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Impartial Vs . Transtibial Drilling throughout Anterior Cruciate Plantar fascia Renovation: The Meta-analysis Using Meta-regression.
OBJECTIVE This study sought to; 1) describe the use 'K-wireless' pedicle screw insertion among adults (age ≥ 18) undergoing a minimally-invasive fusion and 2) perform a systematic review (SR) of all studies that describe a navigated, 'K-wireless' technique with 3D fluoroscopy. METHODS Patients undergoing a minimally invasive fusion requiring pedicle screw fixation for any indication were prospectively enrolled in the observational component of this study. click here An assessment of pedicle breach was performed independently and in duplicate based on a modification of the Belmont grading scale. Articles for the SR were identified from a structured search of MEDLINE from inception to 05/08/2019 without restriction of language. RESULTS A total of 82 pedicle screws were placed in 20 patients who underwent surgery between January and June 2014. There was no significant difference in mean operative time between the cases included in this study and a matched cohort of 20 patients undergoing surgery with 2D-fluoroscopy and K-wire assisted pedicle screw placement (95±13mins vs 87±20mins; p>0.05). There were two major pedicle breaches (Belmont grade 3) in a single patient, yielding a major breach rate of 2.44%. A total of six articles that described the placement of 700 pedicle screws in 160 patients between May 2011 and March 2017 were included in the SR. The overall breach rate was 7.00% (n=37). CONCLUSIONS Percutaneous pedicle screws can be placed accurately and safely using three-dimensional navigation without the use of K-wires and may confer benefits to patients and clinicians by reducing K-wire associated complications and radiation exposure. Late radiation necrosis is a rare entity presenting in 2.2 to 9 % of radiation treated AVMs. It occurs by a mean of 3 years following treatment. There are few reports in the literature of radionecrosis and solid lesions treated with surgery.1-4 To the author´s knowledge this case has the longest time interval between radiosurgery and the presentation of cerebral necrosis. In this surgical video, we present the case of a 51-year-old female with a left supramarginal gyrus AVM that received radiosurgery with gammaknife, and after 20 years she started with seizures and aphasia. The MRI revealed a lesion simulating an intra-axial tumor causing important edema and mass effect. Medical treatment was given including high-dose steroids without success, therefore microsurgery was performed. The surgery was presented in a step-by-step basis and correlation was performed with the involved adjacent anatomy, to illustrate the anatomy of the approach and surgical landmarks. The patient symptoms recovered completely, and the postoperative MRI showed complete resection and resolution of the edema. The histopathological findings were consistent with a radionecrosis and AVM. The patient signed the Institutional Consent Form, which states that he/she accepts the procedure and allows the use of her images and videos for any type of medical publications in conferences and/or scientific articles. BACKGROUND The anterior-only approach could not provide strong fixation whereas the posterior surgery could not clear up the lesions completely. The method combining anterior and posterior approaches to treat the atlantoaxial tuberculosis is advisable. OBJECTIVE To evaluate the effectiveness of anterior transoral debridement combined with posterior fixation and fusion for atlantoaxial tuberculosis. METHODS The clinical data of 20 patients with atlantoaxial tuberculosis who underwent the surgery of anterior transoral debridement combined with posterior fixation and fusion in our hospital were retrospectively analyzed. Antituberculosis drugs were administered for 18 months after surgery. Neurological status, clinical symptoms, fusion, reduction, and complications were all evaluated. RESULTS Surgeries for 20 cases were performed successfully with no injury of spinal cord, nerve and blood vessel. Clinical symptomatic relief was presented on 20 patients (100%). The improvement of postoperative Japanese Orthopaedic Association score, occipitocervical visual analog scale and atlanto-dental interval were significant (P less then 0.05). The average follow-up duration was 33 months (range 24-48 months). Bony fusion was achieved in all 20 cases. No serious complications were documented during follow-up. CONCLUSIONS Anterior transoral debridement combined with posterior fixation and fusion is an effective treatment for atlantoaxial tuberculosis, which plays an important role in removing the lesions and restoring stability. BACKGROUND brown tumors (BT) represent the typical non-malignant lesions of hyperparathyroidism. Mandibles, ribs and large bones are the most usual localization of BT. The diagnosis of these tumors requires biological and radiological assessments. Their treatment is essentially based on parathyroidectomy. CASE DESCRIPTION the present case report describes a patient with primary hyperparathyroidism who developed a cervical BT revealed by slow spinal compression. CONCLUSION the brown tumor when it is localized at the level of the spine can be life-threatening and must be managed as soon as possible. BACKGROUND Resection of an antero-lateral intramedullary lesion requires an approach that best provides a direct in-line access to the part of the lesion that presents at the pial surface which enables a total removal without injuring the spinal tracts. METHOD In this video we show the technique of resection of an antero-lateral intramedullary cavernoma. The vertebral level was identified before surgery, with coils placed percutaneously within the pedicle. A partial unilateral postero-lateral approach was realised. A posterolateral durotomy was performed, the arachnoid was opened and hitched up with stay sutures. The dentate ligament was identified, cut and then turned medially with a stitch to allow a gentle rotation of the spinal cord to enable visualisation of the antero-lateral surface of the cord. This allowed to bring the anterolateral subpial part of the lesion to a relatively more postero-lateral position. A pial stitch was used to enhance and maintain the visualisation of the lesion. The cavernoma was dissected circumferentially and removed in-toto.
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