Frank L. Acosta

The development of postoperative granulation tissue is one of the main postoperative risks after lumbar spine surgery. This granulation tissue may lead to persistent or new clinical symptoms or complicate a follow up surgery. A sensitive non-invasive imaging technique, that could diagnose this granulation tissue at the bedside, would help to develop appropriate treatments. Thus, the purpose of this study was to establish a fast and economic imaging tool for the diagnosis of granulation tissue after lumbar spine surgery, using a new integrated Optical Imaging (OI)/X-ray imaging system and the FDA-approved fluorescent contrast agent Indocyanine Green (ICG).

Study Design Retrospective review of clinical case series. Objective We present our experience with extended (≥3 levels) anterior cervical corpectomy (EACC) and reconstruction. Summary of Background Data Multilevel cervical corpectomy has traditionally been associated with increased graft-related complications and worse clinical outcomes compared with single-level procedures. Data specifically regarding corpectomies across 3 or more levels remains limited. Methods Retrospective review of data on 20 patients who underwent anterior cervical corpectomies with titanium mesh cage reconstruction and supplemental posterolateral fixation across 3 or more levels of the cervical spine. Anteroposterior/lateral plain films were used to determine sagittal balance and cage subsidence. Fusion was defined as the lack of motion on flexion-extension radiographs. Patients underwent preoperative and postoperative clinical assessment using visual analog scores and Nurick grading. Results Surgery was performed for spondylotic myelopathy in 15 patients, osteomyelitis in 4, and fracture in 1. Corpectomies were performed across an average of 3.4 levels. Average follow-up was 33 months. Local autograft was used in all cases except osteomyelitis, where allograft was used instead. Sagittal balance was improved or maintained in all patients and was not related to number of corpectomy levels. An average of 30.2 degrees of kyphosis correction was achieved in 9 patients. All patients demonstrated radiographic evidence of fusion without significant cage subsidence and no cases of instrumentation failure. Improvement in pain and functional scores occurred in all cases. Conclusions Circumferential reconstruction using titanium mesh cages after EACC can provide appropriate, biomechanically stable fixation and allows for significant correction of preexisting kyphosis. Supplemental posterior instrumentation may limit delayed cage subsidence and loss of sagittal balance after this procedure. EACC and circumferential reconstruction seems to be an effective treatment for symptomatic degenerative, traumatic, or infectious pathology involving 3 or more levels of the anterior cervical spine.

The global increase of spinal infections is concomitant with the rise of its risk factors, including HIV/AIDS, diabetes mellitus, intravenous drug use, advanced age, and gunshot wounds to the spine. Because spinal infections have a wide span of presentation, early detection and differentiation are notoriously challenging. Current advances in laboratory and imaging techniques, such as polymerase chain reaction, fluorodeoxyglucose positron emission tomography, and 99mTc-ciprofloxacin scintigraphy, allow for better diagnostic rendering of the infection and its degree of spinal involvement. Less invasive surgical procedures and preventive surgical management have helped reduce spinal infection morbidities such as deformity and neurologic deficit. Although proper antibiotic regimen and correct surgical management are of vital importance to successful patient outcome, early detection remains the most critical factor.

The authors report the successful outcome of a six-level corpectomy across the cervico-thoracic spine with circumferential reconstruction in a patient with extensive osteomyelitis of the cervical and upper thoracic spine. To the authors’ knowledge, this is the first report of a corpectomy extending across six levels of the cervico-thoracic spine. Clinical relevance: the authors recommend anterior cage and plate-assisted reconstruction and additional posterior instrumentation using modern spinal surgical techniques and implants.

OBJECTIVE:. We analyzed the outcome of patients with symptomatic vertebral hemangiomas treated at University of California, San Francisco, over a 20 ye

We retrospectively studied 20 adults who underwent C1-C2 transarticular screw (TAS) fixation utilizing frameless stereotaxy. The study group comprised 13 men and 7 women, with a mean age of 63 years (range 12-87 years). All patients demonstrated clinical and radiographic evidence of C1-C2 instability. The cause of the instability was trauma in 11 patients, rheumatoid arthritis in 6 patients, failed prior surgery in 2 patients, and congenital malformation in 1 patient. All patients underwent stabilization with C1-C2 TASs using image-guided frameless stereotaxy. There were no new or worsening neurologic symptoms reported at 18-month follow-up. Motor weakness improved in seven of nine patients, myelopathy in seven of seven, and gait in three of six patients in whom these deficits were present preoperatively. Postoperative complications included one surgical site abscess, one cutaneous pressure ulcer, and one iliac crest donor site infection. Of 36 screws placed, 33 (92%) were well positioned. Normal C1-C2 alignment was achieved in 17 of 20 (85%) patients. In 4 of 20 cases, screw implant, which was thought to be anatomically difficult, if not impossible, on the basis of routine magnetic resonance or computed tomography imaging, was actually accomplished successfully using surgical navigation. C1-C2 TAS placement is a safe and accurate surgical technique that may improve neurologic function. Use of intraoperative navigation can facilitate achieving difficult surgical trajectories that match the patient's anatomy, thus allowing TAS implant in patients who otherwise would not be candidates for this type of internal fixation.

Low-back pain is the most common health problem for men and women between 20 and 50 years of age, resulting in 13 million doctor visits in the US annually, with significant costs to society in terms of lost time from work and direct and indirect medical expenses. Although the exact origin of most cases of low-back pain remains unknown, it is understood that degenerative damage to the intervertebral disc (IVD) plays a central role in the pathogenic mechanism leading to this disorder. Current treatment modalities for disc-related back pain (selective nerve root blocks, surgical discectomy and fusion) are costly procedures aimed only at alleviating symptoms. Consequently, there is growing interest in the development of novel technologies to repair or regenerate the degenerated IVD. Recently, mesenchymal stem cells (MSCs) have been found to possess the capacity to differentiate into nucleus pulposus–like cells capable of synthesizing a physiological, proteoglycan-rich extracellular matrix characteristic of healthy IVDs. In this article, the authors review the use of MSCs for repopulation of the degenerating IVD. Although important obstacles to the survival and proliferation of stem cells within the degenerating disc need to be overcome, the potential for MSC therapy to slow or reverse the degenerative process remains substantial.

P Neurocutaneous melanosis (NCM) is a rare congenital neurocutaneous syndrome characterized by large or multiple congenital melanocytic nevi and benign or malignant melanocytic tumors of the leptomeninges. The authors report the case of a 5-month-old girl with congenital giant melanocytic nevi who presented with symptomatic hydrocephalus. A right frontal ventriculostomy was performed in the patient. Magnetic resonance imaging demonstrated melanocyte accumulation within the hippocampi, medulla, and cerebellum. Cerebrospinal fluid cytology revealed no presence of melanocytes. A ventriculoperitoneal shunt was placed; the patient's neurological condition improved and she was discharged home in good condition. The diagnosis of neurocutaneous melanosis should be considered in a case in which an infant or child presents with hydrocephalus and either large or multiple (≥ 3) congenital melanocytic nevi. Although our patient's neurological status improved following treatment for hydrocephalus, there is no definitive therapy for NCM and symptomatic patients have a poor prognosis. Our case illustrates to the neurosurgeon the importance of recognizing the likelihood of underlying pathological conditions of the central nervous system in a child with cutaneous melanocytic nevi.