Background: The majority of ventriculoperitoneal (VP) shunt malfunctions are due to proximal catheter failure. Ideal placement of Ommaya reservoirs is desired to avoid toxicity from intraparenchymal chemotherapy infusion. Objective: To determine whether stereotactic placement of ventricular catheters decreases the rate of Ommaya reservoir complications and the rate of proximal VP shunt failure. Methods: Under institutional review board approval, areview of a prospectively collected database was doneidentifying all patients who underwent stereotactic-guided placement of VP shunts and Ommaya reservoirs performed by a single surgeon between November 2007 and November 2009. Neuronavigation was used to preset a surgical plan consisting of an ideal entry point (usually frontal) and target point (ipsilateral foramen of Monro). The navigation probe was passed along this trajectory. After removal of the navigation probe, pre-sized ventricular catheters were passed without a stylet along the created path. Post-operative CT scans and clinical follow-up were assessed. Results: 70 patients (mean age 44.6 years) underwent 52 VP shunt and 18 Ommaya reservoir placement procedures. Rigid cranial fixation was used in all cases. All catheters were placed in a single pass. Mean operative time was 62 min. Mean follow-up was 16.3 months. No proximal malfunctions or Ommaya complications have been seen thus far. One patient required repositioning of an Ommaya reservoir as post-operative CT showed poor placement (1.4%). One patient with hydrocephalus due to cryptococcal meningitis developed an abdominal abscess and required removal of his entire shunt with subsequent replacement. One patient was noted to have a small amount of intraventricular hemorrhage; this did not result in any clinical change and did not require any further intervention. No other surgical complications were noted. Conclusion: In terms of results corroborating decreased proximal malfunction rates, we present the largest series of stereotactic-guided ventricular catheter placements to date. Though time in the operating room is increased due to navigation registration, actual operative time is comparable to procedures without navigation. A longer-term follow-up is needed to assess the longevity of our positive short-term results.

No abstract

No abstract

No abstract

No abstract

Introduction
The extreme lateral interbody fusion technique (XLIF) is a modification of the retroperitoneal approach to the lumbar spine. This is a minimally invasive technique allowing direct access to the disc space without peritoneal or posterior paraspinal musculature damage. Nevertheless, the retroperitoneal part of the colon can be injured in this operative technique. To our knowledge, a study analyzing the anatomical considerations of the extreme lateral interbody fusion technique with regards to potential colon injuries has not been previously performed. Therefore, the aim of this study was to evaluate the potential risk of colon injuries during the extreme lateral approach to the lumbar spine.Materials and Methods
The extreme lateral approach to the lumbar spine was performed on four fresh-frozen cadaveric sides. K-wires were placed into the intervertebral discs and positioned at L1/L2, L2/L3, L3/L4, and L4/L5 levels. Next, the distances from the wires to the most posterior aspect of the adjacent ascending or descending colon were measured.
Results
The mean distance from the intervertebral disc space to the ascending or descending colon was 23.2 mm at the L2/L3 level, 29.5 mm at the L3/L4 level, and 40.3 mm at the L4/L5 level. The L1/L2 level was above the colon on both sides.
Conclusion
Our study quantified the relationship of the retroperitoneal colon during an extreme lateral interbody fusion approach. Our results, as well as previously described cases of bowel perforations, suggest a greater risk for colon injuries at the L2/3 and L3/4 levels.​​​​​​​

Our study details the first experience in a larger series regarding the effects of HAL-assisted treadmill training on quality of life. Whereas five out of six patients showed improvements in mobility scores, only one patient showed improvement of life quality at 6 months follow-up. Life quality is influenced by a multitude of factors and lager randomized trials are needed to assess the effect of HAL-assisted training on quality of life. Implications for Rehabilitation Treadmill training with HAL is safe and feasible for patients with neurologic disorders Treadmill training with HAL improved the functional mobility Improvements in the quality of life were unverifiable.

Study Design. Retrospective review. Objective. The aim of this study was to evaluate the feasibility, safety,s and complications of computer tomography (CT) fluoroscopy-guided percutaneous transpedicular gold fiducial marker insertion to reduce incidence of wrong-level surgery in the thoracic spine. Summary of Background Data. Intraoperative localization of the correct thoracic level can be challenging and time-consuming, especially in obese patients and patients with anatomical variations. In the literature there are very few studies containing low numbers of patients which assessed CT or CT fluoroscopy-guided fiducial marker placement of the thoracic spine. Description of this technique has been similarly scarce. Methods. All patients who underwent percutaneous CT fluoroscopy-guided gold fiducial marker placement of the thoracic spine were retrospectively reviewed. Indications for surgery included degenerative disc disease, infection, spinal metastasis, and intra- and extradural tumors. Gold fiducial markers were placed using a percutaneous CT fluoroscopy-guided transpedicular approach with local anesthesia. In addition, sex, age, body mass index (BMI), thoracic level, related pathology, and procedure-related complications were also recorded. Results. A total of 57 patients (24 females, 33 males) were included. Mean age was 58.6 ± 15.5 years. No complications during CT fluoroscopy-guided gold fiducial marker placement were recorded. Intraoperative localization was successful in all patients. Mean BMI was 32.98 kg/m2 (range, 18.63–56.03 kg/m2), and 63% of patients were obese (>30 kg/m2). T7 (n = 11) was the most often marked vertebral body, followed by T10 (n = 10) and T6 (n = 7). The most cranial and most caudal levels marked were T2 and T12, respectively. Conclusion. Preoperative CT fluoroscopy-guided percutaneous gold fiducial marker placement is safe, feasible, and accurate. The resulting facilitated localization of the intended thoracic level of surgery can reduce the length of surgery and prevent wrong-level surgery. Further studies are needed to evaluate in the effect on exposure to radiation and quantify the difference in operating room time. Level of Evidence: 4