PubMed | Sint Maartenskliniek and Weill Cornell Brain and Spine Center
Type: Journal Article | Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2016
To optimize intraoperative neuromonitoring during extreme lateral interbody fusion (XLIF) by adding transcranial electrical stimulation with motor evoked potential (TESMEP) to previously described monitoring using spontaneous EMG (sEMG) and peripheral stimulation (triggered EMG: tEMG).Twenty-three patients with degenerative lumbar scoliosis had XLIF procedures and were monitored using sEMG, tEMG and TESMEP. Spontaneous and triggered muscle activity, and the MEP of 5 ipsilateral leg muscles, 2 contralateral leg muscles and 1 arm muscle were monitored.During XLIF surgery decreased MEP amplitudes were measured in 9 patients and in 6 patients sEMG was documented. In 4 patients, both events were described. In 30% of the cases (n=7), the MEP amplitude decreased immediately after breaking of the table and even before skin incision. After reduction of the table break, the MEP amplitudes recovered to baseline. In two patients, the MEP amplitude deteriorated during distraction of the psoas with the retractor, while no events were reported using sEMG and tEMG. Repositioning of the retractor led to recovery of the MEP.Monitoring the complete nervous system during an XLIF procedure is found to be helpful since nerve roots, lumbar plexus as well as the intradural neural structures may be at risk. TESMEP has additional value to sEMG and tEMG during XLIF procedure: (1) it informed about otherwise unnoticed events, and (2) it confirmed and added information to events measured using sEMG.
PubMed | University of Michigan, Spine Institute of Louisiana, University of Miami, New York University and 9 more.
Type: | Journal: World neurosurgery | Year: 2016
Older age has been considered a relative contraindication to complex spinal procedures. Minimally invasive surgery (MIS) techniques to treat patients with adult spinal deformity (ASD) have emerged with the potential benefit of decreased approach-related morbidity.To determine whether a minimal clinically important difference (MCID) could be achieved in patients ages 65 years with ASD who underwent MIS.Multicenter database of patients who underwent MIS for ASD was queried. Outcome metrics assessed were Oswestry Disability Index (ODI) and visual analog scale (VAS) scores for back and leg pain. On the basis of published reports, MCID was defined as a positive change of 12.8 ODI, 1.2 VAS back pain, and 1.6 VAS leg pain.Forty-two patients were identified. Mean age was 70.3 years; 31 (73.8%) were women. Preoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis mismatch, and sagittal vertical axis were 35, 24.6, 14.2, and 4.7 cm, respectively. Postoperatively, mean coronal curve, pelvic tilt, pelvic incidence to lumbar lordosis, and sagittal vertical axis were 18, 25.4, 11.9, and 4.9 cm, respectively. A mean of 5.0 levels was treated posteriorly, and a mean of 4.0 interbody fusions was performed. Mean ODI improved from 47.1 to 25.1. Mean VAS back and leg pain scores improved from 6.8 and 5.9 to 2.7 and 2.7, respectively. Mean follow-up was 32.1 months. For ODI, 64.3% of patients achieved MCID. For VAS back and leg pain, 82.9% and 72.2%, respectively, reached MCID.MCID represents the threshold at which patients feel a meaningful clinical improvement has occurred. Our study results suggest that the majority of elderly patients with modest ASD can achieve MCID with MIS.
PubMed | Hospital Israelita Albert Einstein and Weill Cornell Brain and Spine Center
Type: Case Reports | Journal: Einstein (Sao Paulo, Brazil) | Year: 2016
We report a rare case of an unstable flexion-distraction spine fracture with ligament involvement that occurred during a professional female soccer game. There were no neurological dficit. The patient had a painful midline gap which suggested ligamentar injury that was not immediately recognized. Despite that, proper immobilization and referral to hospital for further evaluation avoided additional spinal cord damage. The patient underwent a monosegmental posterior instrumentation spine fusion and after 6 months returned to professional soccer activities. This paper alerts to the possibility of occurrence of severe and unstable spine injuries during soccer practice and the importance of an adequate initial care at the game field in order to avoid iatrogenic neurological injuries.
PubMed | Weill Cornell Brain and Spine Center, Jawaharlal Institute of Postgraduate Medical Education & Research, National Institute of Neurology and Neurosurgery, New York Presbyterian Weill Cornell Medical Center and Menoufia University
Type: Journal Article | Journal: Cureus | Year: 2015
Anterior cerebral artery (ACA) encasement is often considered a contraindication for an endonasal endoscopic transsphenoidal approach. We report a patient with a tuberculum sella meningioma with ACA encasement, in whom a gross total excision was achieved through an endonasal endoscopic transsphenoidal transtuberculum, transplanum approach. The tumor was sharply dissected alongthe left ACA using meticulous bimanual sharp dissection after internal decompression. Moreover, the medial optic canals were opened and the optic nerves decompressed. A gasket seal closure with a nasoseptal flap was performed, and the patient was discharged on postoperative day four with improved vision. This case highlights the ability to remove planum and tuberculum meningiomas with vascular encasement through an endonasal endoscopic approach with the potential for safe vascular dissection. The absence of luminal narrowing can be used to assure the likelihood of a safe arachnoid plane.
Chandra S.,Cornell University |
Parker D.J.,Cornell University |
Barth R.F.,Ohio State University |
Pannullo S.C.,Weill Cornell Brain and Spine Center
Journal of Neuro-Oncology | Year: 2015
Glioblastoma multiforme (GBM) is one of the deadliest forms of human brain tumors. The infiltrative pattern of growth of these tumors includes the spread of individual and/or clusters of tumor cells at some distance from the main tumor mass in parts of the brain protected by an intact blood–brain-barrier. Pathophysiological studies of GBM could be greatly enhanced by analytical techniques capable of in situ single-cell resolution measurements of infiltrating tumor cells. Magnesium homeostasis is an area of active investigation in high grade gliomas. In the present study, we have used the F98 rat glioma as a model of human GBM and an elemental/isotopic imaging technique of secondary ion mass spectrometry, a CAMECA IMS-3f ion microscope, for studying Mg distribution with single-cell resolution in freeze-dried brain tissue cryosections. Quantitative observations were made on tumor cells in the main tumor mass, contiguous brain tissue, and infiltrating tumor cells in adjacent normal brain. The brain tissue contained a significantly lower total Mg concentration of 4.70 ± 0.93 mmol/kg wet weight (mean ± SD) in comparison to 11.64 ± 1.96 mmol/kg wet weight in tumor cells of the main tumor mass and 10.72 ± 1.76 mmol/kg wet weight in infiltrating tumor cells (p < 0.05). The nucleus of individual tumor cells contained elevated levels of bound Mg. These observations have established that there was enhanced influx and increased binding of Mg in tumor cells. They provide strong support for further investigation of altered Mg homeostasis and activation of Mg-transporting channels in GBMs as possible therapeutic targets. © 2015 Springer Science+Business Media New York
PubMed | University of Rochester, New York Presbyterian Weill Cornell Medical Center and Weill Cornell Brain and Spine Center
Type: Journal Article | Journal: Cureus | Year: 2015
Craniopharyngiomas comprise approximately 3% of all intracranial tumors. Preservation of pituitary function after resection represents a significant challenge due to their location in the anterior skull base and aggressive local behavior. We report a case of a 79-year-old woman with a large suprasellar craniopharyngioma who presented with visual loss. MRI revealed a suprasellar cystic mass with mass effect on the optic chiasm and pituitary gland. Following endoscopic endonasal gross total resection of the tumor, the patients pituitary function returned to normal.
PubMed | Cornell University, Ohio State University and Weill Cornell Brain and Spine Center
Type: Journal Article | Journal: Journal of neuro-oncology | Year: 2016
Glioblastoma multiforme (GBM) is one of the deadliest forms of human brain tumors. The infiltrative pattern of growth of these tumors includes the spread of individual and/or clusters of tumor cells at some distance from the main tumor mass in parts of the brain protected by an intact blood-brain-barrier. Pathophysiological studies of GBM could be greatly enhanced by analytical techniques capable of in situ single-cell resolution measurements of infiltrating tumor cells. Magnesium homeostasis is an area of active investigation in high grade gliomas. In the present study, we have used the F98 rat glioma as a model of human GBM and an elemental/isotopic imaging technique of secondary ion mass spectrometry, a CAMECA IMS-3f ion microscope, for studying Mg distribution with single-cell resolution in freeze-dried brain tissue cryosections. Quantitative observations were made on tumor cells in the main tumor mass, contiguous brain tissue, and infiltrating tumor cells in adjacent normal brain. The brain tissue contained a significantly lower total Mg concentration of 4.700.93mmol/kg wet weight (meanSD) in comparison to 11.641.96mmol/kg wet weight in tumor cells of the main tumor mass and 10.721.76mmol/kg wet weight in infiltrating tumor cells (p<0.05). The nucleus of individual tumor cells contained elevated levels of bound Mg. These observations have established that there was enhanced influx and increased binding of Mg in tumor cells. They provide strong support for further investigation of altered Mg homeostasis and activation of Mg-transporting channels in GBMs as possible therapeutic targets.
Fourney D.R.,University of Saskatchewan |
Dettori J.R.,Spectrum Research Inc. |
Hall H.,University of Toronto |
Hartl R.,Weill Cornell Brain and Spine Center |
And 2 more authors.
Spine | Year: 2011
Study Design.: Systematic review of spine care pathways and case study of the Saskatchewan Spine Pathway (SSP). Objective.: (1) What are the differences between clinical pathways and clinical guidelines? (2) Are there examples of clinical pathways in the management of lower back pain (LBP)? Is there evidence that they are successful? (3) What is the SSP, and what are its key features? Summary of Background DATA.: Adherence to evidence-based guidelines for LBP produces superior outcomes and may improve efficiency by reducing unnecessary imaging, ineffective treatments, and inappropriate surgical referrals. A clinical pathway is an attempt to bridge the "translation gap" between guidelines and clinical practice. Methods.: A qualitative review was performed for question 1. For question 2, a systematic review of the English language literature was performed for articles published through March 31, 2011. A case study is provided for question 3. Results.: (1) Evidence for clinical pathways is mainly derived from guidelines, but pathways are distinguished by several features including the coordination of multidisciplinary care, facilitation of communication among care providers, resources for ongoing quality improvements, and a central focus on the patient experience. (2) Five articles describing four clinical pathways met the a priori criteria, but none tested comparative effectiveness. (3) The SSP is unique in that it is (a) inclusive for all types of LBP, (b) based on a classification system, (c) patient-focused mostly at primary care rather than in specialized clinics, (d) implemented in the health care system of a geopolitically defined region, and (e) includes all of the defining features of modern care pathways. Conclusion.: Several clinical pathways for LBP have been described, but effectiveness has not been tested. Clinical Recommendations.: Clinical pathways for LBP need to be further developed and investigated as a means to facilitate guidelines-concordant practice and improve patient outcomes. Level of evidence: Insufficient. Recommendation: Weak. © 2011, Lippincott Williams & Wilkins.
PubMed | University of Arizona and Weill Cornell Brain and Spine Center
Type: | Journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia | Year: 2016
Traumatic atlanto-occipital dislocation (AOD) is an ominous injury with high mortality and morbidity in trauma patients. Improved survival has been observed with advancements in pre-hospital and hospital care. Furthermore, high quality imaging studies are accessible at most trauma centers; these are crucial for prompt diagnosis of AOD. The objective of this study is to perform a comprehensive literature review of traumatic AOD, with specific emphasis on identifying prognostic factors for survival. A review of the literature was performed using the Medline database for all traumatic atlanto-occipital articles published between March 1959 and June 2015; 141 patients from 60 total studies met eligibility criteria for study inclusion. A binary logistic regression model was utilized to identify prognostic factors. The analysis assessed age, sex, spinal cord injury (SCI), traumatic brain injury (TBI), polytrauma injury (PI), and Traynelis AOD Classification. Only TBI was statistically significantly associated with death (OR 8.05 p<0.05); SCI did not reach statistical significance for predicting mortality in AOD patients (OR 1.25 p>0.05). Age, sex, PI, and Traynelis AOD Classification did not meet significance to predict mortality in AOD patients. We found that patients with TBI are eight times more likely to die than patients without TBI. A high degree of suspicion for AOD during pre-hospital care, as well as, prompt diagnosis and management in the trauma center play a key role in the treatment of this devastating injury. The relationship between survival and factors such as TBI and SCI should be further explored.
PubMed | Weill Cornell Brain and Spine Center
Type: Journal Article | Journal: Journal of neurosurgery. Spine | Year: 2014
Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia.Using a surgical database, the authors conducted a retrospective analysis of all patients who had undergone ACDF between August 2008 and October 2011. All patients received a Zero-P implant (DePuy Synthes Spine). The Neck Disability Index (NDI) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, and subsidence were assessed as well.Twenty-two male and 19 female consecutive patients, with a mean age of 58.4 14.68, underwent ACDF (66 total operated levels) in the defined study period. The mean clinical follow-up in 36 patients was 18.6 9.93 months. Radiological outcome in 37 patients was assessed at a mean follow-up of 9.76 months (range 7.2-19.7 months). There were significant improvements in neck and arm VAS scores and the NDI following surgery. The neck VAS score improved from a median of 6 (range 0-10) to 0 (range 0-8; p < 0.001). The arm VAS score improved from a median of 2 (range 0-10) to 0 (range 0-7; p = 0.006). Immediate postoperative dysphagia was experienced by 58.4% of all patients. Complete resolution was demonstrated in 87.8% of affected patients at the latest follow-up. The overall median Bazaz score decreased from 1 (range 0-3) immediately postoperatively to 0 (range 0-2; p < 0.001) at the latest follow-up. Prevertebral soft-tissue thickness significantly decreased across all levels from a mean of 15.8 4.38 mm to 10.1 2.93 mm. Postoperative lordosis was maintained at the latest follow-up. Mean subsidence from the immediate postoperative to the latest follow-up was 4.1 4.7 mm (p < 0.001). Radiographic fusion was achieved in 92.6% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score.A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.