Adnan A. Abla

MR imaging in the diagnosis of spontaneous spinal epidural hematomas.

Three patients with spontaneous (idiopathic) spinal epidural hematomas were diagnosed with magnetic resonance (MR) imaging. Magnetic resonance is an accurate, rapid method of localizing and characterizing the hematomas. We believe that MR (where available) should be the primary method of diagnosis in cases in which spinal epidural hematoma is suspected.

Surgical Management of Orbital Lymphangioma With the Carbon Dioxide Laser

Lymphangiomas of the ocular adnexa, especially those in the orbit, are difficult to treat because the unencapsulated tumor freely interdigitates with normal orbital tissue, obliterating any potential surgical plane. Because of the hemorrhagic and friable nature of the tumor, conventional surgical techniques are frequently complicated by bleeding. We used the CO2 laser to remove these lesions subtotally by controlled vaporization in six patients (four girls and two boys, 5 to 17 years old). Three pupils remained dilated postoperatively because of damage to the ciliary nerves and symblepharon formation occurred in one case. None of these has produced any symptoms. In one case, however, laser treatment may have produced corneal anesthesia.

MAJOR CEREBRAL VESSELS INJURY CAUSED BY A SEATBELT SHOULDER STRAP: CASE REPORT

Major cerebral arterial injury may result from penetrating or blunt trauma. In blunt trauma, clinical suspicion of such injury may not be raised, especially if the cranial CT scan is negative. We report a case of a seatbelt shoulder strap to the neck resulting in injury to three major cerebral vessels as demonstrated by cerebral angiography. Although the initial cranial CT scans were negative, a cerebral infarction ultimately developed. The patient was managed conservatively and recovered most of her functions. The importance of clinical suspicion and cerebral angiography is stressed.

Prevention and management of dysphonia during anterior cervical spine surgery

Dysphonia is a common postoperative complaint following anterior cervical spine surgery (ACSS). The purpose of this study was to analyze voice outcomes following ACSS, to identify risk factors predicting vocal cord impairment, and to develop an algorithm for postoperative management of dysphonic patients.

Complication and Avoidance Techniques in Long-segment Anterior Cervical Fusion: Part II

This article is Part I of a two-part series that will review the most common complications seen in multilevel anterior cervical discectomy and fusion surgery and techniques that can improve outcome and minimize complications. Part I discusses preoperative planning and investigates soft tissue, esophageal, vascular, nerve, spinal cord, and nerve root complications and how to avoid them. Part II will review instrumentation and postoperative complications common in long-segment anterior cervical fusion as well as methods to reduce their incidence.

Allograft Composite Cortical and Cancellous Bone Graft For Anterior Cervical Fusion

At a conservative estimate, surgeons perform 500,000 bone-grafting procedures per year in the United States and many thousands more worldwide. When selecting a bone graft, the spine surgeon needs to consider the specific structural and biological demands that will be placed on the graft. Possible graft materials include autograft cortical bone, cancellous bone, processed allograft bone, and synthetic materials. The use of allograft versus autograft bone graft for spinal fusion remains controversial because of differing strong opinions as to which product is superior, not only for fusion rates but also related to other factors such as comorbidities, potential disease transmission, operative time, and surgical cost. Strong, early fusion is the most desired outcome for any spinal bone graft. Some currently available allografts are composed of both cortical and cancellous bone sandwiched together for use in cervical fusion. This article reviews the advantages of this design as well as its possible drawbacks. Bone Graft Classifications Bone grafts can be classified according to their structural anatomy (cortical or cancellous) and by whether they are donor autograft or allograft. Autograft cortical bone has fewer osteoblasts and osteocytes, often has less surface area contact, and can act as a barrier to vascular ingrowth and remodeling compared with cancellous bone. The advantage of cortical bone is its superior structural strength; however, the initial remodeling response to cortical bone is resorptive due to osteoclastic activity. This process causes some cortical grafts to weaken and fail. Both autograft and allograft bone grafts exhibit similar characteristics in these areas. Autograft cancellous bone becomes progressively stronger because of its ability to induce early, rapid, new bone formation. Cancellous bone, however, rarely is used as graft material for cervical spinal fusion due to the weakness inherent in this more porous bone as it is placed under tension in the disc space. Allograft cancellous bone grafts, because they do not have live bone cells and bone growth factors, are not osteogenic (i.e., able to produce new bone), but they do have osteoconductive properties similar to those of allograft cancellous bone. Osteoconduction is the physical property of the graft that enables it to act as a scaffold for viable bone healing. Osteoconduction allows for the ingrowth of neovasculature and the infiltration of osteogenic precursor cells into the graft site. Finally, osteoinduction refers to the recruitment of host mesenchymal cells from Allograft Composite Cortical and Cancellous Bone Graft For Anterior Cervical Fusion

Post-Laminectomy Spondylolisthesis: Surgical Techniques

Learning Objectives: After reading this article, the participant should be able to:List the causes of postoperative iatrogenic spondylolisthesis.Explain how to dissect postoperative scar tissue during a “redo” lumbar spine exposure.Explain the surgical risks and expected outcome after reoperative lumbar fusion.

Use of Omnipaque Intraoperative Dye in the Surgical Treatment of Pan-Spinal Epidural Abscesses: Technical Case Report.

BACKGROUND AND IMPORTANCE: Spinal epidural abscesses are difficult to diagnose and could have high morbidity and mortality if left untreated. If patients present with acute neurological deficits and evidence of a multilevel ventral spine abscess on neuroimaging, blood cultures should be taken and the abscess emergently evacuated in patients able to tolerate surgical interventions. CLINICAL PRESENTATION: A 57-year-old man presented with lower back pain, which progressed to include urinary retention and evidence of lumbar discitis/osteomyelitis on magnetic resonance imaging. The patient was started on antibiotic therapy. After the patient developed new cervical pain, interval magnetic resonance imaging showed extension of the abscess to involve the cervical, thoracic, and lumbar spine with intraventricular extension. The decision was made to perform a C4 corpectomy and insert a flexible ventriculoperitoneal catheter to serially flush out the abscess. Omnipaque dye was then used to ensure that the entire abscess was evacuated and no septations existed in the anterior epidural space. CONCLUSION: The patients neurological deficits completely resolved, and he is intact a year after the operation. In selected patients with pan-spinal epidural abscesses associated with acute neurological deficits, a combination of an open approach and a catheter-based procedure in addition to an intraoperative monitoring option to ensure complete evacuation of the abscess and absence of septations in the anterior epidural space is a low-morbidity option in the armamentarium of the surgeon. ABBREVIATION: SEA, spinal epidural abscess

Recurrent Lumbar Disc Herniation: Microsurgical Approach

The surgical literature contains little information regarding the technical complexities of revision or “redo” lumbar microdiscectomy. Surgeons frequently assume that the reoperation approach is the same as the original surgical approach, often with disastrous results. Spinal surgeons who perform complex spinal surgery on a regular basis and encounter recurrent herniated discs know this assumption is incorrect. Revision microdiscectomy often can result in the risks of surgical complications and poor outcomes if unprepared. This article addresses the factors that may increase the risk of recurrent disc herniation, the clinical improvement rates after reoperative spinal surgery, and the ways in which advanced surgical techniques may lead to improved outcomes and reduced complications in this subset of surgical patients.

Degenerative Changes Above and Below Lumbar Fusion

Failure of lumbar spinal surgery creates a large burden on patients and society. In the United States,