages of spinal anesthsia include a shorter anesthesia duration, decreased nausea, antiemetic and analgesic requirements, and fewer complications. Successful surgery can be performed using either anesthesia type.

Interactive frameless stereotaxy has been successfully applied to intracranial surgery. It has contributed to the improved localization of deep-seated brain lesions and has demonstrated a potential for reducing both operative time and morbidity. However, it has not been as effectively applied to spinal surgery. The authors describe the application of frameless stereotactic techniques to spinal surgery, specifically pedicle screw fixation of the lumbosacral spine. Preoperative axial computerized tomography (CT) images of the appropriate spinal segments are obtained and loaded onto a high-speed graphics supercomputer workstation. Intraoperatively, these images can be linked to the appropriate spinal anatomy by a sonic localization digitizer device that is interfaced with the computer workstation. This permits the surgeon to place a pointing device (sonic wand) on any exposed spinal bone landmark in the operative field and obtain multiplanar reconstructed CT images projected in near-real time on the workstation screen. The images can be manipulated to assist the surgeon in determining the proper entry point for a pedicle screw as well as defining the appropriate trajectory in the axial and sagittal planes. It can also define the correct screw length and diameter for each pedicle to be instrumented. The authors applied this device to the insertion of 150 screws into the lumbosacral spines of 30 patients. One hundred forty-nine screws were assessed to be satisfactorily placed by postoperative CT and plain film radiography. In this report the authors discuss their use of this device in the clinical setting and review their preliminary results of frameless stereotaxy applied to spinal surgery. On the basis of their findings, the authors conclude that frameless stereotactic technology can be successfully applied to spinal surgery.

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A technique is described for insertion of a cannula in the dorsal aorta of salmon for long-term blood sampling or vascular injection while the fish is confined, but free-swimming. Previous methods for single injections into the dorsal aorta are improved by a modified cannulation technique. The practicality of the technique was tested by introducing Evans Blue (T-1824) into the dorsal aorta of immature pink salmon (Oncorhynchus gorbuscha) in sea water and mature sockeye salmon (O. nerka) in fresh water to make preliminary estimates of blood volumes. It was shown that the technique can also be applied to angiography of salmon.

It is important for the surgeon to be aware of this potential complication and to inform patients who have diplopia that develops from abducens nerve palsy that most of these cranial nerve deficits spontaneously improve.