Search Results (24)

Background/Objectives: Spinal muscular atrophy (SMA) is a neuromuscular disorder frequently associated with progressive scoliosis requiring posterior spinal fusion (PSF). While Nusinersen offers significant clinical benefit, its intrathecal administration is challenging in patients with extensive spinal instrumentation and solid fusion. This study aimed to evaluate the safety, feasibility, and patient acceptance of lumbar laminectomy as a method to restore intrathecal access for repeated Nusinersen delivery in this population. Methods: A retrospective review was conducted in eleven patients with SMA who underwent lumbar laminectomy following prior PSF and confirmed radiographic fusion. Surgical data, injection outcomes, and patient-reported experiences were collected. A structured questionnaire assessed technical success, imaging requirements, sedation, functional response, and satisfaction. Results: Nine out of eleven patients (81.8%) successfully initiated intrathecal Nusinersen therapy through the laminectomy window, receiving a mean of 11.7 injections (range: 10–14). Imaging guidance was used in five cases; three required sedation or anesthesia. Intraoperative dural tears occurred in three patients and were managed without complications. Eight out of nine treated patients reported subjective motor improvement and expressed willingness to undergo the procedure again. No hardware revisions or major adverse events were observed during a mean follow-up of 48.8 months. Conclusions: Lumbar laminectomy is a viable and well-tolerated technique to establish intrathecal access in SMA patients with prior PSF. This approach enables sustained drug delivery and may remain clinically relevant as new intrathecal therapies emerge. Full article

Objectives: This study aims to identify clinical characteristics and biomarkers influencing survival outcomes in colorectal cancer (CRC) patients with spinal metastases. Methods: We conducted a retrospective cohort study involving 27 patients treated for CRC-derived spinal metastases at Johns Hopkins Hospital. Data on demographics, biomarker profiles of the primary colorectal tumor site, surgical outcomes, and survival were collected. Neurological function was assessed pre- and postoperatively using Frankel scores. Survival outcomes included overall survival (OS) and post-metastasis survival. Results: The median age of the patients was 58 years, with 63% being women. The sacral spine was the most frequently involved site (59.3%), followed by the thoracic and lumbar regions. Most patients (89%) already had extraspinal metastases, predominantly in the lungs. Biomarker analysis showed microsatellite stability in 63% of patients and CDX2 (Caudal-type homeobox 2) expression in 37%. Laminectomy was performed in 85% of cases and sacrectomy in 55.6%, leading to postoperative improvements in ambulatory function and neurological status. The main indications included local recurrence of the tumor and neurological deficits attributed to the impinging tumor. The median overall survival was 4.9 years, while the median post-metastasis survival was 3.0 years. Univariable analysis revealed that CK20 expression (p = 0.041) and spinal tumor recurrence (p = 0.045) were significantly associated with shorter post-metastasis survival. Conclusions: This study highlights the prognostic importance of CK20 expression and spinal tumor recurrence in CRC patients diagnosed with spinal metastases. Surgical intervention significantly improved neurological outcomes, enhancing patient quality of life. Further research with larger cohorts is needed to confirm these findings and optimize treatment strategies for this challenging patient population. Full article

Background/Objectives: Synthetic polyethylene glycol (PEG)-based hydrogel sealants, such as Adherus, are commonly used in spinal surgeries to achieve watertight dural closure and prevent cerebrospinal fluid (CSF) leaks. This case report describes an unusual instance of suspected hydrogel sealant migration resulting in an intradural collection at a spinal level remote from the original surgery. Methods: A 57-year-old female with a history of osteoarthritis and prediabetes underwent a minimally invasive L5-S1 laminectomy for the removal of an epidural abscess causing cauda equina and S1 nerve root compression. During the procedure, a dural puncture occurred, which was repaired using Duragen (collagen matrix) and Adherus (synthetic PEG hydrogel sealant). Postoperatively, the patient developed urinary retention and new bilateral posterior leg pain. An MRI on postoperative day four revealed a new peripherally enhancing dorsal intradural collection at the L2 level, causing significant thecal sac narrowing and compression of the cauda equina nerve roots, suggestive of migration of the hydrogel sealant used during surgery. Conservative management was adopted. Results: The patients symptoms gradually resolved. Follow-up imaging at five months showed resolution of the intradural collection, with residual intradural inflammatory changes and arachnoiditis. Conclusions: While PEG-based hydrogel sealants like Adherus are effective in preventing CSF leaks, they can, in rare instances, migrate and cause remote intradural collections with neurological symptoms. Surgeons should exercise meticulous application techniques, thoroughly document the use of sealants, and maintain vigilant postoperative monitoring to mitigate these risks. Full article

Background: This study aims to retrospectively detect associations with postoperative complications in spinal surgeries during the hospitalization period using standardized, single-center data to validate a method for complication detection and discuss the potential future use of generated data. Methods: Data were generated in 2006–2019 from a standardized, weekly complications conference reviewing all neurosurgical operations at the University Hospital Luebeck. Paper-based data were recorded in a standardized manner during the conference and transferred with a time delay of one week into a proprietary complication register. A total of 5575 cases were grouped based on the diagnosis, surgical localization, approach, instrumentation, previous operations, surgery indication, age, ASA score, and pre-existing conditions. Retrospective analysis was performed using a logistic regression detecting complication associations. The results were compared to the literature validating the method of complication detection. Results: Mean cohort age: 58.83 years. Overall complication rate: 10.9%. Mortality rate: 0.25%. The statistically significant complication associations were age; an age of >60; the localization (cervical, thoracic); a cervical tumor or trauma diagnosis; lumbar degenerative conditions, tumor, trauma, or infection; a cervical hemi-/laminectomy and vertebral body replacement; a lumbar hemi-/laminectomy, posterior spondylodesis, and 360° fusion; lumbar instrumentation, with an ASA score of three and four; a ventral and combined/360° approach; a lumbar combined/360° revision; two, three and ≥four pre-existing conditions; hypertension; osteoporosis; arrhythmia; an oncological condition; kidney dysfunction; stroke; and thrombosis. Conclusions: Documenting risk profiles for spinal procedures is important in identifying postoperative complications. The available data provide a comprehensive overview within a single center for spinal surgeries. Standardized complication recording during an established complication conference in the clinical routine enables the detection of significant complications. It is desirable to standardize the registration of postoperative complications to facilitate comparability across different institutions. The results may contribute to national or international databases used for automated AI risk profiling. Full article

Avoiding epidural adhesion following spinal surgery can reduce clinical discomfort and complications. As the severity of epidural adhesion is positively correlated with the inflammatory response, implanting a fibrous membrane after spinal surgery, which can act as a physical barrier to prevent adhesion formation while simultaneously modulates postoperative inflammation, is a promising approach to meet clinical needs. Toward this end, we fabricated an electrospun core–shell fibrous membrane (CSFM) based on polylactic acid (PLA) and infused the fiber core region with the potent natural anti-inflammatory compound docosahexaenoic acid (DHA). The PLA/DHA CSFM can continuously deliver DHA for up to 36 days in vitro and reduce the penetration and attachment of fibroblasts. The released DHA can downregulate the gene expression of inflammatory markers (IL-6, IL-1β, and TNF-α) in fibroblasts. Following an in vivo study that implanted a CSFM in rats subjected to lumbar laminectomy, the von Frey withdrawal test indicates the PLA/DHA CSFM treatment can successfully alleviate neuropathic pain-like behaviors in the treated rats, showing 3.60 ± 0.49 g threshold weight in comparison with 1.80 ± 0.75 g for the PLA CSFM treatment and 0.57 ± 0.37 g for the untreated control on day 21 post-implantation. The histological analysis also indicates that the PLA/DHA CSFM can significantly reduce proinflammatory cytokine (TNF-α and IL-1β) protein expression at the lesion and provide anti-adhesion effects, indicating its vital role in preventing epidural fibrosis by mitigating the inflammatory response. Full article

(1) Background: Testicular cancer, although accounting for only 0.5% to 1% of all solid male cancers, is the most common malignancy in males aged 15 to 35 years. Non-seminomatous germ cell tumors (NSGCT) represent nearly half of all testicular germ cell tumors and are associated with a more aggressive clinical course. Spinal metastases, while rare, pose significant challenges due to their potential to cause spinal cord compression, neurological deficits, and severe pain. This systematic review aims to evaluate prognosis and treatment approaches for spinal metastases in NSGCT, with a focus on multidisciplinary care and treatment outcomes. (2) Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and Embase were searched on 18 September 2024, using the Boolean search strategy [(Nonseminomatous germ cell tumor (NSGCT) AND (spinal OR vertebral metastases)]. Case reports, case series, and cohort studies providing detailed patient data were included. Data on patient demographics, tumor histology, metastatic site, treatments, and outcomes were extracted for analysis. (3) Results: A total of 164 cases of NSGCT with spinal metastases were analyzed, with patients aged 23 to 40 years (median: 31.5 years). The lumbar spine was involved in all cases, and spinal cord compression occurred in 59.8% of patients, often causing severe neurological symptoms such as cauda equina syndrome. Chemotherapy, primarily cisplatin-based, was administered in all cases, while surgical interventions, including laminectomy and vertebrectomy, were performed in cases of spinal compression and instability. Complete remission occurred in only 2.4% of patients. Progressive improvement was observed in 56.7% of cases, while 20.1% of patients died. Outcomes varied, highlighting the importance of individualized, multidisciplinary care to manage both systemic and localized disease. (4) Conclusions: Spinal metastases in NSGCT represent a complex clinical scenario, requiring a combination of chemotherapy, surgery, and in some cases, radiotherapy. Chemotherapy remains essential, but surgery is critical for addressing spinal compression and instability. A multidisciplinary approach is vital for optimizing outcomes, as prognosis is variable, with some patients achieving improvement while others face progressive disease or death. Further research is needed to refine the role of radiotherapy and improve long-term treatment strategies for this rare complication. Full article

Bone regrowth commonly occurs following lumbar decompression surgery. Although it is rare for neurological symptoms to occur due to bone regrowth, this study describes two patients who underwent both decompression and fusion surgeries but experienced spinal canal restenosisthat was severe enough to induce neurological symptoms. A 32-year-old man underwent posterior decompression and posterior lumbar interbody fusion for lumbar canal stenosis at the L4/L5 level 5 years prior. However, the sudden onset of lower back pain occurred 5 years later. Bone overgrowth on the left side was observed at the L4/L5 level. A second surgery was performed, and the patient’s symptoms improved significantly. In the second case, a 56-year-old man underwent posterior decompression and posterior lumbar fusion at the L3/L4 and L4/L5 levels for an L4 burst fracture. One month later, he complained of lower back pain and underwent a second posterior decompression surgery. One year later, he presented to an outpatient clinic with lower back pain and neurological symptoms. Bone overgrowth was observed on both sides at the L4/L5 level. Thus, screw removal and laminectomy at the L3, L4, and L5 levels were performed as a third surgery. This study discusses the factors affecting bone regrowth and the methods that can be used to prevent it. Full article

Laminectomy is a commonly performed surgical procedure by orthopedic and neurosurgeons, aimed at alleviating nerve compression and reducing pain. However, in some cases, excessive proliferation of fibrous scar tissue in the epidural space post-surgery can lead to persistent and intractable lower back pain, a condition known as Failed Back Surgery Syndrome (FBSS). The persistent fibrous tissue causes both physical and emotional distress for patients and also makes follow-up surgeries more challenging due to reduced visibility and greater technical difficulty. It has been established that the application of biomaterials to prevent epidural fibrosis post-lumbar surgery is more beneficial than revision surgeries to relieve dural fibrosis. Hydrogel-based biomaterials, with their excellent biocompatibility, degradability, and injectability and tunable mechanical properties, have been increasingly introduced by clinicians and researchers. This paper, building on the foundation of epidural fibrosis, primarily discusses the strategies for the preparation of natural and polymeric biomaterials to prevent epidural fibrosis, their physicochemical properties, and their ability to mitigate the excessive proliferation of fibroblasts. It also emphasizes the challenges that need to be addressed to translate laboratory research into clinical practice and the latest advancements in this field. Full article

The study cohort consisted of 83 patients with a mean age of 49.55 (SD 13.72) with a female preponderance (60 patients). Here, 32.14% of patients had primary LTS; the remaining were metastases. Clinical presentation included nonspecific back pain (57.83%), weakness (21.69%) and radicular pain (18.07%). History of uterine neoplasia was found in 33.73% of patients. LTS preferentially affected the thoracic spine (51.81%), followed by the lumbar (21.67%) spine. MRI alone was the most common imaging modality (33.33%); in other cases, it was used with CT (22.92%) or X-ray (16.67%); 19.23% of patients had Resection/Fixation, 15.38% had Total en bloc spondylectomy, and 10.26% had Corpectomy. A minority of patients had laminectomy and decompression. Among those with resection, 45.83% had a gross total resection, 29.17% had a subtotal resection, and 16.67% had a near total resection. Immunohistochemistry demonstrated positivity for actin (43.37%), desmin (31.33%), and Ki67 (25.30). At a follow-up of 19.3 months, 61.97% of patients were alive; 26.25% of 80 patients received no additional treatment, 23.75% received combination radiotherapy and chemotherapy, only chemotherapy was given to 20%, and radiotherapy was given to 17.5%. Few (2.5%) had further resection. For an average of 12.50 months, 42.31% had no symptoms, while others had residual (19.23%), other metastasis (15.38%), and pain (7.69%). On follow-up of 29 patients, most (68.97%) had resolved symptoms; 61.97% of the 71 patients followed were alive. Full article

Background and Objectives: To present a new spinal shortening technique for tethered cord syndrome. Tethered cord syndrome (TCS) is a debilitating condition leading to progressive neurological decline. Surgical detethering for TCS is the gold standard of treatment. However, symptomatic retethering of TCS has been reported in 5%–50% of patients after initial release. To solve this problem, posterior spinal shortening osteotomy has been reported. This technique has risks of massive blood loss and neurological deterioration. The authors hereby report a new safe spinal shortening technique for tethered cord syndrome. Materials and Methods: A 31-year-old man with gait disturbance was referred to our hospital. After the delivery of treatment, he underwent surgical untethering of the spinal cord in another hospital. He had hyperreflexia of the Achilles tendon reflex and bilateral muscle weakness of the legs (MMT 3-4). He also had urinary and bowel incontinence, and total sensory loss below L5. An anteroposterior lumbar radiogram indicated partial laminectomy of L3 and L4. Lumbar MRI showed retethering of spinal cord. Results: The patient underwent a new spinal shortening technique for tethered cord syndrome under the guidance of O-arm navigation. First, from the anterior approach, disectomy from T12 to L3 was performed. Second, from the posterior approach, Ponte osteotomy was performed from T12 to L3, shortening the spinal column by 15 mm. The patient was successfully treated surgically. Postoperative lumbar MRI showed that the tension of the spinal cord was released. Manual muscle testing results and the sensory function of the left leg had recovered almost fully upon final follow-up at one year. Conclusions: A retethered spinal cord after initial untethering is difficult to treat. This new spinal shortening technique can represent another good option to release the tension of the spinal cord. Full article

Spinal epidural fibrosis is one of the typical features attributable to failed back surgery syndrome, with excessive scar development in the dura and nerve roots. The microRNA-29 family (miR-29s) has been found to act as a fibrogenesis-inhibitory factor that reduces fibrotic matrix overproduction in various tissues. However, the mechanistic basis of miRNA-29a underlying the overabundant fibrotic matrix synthesis in spinal epidural scars post-laminectomy remained elusive. This study revealed that miR-29a attenuated lumbar laminectomy-induced fibrogenic activity, and epidural fibrotic matrix formation was significantly lessened in the transgenic mice (miR-29aTg) as compared with wild-type mice (WT). Moreover, miR-29aTg limits laminectomy-induced damage and has also been demonstrated to detect walking patterns, footprint distribution, and moving activity. Immunohistochemistry staining of epidural tissue showed that miR-29aTg was a remarkably weak signal of IL-6, TGF-β1, and DNA methyltransferase marker, Dnmt3b, compared to the wild-type mice. Taken together, these results have further strengthened the evidence that miR-29a epigenetic regulation reduces fibrotic matrix formation and spinal epidural fibrotic activity in surgery scars to preserve the integrity of the spinal cord core. This study elucidates and highlights the molecular mechanisms that reduce the incidence of spinal epidural fibrosis, eliminating the risk of gait abnormalities and pain associated with laminectomy. Full article

Spinal epidural hematoma (SEH) is a very rare condition associated with trauma or occurring as a complication of lumbar puncture and can appear spontaneously. It manifests with acute pain and neurological deficits, leading to severe and permanent complications. This study aimed to assess changes in health-related quality of life and functional status following long-term intensive neurorehabilitation in a patient after severe sport-related head injury with a related SEH. The 60-year-old male patient experienced bilateral weakness of lower limbs, loss of sensation, and sphincter dysfunction. A laminectomy was performed, followed by a slight superficial and deep sensation improvement. The patient underwent intensive neurological rehabilitation treatment. The proprioceptive neuromuscular facilitation (PNF) method, PRAGMA device exercises, and water rehabilitation were provided. The study outcomes were assessed using the validated questionaries World Health Organization Quality-of-Life Scale (WHOQOL-BREF) and Health-Related Quality of Life (HRQOL-14) for health-related quality of life as well as the Functional Independence Measure (FIM) and Health Assessment Questionnaire (HAQ) for functional status. A beneficial clinical improvement was observed following the intensive rehabilitation using PNF techniques, training with a PRAGMA device, and water exercises in the case of SEH. The patient’s physical condition significantly improved, with an increase in the FIM score from 66 to 122 pts. (by 56 pts.) and in the HAQ score from 43 to 16 pts. (by 27 pts.). Additionally, the QOL level increased after rehabilitation, with an increase in the WHOQOL-BREF from 37 to 74 pts. (by 37 pts.) and a decrease in unhealthy or limited days, as assessed using the HRQOL-14, from 210 to 168 (by 42 days). In conclusion, the improvement in QOL and functional level in the SEH patient were associated with high-intensity rehabilitation, simultaneous integration of three therapeutic modalities, and committed patient cooperation. Full article

Background: Effective 1 January 2017, single-level endoscopic lumbar discectomy received a Category I Current Procedural Terminology (CPT^®) code 62380. However, no work relative value units (wRVUs) are currently assigned to the procedure. A physician’s payment needs to be updated to commensurate with the work involved in the modern version of the lumbar endoscopic decompression procedure with and without the use of any implants to stabilize the spine. In the United States, the American Medical Association (AMA) and its Specialty Society Relative Value Scale Update Committee (RUC) proposes to the Centers for Medicare and Medicaid Services (CMS) what wRVUs to assign for any endoscopic lumbar surgery codes. Methods: The authors conducted an independent survey between May and June 2022 which reached 210 spine surgeons using the TypeForm survey platform. The survey link was sent to them via email and social media. Surgeons were asked to assess the endoscopic procedure’s technical and physical effort, risk, and overall intensity without focusing just on the time required to perform the surgery. Respondents were asked to compare the work involved in modern comprehensive endoscopic spine care with other commonly performed lumbar surgeries. For this purpose, respondents were provided with the verbatim descriptions of 12 other existing comparator CPT^® codes and associated wRVUs of common spine surgeries, as well as a typical patient vignette describing an endoscopic lumbar decompression surgery scenario. Respondents were then asked to select the comparator CPT^® code most reflective of the technical and physical effort, risk, intensity, and time spent on patient care during the pre-operative, peri- and intra-operative, and post-operative periods of a lumbar endoscopic surgery. Results: Of the 30 spine surgeons who completed the survey, 85.8%, 46.6%, and 14.3% valued the appropriate wRVU for the lumbar endoscopic decompression to be over 13, over 15, and over 20, respectively. Most surgeons (78.5%; <50th percentile) did not think they were adequately compensated. Regarding facility reimbursement, 77.3% of surgeons reported that their healthcare facility struggled to cover the cost with the received compensation. The majority (46.5%) said their facility received less than USD 2000, while another 10.7% reported less than USD 1500 and 17.9% reported less than USD 1000. The professional fee received by surgeons was <USD 1000 for 21.4%, <USD 2000 for 17.9%, and <USD 1500 for 10.7%, resulting in a fee less than USD 2000 for 50% of responding surgeons. Most responding surgeons (92.6%) recommended an endoscopic instrumentation carveout to pay for the added cost of the innovation. Discussion and Conclusions: The survey results indicate that most surgeons associate CPT^® 62380 with the complexity and intensity of a laminectomy and interbody fusion preparation, considering the work in the epidural space using the contemporary outside-in and interlaminar technique and the work inside the interspace using the inside-out technique. Modern endoscopic spine surgery goes beyond the scope of a simple soft-tissue discectomy. The current iterations of the procedure must be considered to avoid undervaluing its complexity and intensity. Additional undervalued payment scenarios could be created if technological advances continue to replace traditional lumbar spinal fusion protocols with less burdensome, yet no less complex, endoscopic surgeries that necessitate a high surgeon effort in terms of time required to perform the operation and its intensity. These undervalued payment scenarios of physician practices, as well as the facility and malpractice expenses, should be further discussed to arrive at updated CPT^® codes reflective of modern comprehensive endoscopic spine care. Full article

Background: Postoperative intracranial hemorrhage (PIH) is a fairly rare but catastrophic perioperative complication following lumbar spine surgery. This is a case report of a 54-year-old male patient who experienced PIH 2 h after an endoscopic L5-S1 laminectomy and discectomy. Case Presentation: A 54-year-old male patient presented with right L5-S1 radiculopathy that corresponded with the picture revealed in medical imaging and the signs seen upon physical examination. Subsequently, he underwent endoscopic L5-S1 laminectomy and discectomy. The patient presented with idiopathic unconsciousness and limb twitching 2 h after surgery. An emergency cranial CT scan was obtained which demonstrated intracranial hemorrhage. Following an emergency consultation with the Department of Neurology and Neurosurgery, the patient underwent an emergency interventional thrombectomy as per their orders. The surgery was performed successfully. However, the patient’s situation did not improve and he died on the second postoperative day. Conclusion: PIH after spinal endoscopic surgery is a rare but horrible complication. Several factors could lead to PIH. However, in this patient, the cause of PIH might be attributed to the long operation time combined with cerebrospinal fluid (CSF) leakage. Great attention should be attached to the issue of PIH development in spinal endoscopic procedures due to constant irrigation. This study aims to highlight the issue of PIH following endoscopic spinal surgery by presenting a case report of a patient who died despite successful surgery. Full article

(1) Background: Primary intraspinal tumors account for 2–15% of all central nervous system (CNS) tumors. Most intraspinal tumors are benign, and about 40% of them occur intradurally, for which early surgery is the preferred treatment. Laminectomy with pedicle screw fixation is the conventional surgical treatment. However, laminectomy with pedicle screw fixation is likely to reduce the spinal range of motion (ROM), with many other complications, although it can maintain the stability of the spine. The aim of this study is to determine whether laminoplasty as a new surgical approach for thoracic and lumbar intradural tumors is superior to laminectomy in preserving spinal ROM, maintaining spinal stability and reducing postoperative complications. (2) Methods: We retrospectively analyzed 50 patients who received intradural tumor resection, including 23 who received traditional laminectomy with pedicle screw fixation and 27 who received new laminoplasty. Spinal ROM was evaluated by lumbar flexion/extension radiograph and biomechanical evaluation. Spinal stability was evaluated by imaging observations of the spinal Cobb angle and laminar bone fusion. Postoperative complications were evaluated according to cerebrospinal fluid (CSF) leakage and the length of hospital stay. (3) Results: Compared with the laminectomy group, patients in the laminoplasty group exhibited a better spinal ROM (31.6 ± 12.0° vs. 21.7 ± 11.8°, p = 0.013), a smaller Cobb angle (9.6 ± 4.3 vs. 12.5 ± 5.3, p = 0.034), a lower incidence of CSF leakage (4/14.8% vs. 11/47.8%, p = 0.015), and a shorter length of hospital stay (13.1 ± 1.8 vs. 15.1 ± 2.3 days, p = 0.001). Most patients in the laminoplasty group had satisfactory bone fusion. The biomechanical experiment also demonstrated that spinal ROM in laminoplasty was larger than that in the laminectomy group. (4) Conclusions: Compared with the traditional surgery, the new laminoplasty surgery can better maintain the stability of the spine, preserve spinal ROM, and reduce postoperative complications. It is a surgical method that can be clinically popularized. Full article