Chiari malformation type 1 (CM-1) is an ectopia of the cerebellar tonsils below the foramen magnum that causes severe disability due to its neurologic symptoms. The treatment of choice for CM-1 is decompression of the craniovertebral junction (CVJ). In some patients only an extradural decompression by removing the atlanto-occipital ligament may be sufficient. In other patients, duraplasty is necessary. In this case, we report the operative technique used to treat a CM-1 in a 16-year-old male patient who presented with severe headache and gait instability. A micro-decompression of the suboccipital bone and posterior arch osteotomy of C1 through a 2-cm midline incision was performed under surgical microscope magnification. A duraplasty was performed through the same approach. The patient was discharged home after 2 days in the hospital and returned to regular activities at school 3 weeks after surgery. The minimally invasive technique presented here is a viable option for the posterior decompression of the CVJ in patients with CM-1 using a low-cost self-retaining retractor.
Background: Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has become one of the standard techniques for approaching ipsilateral decompression, anterior column fusion, and posterior stabilization. This procedure is usually accompanied by the placement of bilateral transpedicular screws in the corresponding segment. The purpose of this study was to evaluate the clinical efficacy of unilateral screw fixation compared with bilateral fixation in patients diagnosed with low-grade symptomatic lumbar spondylolisthesis who underwent an MI-TLIF technique.Methods: A prospective and comparative study was performed in 67 patients with grade 1 symptomatic lumbar spondylolisthesis. The sample was allocated on both unilateral fixation group (n=33) and bilateral fixation group (n=34). Clinical outcomes were evaluated using Oswestry Disability Index (ODI), visual analogue scale (VAS) for leg and back pain, and Short Form 36 Health Survey (SF-36), preoperatively, and at 1, 3, 6, and 12 months postoperatively. Changes over time and differences between the groups were analyzed. Statistical analyses included: Friedman test, Student's t-test and Mann-Whitney's U. A two-tailed P value of <0.05 was considered significant.Results: During 1-year of evaluation there were no significant clinical differences between both groups.Conclusions: Patients with grade 1 symptomatic lumbar spondylolisthesis treated with MI-TLIF with unilateral screw fixation had similar clinical results than those treated with bilateral fixation at 12 months postoperatively.
The principal advantage of intraoperative spinal navigation is the ease of screw placement. However, visualization and the integration of navigation can be explored with the use of navigation-guided full-endoscopic techniques.
To describe the stepwise intraoperative navigation-assisted unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) technique and to present our preliminary results in a Mexican population.
A 10-step summary of the UBE-TLIF operative technique was described, and the clinical and radiological results are presented and analyzed.
A total of 7 patients were treated. We observed the value of integrating navigation and endoscopic visualization when decompression had to be performed.
Together, intraoperative navigation and direct visualization through the endoscope may be a useful surgical tool for surgeons with experience in endoscopic spinal surgery.
Various minimally invasive techniques have been reported as an alternative to conventional lumbar decompression. The major advantage of these minimally invasive procedures lies in their reduction of unnecessary exposure and tissue trauma. Our objective was to describe a minimally invasive procedure for lumbar spinal stenosis decompression by enlarging the lumbar interspinous space, approaching it with a tubular retractor, and assisting with microscopy. Thoracolumbar fascia and paravertebral muscles are preserved throughout the whole procedure. Iatrogenic instability of the spine can be avoided if during the procedure both joints are just undercut in order to decompress the subarticular space. The approach described in this manuscript could be used as an alternate minimally invasive surgical procedure for the treatment of central and lateral lumbar spinal stenosis.
Anterior cage migration is the most infrequent and dangerous complication seen in posterior lumbar interbody fusion (PLIF) procedures. We report the case of a 74-year-old woman who underwent PLIF at the L5-S1 level. During the surgery, one of the PLIF-cages dislodged anteriorly into the abdominal cavity without vascular injury. An anterior retroperitoneal approach to remove the cage and complete the fusion was made. The patient was discharged 2 weeks later with encouraging clinical results. In a patient hemodynamically stable, removing the cage by a vascular surgeon, and complete the Anterior Lumbar Interbody Fusion could be a feasible option at L5-S1.
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