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  • Author or Editor: Praveen V. Mummaneni x
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Introduction: Minimally Invasive Spine Surgery video supplement

Praveen V. Mummaneni

This video supplement of Neurosurgery Focus is devoted to minimally invasive spine surgery. Minimally invasive spine surgery has gained popularity amongst patients and physicians over the past decade because it has been shown in select instances to lower blood loss and reduce length of hospital stay for appropriately selected candidates.

This supplement includes videos from many of the leaders in the field. Pioneers like Frank LaMarca, Paul Park, Cheerag Upadhyaya, Juan Uribe, and Mike Wang have all sent in videos depicting minimally invasive spinal deformity surgery options. The supplement also includes videos from several different countries, demonstrating how widespread and nuanced minimally invasive spinal procedures have become. Drs. Barbagallo, Certo, Sciacca, and Albanese from Italy; Drs. Gragnaniello and Seex from Australia; and Drs. Liao, Wu, Huang, Wang, Chang, Cheng, and Shih from Taiwan have all sent in nuanced surgical videos that will be of interest to many viewers.

I personally enjoyed viewing videos on lumbar degenerative disease surgery depicting unique surgical nuances to treat common problems. Dr. Beejal Amin, Dr. Harel Deutsch, Dr. Daniel Lu, and Dr. Adam Kanter have each submitted videos depicting lumbar decompression and/or fusion for lumbar degenerative stenosis and spondylosis.

This supplement also included videos depicting the minimally invasive treatment of uncommon spinal pathologies as well. Videos from Dr. Fred Geisler, Dr. John O'Toole, and Dr. Noel Perin covered topics as varied as sacroiliac joint dysfunction, spinal arteriovenous malformations, and sympathetic chain surgery.

I hope that you enjoy this issue of Neurosurgical Focus devoted to videos depicting the surgical nuances of minimally invasive spinal surgery. This video supplement has international appeal, and it has been an honor to be a guest editor on this superb supplement.

In Neurosurgical Focus Volume 35 (2013): Issue v2supplement (Jul 2013): Video Atlas - Minimally Invasive Spine Surgery

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Nucleus replacement technologies

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2007

Domagoj Coric and Praveen V. Mummaneni

✓ Nucleus replacement offers a less invasive alternative to traditional fusion or total disc replacement techniques in the treatment of symptomatic lumbar degenerative disc disease (DDD). The authors discuss the classification of nucleus replacement devices as well as their potential indications. The authors review the history and evolution of nucleus replacement devices emphasizing several that are actively in US Investigational Device Exemption pilot feasibility trials. Nucleus replacement devices can be functionally categorized as elastomeric and mechanical. A classification scheme is discussed. Nucleus replacement remains investigational, but early clinical results have been encouraging. Further clinical investigation with well-designed prospective, randomized pivotal trials is needed to determine the efficacy of nucleus replacement in the treatment of lumbar DDD, as well as its ideal indications.

In Journal of Neurosurgery: Spine Volume 8: Issue 2 (Feb 2008)

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Minimally invasive spine surgery

Adam S. Kanter and Praveen V. Mummaneni

In Neurosurgical Focus Volume 25 (2008): Issue 2 (Aug 2008): Contemporary Minimally Invasive Spine Surgery

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The future in the care of the cervical spine: interbody fusion and arthroplasty

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Praveen V. Mummaneni and Regis W. Haid

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion.

Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty.

In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

In Journal of Neurosurgery: Spine Volume 1: Issue 2 (Sep 2004)

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Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes

Darryl Lau, Dean Chou and Praveen V. Mummaneni

OBJECT

In the treatment of cervical spondylotic myelopathy (CSM), anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF) are effective decompressive techniques. It remains to be determined whether ACCF and ACDF offer equivalent outcomes for multilevel CSM. In this study, the authors compared perioperative, radiographic, and clinical outcomes between 2-level ACCF and 3-level ACDF.

METHODS

Between 2006 and 2012, all patients at the authors' hospital who underwent 2-level ACCF or 3-level ACDF performed by 1 of 2 surgeons were identified. Primary outcomes of interest were sagittal Cobb angle, adjacent-segment disease (ASD) requiring surgery, neck pain measured by visual analog scale (VAS), and Nurick score. Secondary outcomes of interest included estimated blood loss (EBL), length of stay, perioperative complications, and radiographic pseudarthrosis rate. Chi-square tests and 2-tailed Student t-tests were used to compare the 2 groups. A subgroup analysis of patients without posterior spinal fusion (PSF) was also performed.

RESULTS

Twenty patients underwent 2-level ACCF, and 35 patients underwent 3-level ACDF during a 6-year period. Preoperative Nurick scores were higher in the ACCF group (2.1 vs 1.1, p = 0.014), and more patients underwent PSF in the 2-level ACCF group compared with patients in the 3-level ACDF group (60.0% vs 17.1%, p = 0.001). Otherwise there were no significant differences in demographics, comorbidities, and baseline clinical parameters between the 2 groups. Two-level ACCF was associated with significantly higher EBL compared with 3-level ACDF for the anterior stage of surgery (382.2 ml vs 117.9 ml, p < 0.001). Two-level ACCF was also associated with a longer hospital stay compared with 3-level ACDF (7.2 days vs 4.9 days, p = 0.048), but a subgroup comparison of patients without PSF showed no significant difference in length of stay (3.1 days vs 4.4 days for 2-level ACCF vs 3-level ACDF, respectively; p = 0.267). Similarly, there was a trend toward more complications in the 2-level ACCF group (20.0%) than the 3-level ACDF group (5.7%; p = 0.102), but a subgroup analysis that excluded those who had second-stage PSF no longer showed the same trend (2-level ACCF, 0.0% vs 3-level ACDF, 3.4%; p = 0.594). There were no significant differences between the ACCF group and the ACDF group in terms of postoperative sagittal Cobb angle (7.2° vs 12.1°, p = 0.173), operative ASD (6.3% vs 3.6%, p = 0.682), and radiographic pseudarthrosis rate (6.3% vs 7.1%, p = 0.909). Both groups had similar improvement in mean VAS neck pain scores (3.4 vs 3.2 for ACCF vs ACDF, respectively; p = 0.860) and Nurick scores (0.8 vs 0.7, p = 0.925).

CONCLUSIONS

Two-level ACCF was associated with greater EBL and longer hospital stays when patients underwent a second-stage PSF. However, the length of stay was similar when patients underwent anterior-only decompression with either 2-level ACCF or 3-level ACDF. Furthermore, perioperative complication rates were similar in the 2 groups when patients underwent anterior decompression without PSF. Both groups obtained similar postoperative cervical lordosis, operative ASD rates, radiographic pseudarthrosis rates, neurological improvement, and pain relief.

In Journal of Neurosurgery: Spine Volume 23 (2015): Issue 3 (Sep 2015): Pages 263-395

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The future in the care of the cervical spine: interbody fusion and arthroplasty

Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

Praveen V. Mummaneni and Regis W. Haid

✓ In the past 50 years tremendous advances have been made in the treatment of cervical disc disease with cervical fusion. Fusion rates have surpassed 95% after application of anterior cervical implants. Adjacent-segment degeneration, however, has plagued the long-term clinical success of cervical fusion.

Cervical arthroplasty has been introduced to maintain cervical motion and potentially avoid or minimize adjacent-segment degeneration. If cervical arthroplasty is successful, the long-term results of surgery for cervical disc disease may improve; however, there are associated drawbacks that must be overcome. Implant wear, fatigue, and failure have been reported in cases of large-joint arthroplasty, and research is underway to limit these problems in cervical arthroplasty.

In this article the authors trace the evolution of cervical fusion and the new technique of cervical arthroplasty. The nomenclature of cervical arthroplasty will also be introduced.

In Neurosurgical Focus Volume 17: Issue 3 (Sep 2004): Cervical Arthroplasty

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Editorial. Nuances of restoration of lumbar lordosis using an MIS anterior column release versus posterior 3-column osteotomy

Michael S. Virk and Praveen V. Mummaneni

In Neurosurgical Focus Volume 43: Issue 2 (Aug 2017): Minimally Invasive Spinal Surgery

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Introduction. Minimally invasive spine surgery

Erica F. Bisson, Deshpande V. Rajakumar and Praveen V. Mummaneni

In Neurosurgical Focus Volume 43: Issue 2 (Aug 2017): Minimally Invasive Spinal Surgery

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Stimulus-evoked electromyography testing of percutaneous pedicle screws for the detection of pedicle breaches: a clinical study of 409 screws in 93 patients

Presented at the 2009 Joint Spine Section Meeting 

Michael Y. Wang, Guillermo Pineiro and Praveen V. Mummaneni

Object

Percutaneous pedicle screws have recently become popularized for lumbar spinal fixation. However, successful anatomical hardware placement is highly dependent on intraoperative imaging. In traditional open surgery, stimulus-evoked electromyography (EMG) responses can be useful for detecting pedicle screw breaches. The use of insulated sleeves for percutaneous screws has allowed for EMG testing in minimally invasive surgery; however, no reports on the reliability of this testing modality have been published.

Methods

A total of 409 lumbar percutaneous pedicle screws were placed in 93 patients. Levels of instrumentation included L-1 (in 12 patients), L-2 (in 34), L-3 (in 44), L-4 (in 120), L-5 (in 142), and S-1 (in 57 patients). Intraoperative EMG stimulation thresholds were obtained using insulating sleeves over a metallic tap prior to final screw placement. Data were compared with postoperative fine-cut CT scans to assess pedicle screw placement. Data were collected prospectively and analyzed retrospectively.

Results

There were 5 pedicle breaches (3 medial and 2 lateral; 3 Grade 1 and 2 Grade 2 breaches) visualized on postoperative CT scans (1.2%). Two of these breaches were symptomatic. In 2 instances, intraoperative thresholds were the sole basis for screw trajectory readjustment, which resulted in proper placement on postoperative imaging. Thirty-five screw trajectories were associated with a threshold of less than 12 mA. However, all breaches were associated with thresholds of greater than 12 mA. Using thresholds below 12 mA as the indicator of a screw breach, this resulted in a sensitivity of 0.0, specificity of 90.3, positive predictive value of 0.0, and negative predictive value of 0.98. Utilizing a threshold of any decreased stimulus (< 20 mA) would have detected 60% of breaches, with a mean threshold of 16.25 mA.

Conclusions

While these data are limited by the low number of radiographic breaches, it appears that tap stimulation with an insulating sleeve may not be reliable for detecting low-grade radiographically breached pedicles using typical stimulation thresholds (< 12 mA). Imaging-based modalities remain more reliable for assessing percutaneous pedicle screw trajectories until more robust and sensitive electrophysiological testing methods can be devised.

In Journal of Neurosurgery: Spine Volume 13 (2010): Issue 5 (Nov 2010)

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The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy

Clinical article

Darryl Lau, Dean Chou, John E. Ziewacz and Praveen V. Mummaneni

Object

Smoking is one of the leading causes of preventable morbidity and death in the US and has been associated with perioperative complications. In this study, the authors examined the effects of smoking on perioperative outcomes and pseudarthrosis rates following anterior cervical corpectomy.

Methods

All adult patients from 2006 to 2011 who underwent anterior cervical corpectomy were identified. Patients were categorized into 3 groups: patients who never smoked (nonsmokers), patients who quit for at least 1 year (quitters), and patients who continue to smoke (current smokers). Demographic, medical, and surgical covariates were collected. Multivariate analysis was used to define the relationship between smoking and blood loss, 30-day complications, length of hospital stay, and pseudarthrosis.

Results

A total of 160 patients were included in the study. Of the 160 patients, 49.4% were nonsmokers, 25.6% were quitters, and 25.0% were current smokers. The overall 30-day complication rate was 20.0%, and pseudarthrosis occurred in 7.6% of patients. Mean blood loss was 368.3 ml and mean length of stay was 6.5 days. Current smoking status was significantly associated with higher complication rates (p < 0.001) and longer lengths of stay (p < 0.001); current smoking status remained an independent risk factor for both outcomes after multivariate logistic regression analysis. The complications that were experienced in current smokers were mostly infections (76.5%), and this proportion was significantly greater than in nonsmokers and quitters (p = 0.013). Current smoking status was also an independent risk factor for pseudarthrosis at 1-year follow-up (p = 0.012).

Conclusions

Smoking is independently associated with higher perioperative complications (especially infectious complications), longer lengths of stay, and higher rates of pseudarthrosis in patients undergoing anterior cervical corpectomy.

In Journal of Neurosurgery: Spine Volume 21 (2014): Issue 4 (Oct 2014): Pages 499-686