Surgical Techniques Development

The operative management of complex abdominal wall hernias in nonagenarians entails significant risk, with emergent repair associated with mortality rates approaching 40%. We report the case of a functionally independent 90-year-old male presenting with a 48 h history of abdominal pain, obstipation, and emesis, consistent with an acute-on-chronic incarcerated ventral hernia. Despite advanced age and elevated perioperative risk, multidisciplinary evaluation supported surgical intervention. Laparotomy revealed a 22 × 18 cm hernia sac harboring an elongated sigmoid and approximately 150 cm of small intestine with signs of compromised perfusion secondary to an internal constriction band. Following adhesiolysis and decompression, bowel viability was restored, and a mesh repair was performed. The postoperative course was notable for transient respiratory failure necessitating reintubation and ICU management; however, full recovery was achieved by one-month follow-up. This case demonstrates that comprehensive assessment, rather than chronological age, should guide operative decision-making in nonagenarians and underscores the feasibility of complex abdominal wall reconstruction in this cohort when supported by multidisciplinary care and perioperative resources.

Background and objective: Heterotopic ossification (HO) of the plantar fascia is an exceptionally rare condition, with only a few cases mentioned in the literature. In comparison, calcification of the fascia occurs more frequently, especially in cases of chronic plantar fasciitis. Tenex™, a percutaneous ultrasonic tenotomy system initially designed for tendinopathy treatment, may offer a minimally invasive alternative to conventional surgery in selected cases of HO. So, the aim of this case report was to assess the improvement in the pain and in the foot function after a percutaneous ultrasonic debridement. Case presentation: We present the case of an 82-year-old male with a history of hypertension and hyperuricemia, who reported a two-year history of mechanical-type plantar pain described as “walking on a stone.” Radiographs and MRI confirmed heterotopic ossification at the central component of the plantar fascia. Pain and function were assessed with the Foot Function Index (FFI). Under ultrasound and fluoroscopic guidance, percutaneous ultrasonic debridement with Tenex™ was performed following tibial and sural nerve block and conscious sedation. The procedure was completed in 6 min and 29 s of cutting time. After surgery, the patient wore a protective shoe for 3 weeks, followed a relative rest protocol, and received NSAIDs for 5 days. At 48–72 h, the patient reported noticeable pain relief, with significant functional improvement after 1 month. Conclusions: This case shows how Tenex™ effectively treats plantar fascia HO. It led to quick symptom relief and functional recovery. The ultrasonic percutaneous debridement with Tenex™ was a safe and effective option compared to open surgery for this patient. However, more research is needed to set standardized treatment protocols and assess long-term results.

Background/Objectives: A variety of techniques for pedicle screw placement exist. Efficiency claims have varied, but limited data are available to support or refute these claims. Our goal was to study our screw placement efficiency, reporting real-time screw placement using O-arm 3D navigation. Methods: We prospectively enrolled patients from July 2019 to February 2022 who were undergoing primary procedures involving thoracolumbar pedicle and pelvic screw placement with O-arm navigation. Screw time began at the first placement of the navigated probe/awl and ended once the navigated screwdriver was removed from the screw head. Confirmatory 3D scans were performed to assess all screw placements. Results: The real-time average to place pedicle screws was 2 min 9 s (SD ± 1 min 5 s); for pelvic screws, this was 3 min 36 s. Screw placement was slightly faster in pediatric patients (2 min 3 s) vs. adults (2 min 24 s), p < 0.001. Screw placement was faster in the thoracic spine (2 min 2 s) vs. the lumbosacral spine (2 min 22 s), p < 0.001. Screw placement was faster in adolescent idiopathic scoliosis (2 min 0 s) vs. all other diagnoses (2 min 24 s), p < 0.001. Screw placement performed by a single attending surgeon (2 min 24 s) was no different from dual-surgeon placement(2 min 13 s), p = 0.35. Conclusions: Our screw placement time is shorter than previously published estimates, and has a very high accuracy rate. While there are variations in how time is reported compared to the previous literature, our study serves as a benchmark for real-time screw placement for future studies. The use of navigation technology for pedicle and pelvic screw placement can be efficient.