Volume 31: Issue 5 (Nov 2019): Pages 619-773
in Journal of Neurosurgery: SpineIllustration from Dauleac et al. (pp 756–763). Copyright Corentin Dauleac. Published with permission.
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In Brief
The authors performed a systematic review of the published literature for the use of nerve transfers to restore various upper-extremity functions in patients with cervical spinal cord injury/tetraplegia. The use of nerve transfers in tetraplegia is continuously evolving and has gained significant momentum over the last decade. These procedures have shown encouraging results and are increasingly considered as part of the comprehensive reconstructive strategy in patients with tetraplegia.
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In Brief
The authors present early results of a prospective, single-institution clinical trial of nerve transfers to restore upper-extremity functions in patients with cervical SCI/tetraplegia. The use of nerve transfers in tetraplegia is continuously evolving and has gained significant momentum over the last decade. In the authors’ experience, nerve transfers have demonstrated encouraging results and are increasingly considered as part of the comprehensive reconstructive strategy in patients with tetraplegia.
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In Brief
A single-center retrospective cohort study was performed on patients undergoing cervical disc arthroplasty (CDA). The amount of residual exposed endplate was found to predict the development of high-grade heterotopic ossification. Radiographic adjacent-segment disease increased in an obligatory manner following CDA and is highly linked to specific levels (e.g., C6–7) rather than the presence or absence of an adjacent arthroplasty device. The presence of an artificial disc is, however, protective against further degenerative change at the index level of operation.
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In Brief
Patients seeking out minimally invasive surgery (MIS) may have higher expectations regarding their outcomes, and the difference between expectations and actuality may play a larger role in patient satisfaction after MIS than after open surgeries. The authors assessed the effect of preoperative expectations, postoperative outcome actuality, and the difference between the two on postoperative satisfaction following MIS lumbar fusion procedures, and their study is one of the first to document a strong relationship between patient satisfaction and the actual postoperative outcome itself, regardless of preoperative expectation or the realization of expected results.
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In Brief
The authors examined the impact on patient outcomes of a monitoring system frequently used during one of the most common spine deformity surgeries. The results of this study have the potential to inform surgical practice in future deformity spine surgery.
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In Brief
The authors studied whether a brief, recently developed questionnaire correlated with a longstanding but cumbersome survey for evaluating patient-reported outcomes after lumbar spine surgery. Their results suggest that a faster, less-onerous survey may be a reasonable surrogate, thereby saving time and administrative costs in administering and recording surveys for this valuable data.
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In Brief
In a retrospective analysis of a database of spine deformity patients, the authors explored the relationship between preoperative BMI and postoperative outcomes of deformity surgery, such as the degree of correction achieved in the sagittal vertical axis (SVA) and health-related quality of life outcomes. The results show that although higher baseline BMIs do not prevent operative change of the SVA, outcomes of surgery in overweight and obese patients tend to be worse despite adequate restoration of a proper SVA, information that may aid spine surgeons in the process of selecting candidates for deformity surgery.
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In Brief
Although restoration of the sagittal alignment can produce excellent radiological and clinical outcomes for adult spinal deformity, proximal junctional kyphosis frequently occurs at the proximal junction after long-segment fusion. The authors found that proximal junctional kyphosis decreased significantly in the flexible rod group. Thus they suggest that solid long-segment fixation and the use of a flexible rod may become another surgical option for spine reconstruction surgery.
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In Brief
This study systematically reviews the literature on giant presacral schwannoma and evaluates the effect of tumor morphology and resection technique (en bloc vs gross-total resection vs subtotal resection) on progression-free survival. All prior literature has been case reports and small case series. The results of this study find en bloc and piecemeal gross-total resection provide similar progression-free survival.
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In Brief
The authors’ objective was to review the available literature regarding the symptoms, treatment options, and survival for patients with glioblastoma that had spread to their spinal cord. This study demonstrates no significant improvements in survival have been gained since the time of a systematic review conducted in 2010. Median survival is poor, at 2.8 months after diagnosis of spinal dissemination, with a 1-year actuarial survival rate of 2.7%. However, screening and treatment for this condition remain inconsistent with the review demonstrating a marked need for better documentation of this type of metastatic spread in order to inform future research protocols and treatment algorithms.
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In Brief
This is the first systematic review of asymptomatic spinal dural arteriovenous fistulas. This article suggests the distinct features of asymptomatic spinal dural arteriovenous fistulas, which can contribute to the elucidation of the pathophysiology of spinal dural arteriovenous fistulas.
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In Brief
In this study, using institutional data, the authors validate an algorithm previously derived from national data, in order to better predict the discharge location of patients undergoing spine surgery. This predictive algorithm may serve as an important tool for clinical teams, allowing for better prediction and management of spine surgery patients.
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In Brief
The authors identify intraoperative opioid administration as a critical early and potentially modifiable predictor of postoperative ileus. Their derived assessment scale, which incorporates 5 independent ordinal classifications, represents a simple tool for clinicians that can be used at a clinically opportune time to predict the risk of this complication. Accordingly, treating surgeons can more rationally counsel patients during their preoperative discussions and even consider potential prophylactic strategies, particularly for patients deemed at high risk.
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In Brief
In this paper, the authors describe the anatomy of the spinal cord arachnoid, reporting the macroscopic and microscopic descriptions of the dorsal, ventral, and lateral parts of the spinal subarachnoid space. This completes the current understanding of these structures. The originality of the work is the description of cisterns in the spinal subarachnoid space, which have practical applications that are discussed.
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