Lumbar Approach Research Articles

Impact of Age on the Occurrence of Vascular Complications in Patients Undergoing Anterior Lumbar Approach Surgery.

Retrospective cohort study. To investigate the impact of age on the incidence of vascular complications in patients undergoing anterior lumbar approach surgery. Anterior approach lumbar spinal surgery may facilitate the use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of this approach, risks related to vascular injury in older patients have been described in the literature. In total, 751 consecutive patients with degenerative spinal pathology who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation (360), total disc replacement, or hybrid procedures (ALIF and total disc replacement) were included. Data collected included general patient descriptive data, surgery details, intraoperative vascular injury, and postoperative vascular complications (deep vein thrombosis and/or pulmonary embolism). Rates of vascular complications were compared across age groups. In addition, the mean age of patients was compared between those with versus without vascular complications. Overall mean age was 50.4 years (range: 20-83 yr). The mean estimated blood loss was 91.3mL (range: 10-2800mL). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins (mean blood loss was 721mL, and all were repaired intraoperatively). Postoperatively, 6 patients (0.8%) developed deep vein thrombosis and/or pulmonary embolism (one patient had both). With respect to age, there were no significant differences in rates of intraoperative, postoperative, or combined vascular complication rates across the age group ( P > 0.38). In addition, there were no statistically significant differences in the mean ages of patients with versus those without vascular complications ( P > 0.17). Overall incidence of vascular complications was 2.0%. No relationship between vascular complications and age was demonstrated. These data suggest that increased age may not necessarily be an absolute contraindication for anterior lumbar approach surgery. Level III.

A retrospective analysis of perioperative complications of lateral approach lumbar interbody fusion in patients with prior abdominal surgery or a history of colonic inflammatory disease

BACKGROUND CONTEXTLateral approaches for lumbar interbody fusion (LIF) allow for access to the lumbar spine and disc space by passing through a retroperitoneal corridor either pre- or trans-psoas. A contraindication for this approach is the presence of retroperitoneal scarring that may occur from prior surgical intervention in the retroperitoneal space or from inflammatory conditions with fibrotic changes and pose challenges for the mobilization and visualization needed in this approach. However, there is a paucity of evidence on the prevalence of surgical complications following lateral fusion surgery in patients with a history of abdominal surgery. PURPOSEThe primary aim of this study is to describe the association between surgical complications following lateral interbody fusion surgery and prior abdominal surgical. STUDY DESIGNRetrospective study. PATIENT SAMPLEPatients over the age of 18 who underwent lateral lumbar interbody fusion at a large, tertiary care center between 2011 and 2019 were included in the study. OUTCOME MEASURESThe primary outcome included medical, surgical, and thigh-related complications either in the intraoperative or 90-day postoperative periods. Additional outcome metrics included readmission rates, length of stay, and operative duration. METHODSThe electronic health records of 250 patients were reviewed for demographic information, surgical data, complications, and readmission following surgery. The association of patient and surgical factors to complication rate was analyzed using multivariable logistic regression. Statistical analysis was performed using R statistical software (R, Vienna, Austria). RESULTSOf 250 lateral interbody fusion patients, 62.8% had a prior abdominal surgery and 13.8% had a history of colonic disease. The most common perioperative complication was transient thigh or groin pain/sensory changes (n=62, 24.8%). A multivariable logistic regression considering prior abdominal surgery, age, BMI, history of colonic disease, multilevel surgery, and the approach relative to psoas found no significant association between surgical complication rates and colonic disease (OR 0.40, 95% CI 0.02–2.22) or a history of prior abdominal surgeries (OR 0.56, 95% CI 0.20–1.55). Further, the invasiveness of prior abdominal surgeries showed no association with overall spine complication rate, lateral-specific complications, or readmission rates (p>.05). CONCLUSIONThough retroperitoneal scarring is an important consideration for lateral approaches to the lumbar spine, this study found no association between lateral lumbar approach complication rates and prior abdominal surgery. Further study is needed to determine the impact of inflammatory colonic disease on lateral approach spine surgery.

Is the Use of Intraoperative Neuromonitoring Justified During Lumbar Anterior Approach Surgery?

Intraoperative neuromonitoring (IONM) became widely used in spine surgery to reduce the risk of iatrogenic nerve injury. However, the proliferation of IONM has fallen into question based on effectiveness and costs, with a lack of evidence supporting its benefit for specific spine surgery procedures. The purpose of this study was to evaluate the use of IONM and the rate of neurological injury associated with anterior lumbar spinal surgery. This was a retrospective study on a consecutive series of 359 patients undergoing lumbar anterior approach surgery for anterior lumbar interbody fusion (ALIF), total disc replacement (TDR), or hybrid (ALIF with TDR) for the treatment of symptomatic disc degeneration. Patients undergoing any posterior spine surgery were excluded. Operative notes were reviewed to identify any changes in IONM and the surgeon's response. Clinic notes were reviewed up to 3 months postoperatively for indications of iatrogenic nerve injury. There were 3 aberrant results with respect to IONM. Changes in IONM of a lower extremity occurred for 1 patient (0.3%). The surgeon evaluated the situation and there was no observable reason for the IONM change. Upon waking, the patient was found to have no neurological deficit. There were 2 cases of neurologic deficits in this population, which were classified as false-negatives of IONM (0.56%, 95% CI: 0.1% to 1.8%). In both cases, the patients were found to have a foot drop after the anterior approach surgery. In this study, there was 1 false-positive and 2 false-negative results of IONM. These data suggest that IONM is not beneficial in this population. However, many surgeons may feel obligated to use IONM for medicolegal reasons. There is a need for future studies to delineate cases in which IONM is beneficial and the type of monitoring to use, if any, for specific spine surgery types. This study questions the routine use of IONM in anterior lumbar approach surgery for the treatment of symptomatic disc degeneration. This has significant implications related to the cost of this practice.

The Transabdominal Lumbar Approach (TALA) for Robotic Renal Surgery-A Retrospective Single-Center Comparative Study and Step-by-Step Description of a Novel Approach.

The transperitoneal approach (TP) and the retroperitoneal approach (RP) are two common methods for performing nephrectomy or partial nephrectomy. However, both approaches face difficulties, such as trocar placement and limited working space (RP). TP is impaired in the case of dorsal tumors and dissection of the renal artery can be challenging due to the anatomic localization dorsally to the renal vein. A hybrid approach that combines both methods has been previously reported in a case series, but not evaluated systematically. This study proposes a modified hybrid approach, which we call the transabdominal lumbar approach (TALA), involving late robotic docking after elaborating the retroperitoneum using conventional laparoscopy. The study compares the last 20 consecutive patients who underwent RP and the last 20 patients who underwent TALA at our institution. The investigated variables include operative time and amount of blood loss, hospitalization duration, postoperative analgesia requirement, and postoperative complications. The study found no significant difference in operative time, blood loss, ischemia time, or hospital stay between the two groups. The TALA group had fewer complications regarding Clavien-Dindo category 3, but one complication of category 4. In Conclusion, TALA is a safe and promising approach that combines the advantages of RP and TP.

Intrathecal cervical analgesia for cancer pain: a 12-year follow-up study in a comprehensive cancer center

BackgroundIntrathecal analgesia plays a key role for patients suffering refractory cancer pain. Nevertheless, intrathecal drug delivery systems (IDDS), requiring a cervical catheter tip implantation, have been poorly described in medical...

Retroperitoneoscopic Ureterolithotomy for the Management of Proximal Ureteric Stones: Initial Clinical Experience

Objective: Laparoscopic ureterolithotomy provides results equivalent to open ureterolithotomy for proximal ureteric stones, can be performed transperitoneally and retroperitoneally. The study aims to assess the efficacy of retroperitoneoscopic ureterolithotomy for managing proximal ureteral stones. Patients and Methods: It was a retrospective study carried out in the period from March 2018 to November 2021. 14 patients with proximal ureteric stones 16–26 mm (20.07± 02.8), all located above the upper border of the sacroiliac joint. Eleven (78.57%) patients underwent retroperitoneoscopy as a primary procedure, one (07.14%) had a history of failed ESWL, and two patients (14.28%) failed retrograde ureteroscopy. Retroperitoneoscopic ureterolithotomy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital and homemade balloon dissection and secured 10 mm Hasson trocar at the primary port site, and 0° telescope advanced. Two 5-mm trocars were placed under visualization forming a triangle. The stone was removed from the primary port site while visualizing retrieval through the 5 mm. port using a fine 30° Cystoscope. Ureterotomy closure was performed by intracorporeal interrupted sutures of 4-0 polyglactin over 5 fr double-J stent, and a drain was left in the retroperitoneum. Results: Retroperitoneoscopic ureterolithotomy was accomplished in 11 out of 14 cases (78.58%). Three (21.42%) were converted to open surgery (2) and transperitoneal ureterolithotomy (1). The reason for open conversion was the failure to locate the ureter due to severe adhesion in 1 case, technical problems during dissection in 1 case, and another access problem, injury to the peritoneum, which was converted to the transperitoneal route. In 11 successful cases, the mean operative time was 126.5 ± 23.81 (90-170) min. There was no requirement for transfusions. There were no major perioperative and post-operative complications were observed. According to the modified Clavien classification, 07(63.63%) patients were reported to be grade I, whereas 04(36.36%) patients were reported to be grade II. One patient was managed with a course of antibiotics due to post-operative fever. Two patients who developed subcutaneous emphysema and superficial wound infection were treated conservatively. One urinary leakage was subsided by urethral re-catheterization. The drain was removed at 03.81 ±01.25(03-07) days. The mean hospital stay was 04.09 ± 01.13 (03-07) days. Conclusion: Retroperitoneoscopic ureterolithotomy has acceptable overall complication rates. It is an effective, low-morbidity alternative for the treatment of proximal ureter stones. Bangladesh J. Urol. 2022; 25(2): 84-92

The Development and Application of a Cost-Effective Cervical Spine Phantom for Use in Fluoroscopically Guided Lateral C1-C2 Spinal Puncture Training.

Lateral C1-C2 spinal punctures are uncommon procedures performed by radiologists for access to CSF and contrast injection when a lumbar approach is contraindicated and an alternate method of access becomes necessary. There are limited opportunities to learn and practice the technique. We aimed to develop and assess the efficacy of a low-cost, reusable cervical spine phantom for training in fluoroscopically guided lateral C1-C2 spinal puncture. The phantom was constructed with a cervical spine model, an outer tube representing the thecal sac, an inner balloon representing the spinal cord, and polyalginate to replicate soft tissue. The total cost of materials was approximately US $70. Workshops were led by neuroradiology faculty experienced in the procedure using the model under fluoroscopy. Survey questions were assessed on a 5-point Likert scale. Participants were given pre- and postsurveys assessing comfort, confidence, and knowledge of steps. Twenty-one trainees underwent training sessions. There was significant improvement in comfort level (Δ: 2.00, SD: 1.00, P value < .001); confidence (Δ: 1.52 points, SD: 0.87, P value < .001); and knowledge (Δ: 2.19, SD: 0.93, P value < .001). Eighty-one percent of participants found the model "very helpful" (5/5 on Likert scale), and all participants were "very likely" to recommend this workshop to others. This cervical phantom model is affordable and replicable and demonstrates training utility to prepare residents for performing lateral C1-C2 spinal puncture. This is a rare procedure, so the use of a phantom model before patient encounters is invaluable to resident education and training.

Lumbar Sympathetic Chain Tract and Mobility of Oblique Lumbar Interbody Fusion Approach: A Cadaveric Study

To assess lumbar sympathetic chain (LSC) relation to the surgical corridor for oblique lumbar approach and the ability to mobilize the LSC. Forty-three cadavers were included. Left-sided anterior retroperitoneal approach was performed in a supine position. Distance between the great vessels and psoas muscle (oblique corridor) and distance between great vessels and LSC at L2/3, L3/4, and L4/5 disc levels were measured. Mobilization of LSC at each disc level was done either close to or away from the psoas muscle and each mobilization distance was measured. The presence rates of LSC in oblique corridor were 19.5%, 43%, and 75.7% at L2/3, L3/4, and L4/5 levels, respectively. At L2/3 disc level, mean distance between psoas muscle and LSC and its mobility were 0.61±1.31 mm, and 2.72±1.24 mm, respectively. At L3/4 disc level, mean distance between psoas muscle and LSC and its mobility were 1.72±2.53 mm, and 3.11±1.02 mm, respectively. At L4/5 disc level, mean distance between psoas muscle and LSC and its mobility were 2.94±3.52 mm, and 2.53±1.03 mm, respectively. The mean width of corridor of L2/3, L3/4, and L4/5 were 10.73±5.82, 12.63±5.02, and 15.43±6.31 mm, respectively. The LSC tract usually lies in the oblique corridor in L4/5 but keeps decreasing in prevalence when approaching L3/4 and L2/3 levels. It can be mobilized a few millimeters close to or away from the psoas muscle. Care should be taken to prevent LSC injury, particularly when the LSC needs to be retracted along with the psoas muscle.

Letter: Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition.

To the Editor: We read with great interest the recent publication by De Biase et al1 entitled “Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition.” The authors have compared spinal anesthesia with general anesthesia in elective spine surgery to look at the differences in postoperative fatigue, postoperative cognitive dysfunction, and quality of life. They have calculated the sample size to be 25 patients in each group for a total of 50 patients. Although the authors have claimed to look at the abovementioned outcomes in spinal surgery, they have included only patients who are undergoing lumbar spine surgery in the sample. Hence, the results of this study might vary among other segments of the spine such as cervical, thoracic, sacrum, and coccyx. They have also mixed anterior and posterior approaches while reporting the outcomes, while a complication in the anterior cervical approach may have completely different outcomes than a complication in the posterior lumbar approach. Therefore, the quality of life and fatigue may vary completely differently. We suggest a more appropriate title for the study: “Lumbar Spine Surgery Under Spinal vs General Anesthesia: Prospective Analysis of Quality of Life, Fatigue, and Cognition.”

V-007 LESSONS LEARNED DURING THE ABDOMINAL WALL RECONSUTRCTION FOR A MULTIRECURRENT LUMBAR HERNIA AFTER BONE GRAFT HARVESTING

Abstract The best approach for lateral incisional hernia is not known. Among these difficult hernias, those arising from iliac crest harvesting can be particularly challenging. The objective of this video is to illustrate the surgical approach of a multirecurrent case with the need of adding a posterior component separation A 70 years old woman with 2 previous attempts of repair was referred to our center. With the patient in a 45 degrees lateral decubitus, a posterior lumbar approach was initiated through the previous scar. The retromuscular preperitoneal plane was accessed with difficulty due to previous meshes in the subdiaphragmatic, iliac and posterior areas. A big tear on the medial peritoneum changed our plan to add a posterior component separation. As we did not want to enlarge the lumbar incision to denervate more the lateral abdominal wall, we decided to make an accessory midline incision. Probably, an ETEP approach could have been better even before making the posterior incision. Once the retromuscular plane was dissected, the hole in the peritoneum could be closed. The reconstructive phase consisted in making a taco configuration using the combination of a permanent and absorbable mesh. We have learned from this case, that an eTEP dissection of the retromuscular plane could have helped to avoid the accessory midline incision. It is also important to consider the potential iatrogenic denervation we could add in case of enlargement of the incision.

197. Subtherapeutic perioperative levels of cefuroxime inside cannulated pedicle screw commonly used in spine surgery: results from an experimental microdialysis study

BACKGROUND CONTEXT Despite minimal invasive spine techniques, postoperative implant associated vertebral osteomyelitis remains a risk of great morbidity for the patient. Perioperative antibiotic prophylaxis is important for prevention of postoperative infection and local tissue concentrations can be measured with microdialysis. We hypothesized that cefuroxime concentrations in relation to a cannulated pedicle screws may be insufficient for prevention of postoperative infection. PURPOSE The aim was to compare perioperative cefuroxime concentrations inside a cannulated pedicle screw to the adjacent noninstrumented lumbar vertebral pedicle. STUDY DESIGN/SETTING In vivo experimental pharmacokinetics study of cefuroxime concentrations in an acute preclinical porcine model. PATIENT SAMPLE Not applicable. OUTCOME MEASURES The primary end-point was the time above cefuroxime clinical breakpoint minimal inhibitory concentration for Staphylococcus aureus of 4 µg/mL (T>MIC4) METHODS Microdialysis probes were placed in a cannulated pedicle screw and the adjacent non-instrumented lumbar vertebral pedicle (L1) in 8 female pigs through a surgical posterior open lumbar approach. Following a single-dose intravenous cefuroxime administration (1.5 g), microdialysates and plasma were dynamically sampled over 8 hours. RESULTS Mean T>MIC4 (range) was 123 min (112-175) in plasma, 101 min (68-144) in the non-instrumented vertebral pedicle and 0 min (0-0) inside the cannulated pedicle screw. CONCLUSIONS A single-dose intravenous cefuroxime administration (1.5 g) seems insufficient for antibiotic prophylaxis inside a cannulated pedicle screw placed in the lumbar spine. Sufficient concentrations were achieved in the adjacent non-instrumented vertebral pedicle for up to 1.5-2 hours. Therefore, alternative dosing regimens should be considered in minimal invasive spine surgery longer than 1.5 hours and additional prophylactic strategies against infection may be applied in high-risk patients. FDA DEVICE/DRUG STATUS Cefuroxime (Approved for this indication) Despite minimal invasive spine techniques, postoperative implant associated vertebral osteomyelitis remains a risk of great morbidity for the patient. Perioperative antibiotic prophylaxis is important for prevention of postoperative infection and local tissue concentrations can be measured with microdialysis. We hypothesized that cefuroxime concentrations in relation to a cannulated pedicle screws may be insufficient for prevention of postoperative infection. The aim was to compare perioperative cefuroxime concentrations inside a cannulated pedicle screw to the adjacent noninstrumented lumbar vertebral pedicle. In vivo experimental pharmacokinetics study of cefuroxime concentrations in an acute preclinical porcine model. Not applicable. The primary end-point was the time above cefuroxime clinical breakpoint minimal inhibitory concentration for Staphylococcus aureus of 4 µg/mL (T>MIC4) Microdialysis probes were placed in a cannulated pedicle screw and the adjacent non-instrumented lumbar vertebral pedicle (L1) in 8 female pigs through a surgical posterior open lumbar approach. Following a single-dose intravenous cefuroxime administration (1.5 g), microdialysates and plasma were dynamically sampled over 8 hours. Mean T>MIC4 (range) was 123 min (112-175) in plasma, 101 min (68-144) in the non-instrumented vertebral pedicle and 0 min (0-0) inside the cannulated pedicle screw. A single-dose intravenous cefuroxime administration (1.5 g) seems insufficient for antibiotic prophylaxis inside a cannulated pedicle screw placed in the lumbar spine. Sufficient concentrations were achieved in the adjacent non-instrumented vertebral pedicle for up to 1.5-2 hours. Therefore, alternative dosing regimens should be considered in minimal invasive spine surgery longer than 1.5 hours and additional prophylactic strategies against infection may be applied in high-risk patients.

Early Reoperation Rates and Its Risk Factors after Instrumented Spinal Fusion Surgery for Degenerative Spinal Disease: A Nationwide Cohort Study of 65,355 Patients.

Reoperation is a major concern in spinal fusion surgery for degenerative spinal disease. Earlier reported reoperation rates were confined to a specific spinal region without comprehensive analysis, and their prediction models for reoperation were not statistically validated. Our study aimed to present reasonable base rates for reoperation according to all possible risk factors and build a validated prediction model for early reoperation. In our nationwide population-based cohort study, data between 2014 and 2016 were obtained from the Korean National Health Insurance claims database. Patients older than 19 years who underwent instrumented spinal fusion surgery for degenerative spinal diseases were included. The patients were divided into cases (patients who underwent reoperation) and controls (patients who did not undergo reoperation), and risk factors for reoperation were determined by multivariable analysis. The estimates of all statistical models were internally validated using bootstrap samples, and sensitivity analyses were additionally performed to validate the estimates by comparing the two prediction models (models for 1st-year and 3rd-year reoperation). The study included 65,355 patients: 2939 (4.5%) who underwent reoperation within 3 years after the index surgery and 62,146 controls. Reoperation rates were significantly different according to the type of surgical approach and the spinal region. The third-year reoperation rates were 5.3% in the combined lumbar approach, 5.2% in the posterior lumbar approach, 5.0% in the anterior lumbar approach, 3.0% in the posterior thoracic approach, 2.8% in the posterior cervical approach, 2.6% in the anterior cervical approach, and 1.6% in the combined cervical approach. Multivariable analysis identified older age, male sex, hospital type, comorbidities, allogeneic transfusion, longer use of steroids, cages, and types of surgical approaches as risk factors for reoperation. Clinicians can conduct comprehensive risk assessment of early reoperation in patients who will undergo instrumented spinal fusion surgery for degenerative spinal disease using this model.

Outcomes following transpsoas lateral lumbar interbody fusion

The transpsoas lateral lumbar interbody fusion (LLIF) is utilized to treat multiple spinal conditions ranging from degenerative disorders to spinal deformities. The transpsoas LLIF was developed to limit the vascular complications of the anterior lumbar approach and minimize extensive soft tissue dissection and neural manipulation of the posterior approach. Compared to other fusion techniques, the transpsoas LLIF has demonstrated more favorable clinical outcomes (lower VAS and ODI scores), a greater improvement in radiological outcomes, lower risk of bleeding, shorter operative times, and higher fusion rates. It is a cost-effective technique that is associated with a shorter length of stay, lower reoperation/readmission rates, and minimal risk of complications. This review provides an overview of transpsoas LLIF and highlights the surgical outcomes, including operative and postoperative complications associated with this surgical technique.

Transpsoas lateral lumbar interbody fusion technique and indications

Multiple surgical approaches to the lumbar spine exist, with recent trends towards minimally invasive techniques to decrease tissue trauma, hospitalization duration, and postoperative pain. Lateral minimally invasive approachs to the lumbar spine have become popular with the transpsoas approach being one pathway for access. This chapter will review the transpsaos lateral lumbar approach technique and highlight indications for its utilization.

Indolent Infection After Lumbar Interbody Fusion: An Under-recognized Cause of Pseudarthrosis, Which Can Be Successfully Treated With Anterior Revision Fusion.

Introduction:Bacterial infection is a common etiology for pseudarthrosis after transforaminal lumbar interbody fusion, although it is often difficult to identify because of a delayed presentation and normal laboratory values. The primary goal of this study was to present a series of cases demonstrating patients with infection-related pseudarthrosis successfully managed with anterior revision.Methods:We retrospectively reviewed patients presenting to a single academic spine center who were found to have evidence of Cutibacterium acnes or coagulase-negative Staphylococcus infection on routine culturing of lumbar interbody fusion revisions from July 2019 to January 2021. All patients underwent salvage of a transforaminal lumbar interbody fusion pseudarthrosis through an anterior lumbar approach.Results:A total of six patients managed for pseudarthrosis secondary to suspected infection were eligible for this study (mean age 64.8 years, range 54-70 years; mean body mass index, range 24.5-39.1). Persistent radiculopathy was the primary presenting symptom in all patients with a mean time to revision of 17 months. Coagulase-negative Staphylococcus was the primary pathogen, identified from intraoperative samples in 50% of the cases. All patients demonstrated a resolution of symptoms after placement of an anterior lumbar interbody cage, without intraoperative complications, and a subsequent antibiotic regimen.Discussion:Indolent infection is an under-recognized cause of pseudarthrosis of the lumbar spine. Revision surgery through an anterior lumbar approach, which promotes ease of cage removal and optimized alignment and surface area available for revision fusion, is sufficient to manage pseudarthrosis due to infection.

Ultrasound-guided transforaminal approach for nusinersen delivery in adult spinal muscle atrophy patients with challenging access.

Previous papers on ultrasound (US)-guided delivery of nusinersen in patients with spinal muscle atrophy (SMA) described good results with translaminar approach. However, this approach is not possible in patients with spinal fusion and no visible interlaminar space on pre-procedural computed tomography (CT). US-guided transforaminal nusinersen delivery is a potential option that warrants investigation. Twenty adult SMA patients with challenging access were treated in our institution under cone beam CT (CBCT) guidance. The patients were already in the maintenance phase of the dosing protocol and were prospectively evaluated for US-guided transforaminal approach. After they completed one injection via US-guided transforaminal approach, success and safety of the approach were analyzed. Patients shared their experience on US-guided in comparison to CBCT-guided injections. US-guided transforaminal puncture was possible in 14 (70.0%) patients, although 2 of them required needle repositioning under fluoroscopy due to inadvertent access of a prominent vein. US-guided transforaminal approach was therefore successful in 60% of patients. Mild adverse events were recorded in four patients. The survey on patients' experience showed that seven reported no difference in the two approaches, six preferred the US-guided procedure, and one preferred the CBCT-guided procedure. US-guided transforaminal lumbar approach is an effective and safe method of intrathecal nusinersen delivery in adult SMA patients with challenging spinal access and could be considered the first option in appropriately selected adult SMA patients requiring transforaminal nusinersen delivery.

Acute Arterial Iliac-Femoral Thrombosis During Doble Lumbar Approach for Degenerative Spondylolisthesis

Vascular complications during anterior lumbar approach are well known, however arterial thrombosis is extremely rare. We report a case of an acute left external iliac artery and common femoral artery thrombosis during a doble lumbar approach. The diagnosis was made in the immediate postoperative period and a iliofemoral thromboendarterectomy was performed by a cardiovascular surgeon. The patient developed a left leg compartment syndrome due to a reperfusion injury which was treated in the same surgical stage through a wide fasciotomy.

Adrenal abscess in a preterm neonate with sepsis

The adrenal abscess is a rare complication of adrenal hemorrhage in the neonatal period. Due to its rare occurrence and non-specific signs, diagnosing and treating an adrenal abscess in the neonatal period might be challenging. We present herein a 3-week-old male neonate with an adrenal abscess associated with Escherichia coli sepsis, which was successfully treated by open surgery (using the minimal posterior lumbar approach) following an unsuccessful ultrasound-guided percutaneous drainage. • A neonatal adrenal gland abscess is a rare pathology. • Male neonate with the right adrenal abscess as a complication of Escherichia coli sepsis is presented. • The abscess was successfully treated by surgery after two unsuccessful attempts of percutaneous drainage.

Long-Term Results of Anterior-Only Lumbar Interbody Fusions in Rheumatoid Arthritis Patients: Comparative Retrospective Cohort Study

Rheumatoid arthritis (RA) is a risk factor of lumbar spine surgical failure. The interest of anterior lumbar fusion in this context remains unknown. This retrospective study aimed to compare the outcome of anterior-only fusions between RA patients and non-RA (NRA) patients to treat lumbar spine degenerative disorders. NRA and RA groups including anterior-only fusion were compared. Clinical data (Visual Analog Scale score axial back pain scale, the Oswestry Disability Index, and a questionnaire of satisfaction regarding the surgical result); radiologic data (bone fusion, sagittal balance analysis); and adverse events were assessed using repeated measure 1-way analysis of variance. The mean follow-up was 9.5 years (95% confidence interval [7.1-12.2]) for the RA group (n= 13) and 9.4 years (95% confidence interval [8.7-10.3]) for the NRA group (n= 36). Anterior fusion improved clinical outcome without any effect of RA (Visual Analog Scale score axial back pain scale; P < 0.001/Oswestry Disability Index; P= 0.01). The presence of RA influenced neither the satisfaction as the regards the surgical result nor spine balance nor bone fusion. Context of RA increased the surgical revision rate (10 patients [76.9%] for RA group vs. 3 patients [8.8%] for the NRA group; P= 0.001) because of the occurrence of an adjacent segment disease needing surgical revision (P= 0.028), especially the occurrence of intervertebral frontal dislocation (P= 0.02). As noticed for posterior-only fusion, the anterior lumbar approach in RA patients does not seem to avoid the occurrence of an adjacent segment disease.

Comparison of Taylor Approach vs Lumbar Approach of Spinal Anaesthesia in Terms of Difficulty to Perform in Patients Undergoing Transuretheral Resection of Prostate

Comparison of Taylor Approach vs Lumbar Approach of Spinal Anaesthesia in Terms of Difficulty to Perform in Patients Undergoing Transuretheral Resection of Prostate