Adetokunbo A. Oyelese

A brief history of endoscopic spine surgery

Few neurosurgeons practicing today have had training in the field of endoscopic spine surgery during residency or fellowship. Nevertheless, over the past 40 years individual spine surgeons from around the world have worked to create a subfield of minimally invasive spine surgery that takes the point of visualization away from the surgeons eye or the lens of a microscope and puts it directly at the point of spine pathology. What follows is an attempt to describe the story of how endoscopic spine surgery developed and to credit some of those who have been the biggest contributors to its development.

Use of intraoperative computed tomography in complex craniofacial trauma: an example of on-table change in management.

The primary goals in repairing complex craniofacial fractures are restoration of occlusion and mastication, and anatomic reconstruction of a symmetric facial skeleton. Failure to accomplish these goals may result in the need for secondary operations. Recognition of malreduction may not be appreciated until review of a postoperative computed tomographic (CT) scan. Intraoperative CT scanning enables immediate on-table assessment of reduction and fixation, allowing alteration of the surgical plan as needed. We report using intraoperative CT scanning while repairing a panfacial injury in which malreduction was appreciated intraoperatively and corrected. Intraoperative CT can be used to improve outcomes and quality of complex facial fracture repair.

Interdisciplinary Management of Minimally Displaced Orbital Roof Fractures: Delayed Pulsatile Exophthalmos and Orbital Encephalocele

Traumatic orbital roof fractures are rare and are managed nonoperatively in most cases. They are typically associated with severe mechanisms of injury and may be associated with significant neurologic or ophthalmologic compromise including traumatic brain injury and vision loss. Rarely, traumatic encephalocele or pulsatile exophthalmos may be present at the time of injury or develop in delayed fashion, necessitating close observation of these patients. In this article, we describe two patients with minimally displaced blow-in type orbital roof fractures that were later complicated by orbital encephalocele and pulsatile exophthalmos, prompting urgent surgical intervention. We also suggest a management algorithm for adult patients with orbital roof fractures, emphasizing careful observation and interdisciplinary management involving plastic surgery, neurosurgery, and ophthalmology.

Intraoperative Computed Tomography Navigational Assistance for Transforaminal Endoscopic Decompression of Heterotopic Foraminal Bone Formation After Oblique Lumbar Interbody Fusion.

Transforaminal endoscopic spine surgery is an emerging technique in spine surgery, but it offers 2 distinct challenges to spine surgeons looking to adopt it: 1) targeting spine pathology and 2) understanding the endoscopic anatomy visualized through the endoscope. Intraoperative computed tomography (CT)-guided navigation is also an emerging technique in spine surgery that is becoming widely adopted for its benefits in assisting surgeons in localizing pathology and guided spine instrumentation placement. In this technical note, we describe a technique that uses intraoperative CT-guided navigation concomitantly with a transforaminal endoscopic approach to decompress a L4-L5 foraminal heterotopic bone formation after an oblique lumbar interbody fusion. The addition of intraoperative CT-guided navigation proved beneficial in targeting the pathology during the procedure and ensuring that the pathology was resolved by offering postoperative CT visualization of the decompressed neural foramen.

Transforaminal Endoscopic Decompression for Foot Drop 12 Years After Lumbar Total Disk Replacement

Lumbar total disk replacement is considered for the treatment of lumbar degenerative disk disease with the hope that by preserving motion, the long-term fusion complication of adjacent segment disease can be avoided. The complications of lumbar total disk replacement can be divided into approach-related and long-term complications. Little has been described about the complications and treatment for complications >10 years after the device has been implanted. Here we describe a transforaminal endoscopic diskectomy procedure for a patient presenting with foot drop 12 years after a L5-S1 total disk replacement.

Transforaminal Endoscopic Decompression in the Setting of Lateral Lumbar Spondylolisthesis

BACKGROUND Lateral subluxation of the vertebra is commonly seen in degenerative lumbar scoliosis. Transforaminal endoscopic spine surgery is an emerging technique in spine surgery but has never been described as a treatment option for lumbar radiculopathy in the setting of lateral lumbar spondylolisthesis. METHODS A technique for endoscopic treatment of lumbar disc herniation in the setting of lateral spondylolisthesis is presented. We retrospectively reviewed 199 cases of patients who underwent transforaminal endoscopic surgery in a 3-year period with a minimum follow-up of 1 year. RESULTS Between 2014 and 2017, 4 patients (average age, 74.8 years; range, 69-82 years) underwent transforaminal endoscopic discectomy procedures for disc herniations at the level of lateral subluxation. One patient whose lateral subluxation was above an instrumented fusion required an extension of fusion to the operated level 5 months after endoscopic surgery for a reherniation. For the other 3 patients, mean visual analog scale score for radicular pain improved from an average pain score of 8.3 before surgery to 3.0 1 year after surgery, and Oswestry Disability Index improved from 26.7 to 4.7. CONCLUSIONS Transforaminal endoscopic surgery for lumbar disc herniation in the setting of lateral subluxation of vertebral bodies is a unique minimally invasive approach for treatment of lumbar radiculopathy that might be considered as an alternative treatment to deformity correction surgery in older patients.

Occipitocervical and Upper Cervical Metastatic Spinal Disease

Patients with metastatic spinal disease of the occipitocervical junction and upper cervical spine can often present a treatment challenge to the practitioner. This is due to the unique bony anatomy of C1 and C2, complicated surrounding neurovascular anatomy, and unique regional spinal biomechanics. By incorporating information obtained from history and physical examination, assessment of overall medical condition, and imaging findings, the practitioner can help formulate a personalized treatment plan that reduces the risk of patient harm and maximizes potential benefit. This requires a multimodality treatment team approach with medical oncology, radiation oncology, and spine surgery all providing essential input in consultation with the patient. We provide an overview of the treatment strategy for patients that harbor tumors of this complicated spinal region.

Minimally invasive direct lateral, retroperitoneal transforaminal approach for large L1–2 disc herniations with intraoperative CT navigational assistance: technical note and report of 3 cases

Upper lumbar (L1-2, L2-3) disc herniations are distinct in their diffuse presenting clinical symptomatology and have poorer outcomes with surgical intervention than those following mid and lower lumbar disc herniations and disc surgery. The authors present the cases of 3 patients with L1-2 disc herniations and significant stenosis of the spinal canal. The surgical approach used here combined the principles of transforaminal percutaneous endoscopic discectomy and the extreme lateral lumbar interbody fusion procedures with intraoperative CT-guided navigational assistance. The approach provides a safe corridor of direct visualization to the ventral thecal sac with minimal bony resection and could, in principle, reduce neurological injury and biomechanical instability, which likely contribute to poor outcomes at this level.

Surgical management of spinal metastases

ABSTRACT Introduction: Metastatic spinal disease is a source of significant morbidity in patients with cancer. Recent advancements in adjuvant oncologic therapy has led to increased survival for many patients who harbor neoplastic disease. As a result of this, the chance of developing metastatic spinal disease over the course of a cancer patient’s lifespan has increased. Symptomatic metastatic spinal disease can cause significant morbidity including severe pain, neurologic deficit, and loss of ambulation. Current treatment of these patients typically involves the use of multiple modalities, including surgery, radiation, and chemotherapy. Areas covered: An extensive literature review was performed to support the author’s opinion on the matter of surgical management of spinal metastatic disease. Pubmed was utilized as a primary search engine. Expert commentary: Despite advances in chemotherapy and radiation therapy, surgery remains a mainstay in many of these patients, particularly with those with either significant metastatic spinal epidural compression or spinal instability. This review discusses the surgical management of metastatic spinal disease including a framework for decision making and technical considerations when deciding to operate on these patients.

Clinical efficacies of gemcitabine combined with docetaxel single or plus bevacizumab as second-line therapy for malignant pleural mesothelioma

Background: The aims of this study were to evaluate the clinical efficacies and safety of gemcitabine combined with docetaxel as second-line therapy for malignant pleural mesothelioma (MPM), and to compare the effect of combining with bevacizumab or not. Methods: A total of 37 MPM patients were collected, among whom 21 patients were treated with chemotherapy alone (group GD), and 16 patients were treated with chemotherapy + bevacizumab (group A + GD). Results: Of the 37 patients, 23 patients achieved the control of their disease conditions, including 1 case of complete response (CR), 9 cases of partial response (PR), 13 cases of stable disease (SD), and 14 cases of progressive disease (PD). The progression free survival (PFS) time was 4.5 months, and the overall survival (OS) time was 12.0 months. The objective response rates (ORR) in groups GD and A + GD were 23.8% and 31.3%, respectively, χ 2 =1.255, P=0.145, and the difference was not statistically significant; the disease control rate (DCR) in groups GD and A + GD were 52.4% and 75.0%, respectively, χ 2 =3.975, P=0.044, and the difference showed statistically significant. PFS in groups GD and A + GD were 4.0 and 5.4 months, respectively, χ 2 =4.615, P=0.032. OS in group GD and A + GD was 11.3 and 13.6 months, respectively, χ 2 =4.484, P=0.028. The difference was statistically significant. Conclusions: For MPM patients, if the disease proceeds after the first-line treatment (pemetrexed combined with platinum), the chemotherapy regimen of gemcitabine combined with docetaxel can be performed for the patients with better PS scores. The addition of bevacizumab can further improve the efficacies, and the adverse reactions can be tolerated.