The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity

Purpose

The recent proliferation of minimally invasive lateral lumbar interbody fusion (LLIF) techniques has drawn attention to potential for these techniques to control or correct sagittal misalignment in adult spinal deformity. We systemically reviewed published studies related to LLIF use in adult spinal deformity treatment with emphasis on radiographic assessment of sagittal balance.

Methods

A literature review was conducted to examine studies focusing on sagittal balance restoration in adult degenerative scoliosis with the LLIF approach.

Results

Fourteen publications, 12 retrospective and 2 prospective, reported data regarding lumbar lordosis correction (1,266 levels in 476 patients) but only two measured global sagittal alignment.

Conclusion

LLIF appears to be especially effective when the lumbar lordosis and sagittal balance correction goals are less than 10° and 5 cm, respectively. However, the review demonstrated a lack of consistent reporting on sagittal balance restoration with the MIS LLIF techniques.

     

Bilateral negative airway pressure pulmonary edema (NPPE)--a case report--

A case of negative pressure bilateral pulmonary edema in a 28 years old healthy female patient, scheduled for diagnostic pelvic laparoscopy for infertility. Following extubation and apparent recovery from anesthesia, she had strong inspiratory efforts due to airway obstruction caused by coughing and laryngeal spasm, that lead to negative pressure bilateral pulmonary edema. The pulmonary edema disappeared within few hours. She was breathing spontaneously through CPAP system (mask-bag-expiratory valve). Diuretics and lungs physiotherapy helped in controlling patient's complication.     

Incidence of surgical wound infections a prospective study in the Rabat Mohamed-V military hospital, Morocco

OBJECTIVES: The authors had for aim to determine prospectively the incidence of surgical site infections (SSI) in a visceral surgery department, in the Mohamed V military hospital (Rabat), and to identify risk factors. PATIENTS AND METHODS: All patients who had undergone surgery between April 1 and September 30, 2002 and were then admitted in the visceral surgery unit were included in this study. Patients were assessed within the following month. For each patient, data including perioperative factors, type of procedure, and SSI occurrence were collected on a standardized form. RESULTS: During the study, 310 patients were operated. The number of surgical wound infections was 16 (5.2%). This analysis pointed out: 11 superficial wounds, 5 deep wounds, and 1 organ/site wound. Emergency, age, ASA score, Altemeier classification, and procedure duration were found to be risk factors for SSI in visceral surgery. According to the NNIS index, SSI rates increase from 2.7% for patients with a risk index of 0 to 10.2% for patients with a risk index of 3. CONCLUSION: The high incidence of SSI emphasizes the importance of implementing SSI surveillance in surgery to obtain standardized incidence ratios necessary for adapted control measures.     

Right-sided non-bacterial thrombotic endocarditis in a chronic hemodialysis patient with Muir-Torre syndrome

Endocarditis is a recognised complication ofhemodialysis. This is generally only thought of in terms of infective vegetations. We present a case of right-sided NBTE in a patient with an indwelling venous catheter who also had advanced pelvic malignancy. The unusual side of this patient's endocarditic lesions implicates a role for the venous catheter in determining the site of non-bacterial thrombus formation. It is also a reminder that endocarditis is always a risk when using central venous catheters, even after appropriate sterile precautions have been taken.     

A case of myopathy associated with hypothyroidism and hyperprolactinaemia

We report a case of a serious myopathy related to hypothyroidism with pituitary enlargement and hyperprolactinemia. CASE REPORT: Mr D.L 33 years old man suffering from myalgia, muscular weakness and cramps for six months. The laboratory check-up revealed a high serum creatin phosphokinase level, an autoimmune hypothyroidism, hyperprolactinemia and pituitary enlargement. The electromyogram was normal and the muscle biopsy showed no obvious inflammation. The outcome was favourable under L. thyroxin. DISCUSSION: The frequency of myopathy during hypothyroidism ranges from 30 to 80%. The main symptoms related are weakness, muscular cramps and myalgia. However, hyperprolactinemia and pituitary enlargement described in this case are due to reactional mechanism. These several hypothyroid manifestations improve remarkably under L.thyroxin. CONCLUSION: Proximal myopathy may rarely be displayed as the sole manifestation of hypothyroidism. Therefore, it is recommended that hypothyroid myopathy should be taken into account during differential diagnosis of proximal muscle weakness.     

Effects of hypogonadism and testosterone administration on depression indices in HIV-infected men

Hypogonadism is prevalent among human immunodeficiency virus-infected men, in whom significantly reduced quality of life and mood disturbances have been reported. Previous studies have not investigated the relationship between depression score and gonadal function among such patients. We first compared depression scores in hypogonadal (n = 52) and eugonadal (n = 10) patients with acquired immunodeficiency syndrome (AIDS) wasting, matched for weight and disease status, and then investigated the effects of testosterone administration on depression score in a randomized, double-blind, placebo-controlled study among the group of hypogonadal men with AIDS wasting. The primary end point in all comparisons was the Beck Depression Inventory. Hypogonadal patients demonstrated significantly increased scores on the Beck inventory compared with eugonadal-, age-, weight-, and disease status-matched subjects (15.5+/-1.1 vs. 10.6+/-1.4 mean +/- SEM, P = 0.02). Among the combined hypogonadal and eugonadal subjects, a significant inverse correlation was seen between the Beck score and both free (r = 0.41, P<0.01) and total serum testosterone levels (r = -0.43, P<0.001). The relationship between the Beck score and testosterone levels remained highly significant, controlling for weight, viral load, CD4 count, and antidepressant use (P<0.01 for free testosterone, P<0.001 for total testosterone). Furthermore, when subjects were divided into two groups, based on a Beck score greater than 18 or less than or equal to 18, serum total and free testosterone levels were significantly lower in the subjects with a Beck score greater than 18, whereas there were no differences in weight, viral load, CD4 count, or Karnofsky status. End of study data were available in 39 patients who completed the randomized, placebo-controlled study. Beck score decreased significantly only in the subjects receiving testosterone (-5.8+/-1.3, P< 0.001), but not in subjects randomized to placebo (-2.7+/-1.3, P> 0.05). In a regression analysis, the change in Beck score was related significantly to change in weight (P<0.01). These data demonstrate increased depression score in association with hypogonadism in men with AIDS wasting, independent of weight, virologic status, and other disease factors. In such patients, administration of testosterone results in a significant improvement in depression inventory score. This effect may be a direct effect of testosterone or related to positive effects of testosterone on weight and/or other anthropometric indices. Additional studies are needed to assess the effects of testosterone on clinical depression indices in human immunodeficiency virus-infected patients.     

Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery

Background contextThe vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia.PurposeThe goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord.Study design/settingThis is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases.MethodsAll cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases.ResultsMost patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months.ConclusionsTemporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome.