David B. Choi

Transforaminal Endoscopic Solution to a Kyphoplasty Complication: Technical Note

Kyphoplasty is a minimally invasive spine surgical procedure performed to stabilize and treat the pain caused by a spine compression fracture. Complications are rare with kyphoplasty and include cement extrusion into the vertebral canal leading to spinal cord or nerve root compression. Herein, the authors present a case of a 72-year-old woman who presented with symptoms of a right L2 radiculopathy after a kyphoplasty procedure. Computed tomography imaging showed leakage of the kyphoplasty cement into the neural foramen above and medial to the right L2 pedicle. A transforaminal endoscopic surgical approach was used to remove the cement and decompress the L2 nerve. The patients postoperative clinical course was uneventful. Clinicians should be aware that for the treatment of complications to vertebroplasty and kyphoplasty procedures, minimally invasive transforaminal endoscopic surgery is one option to avoid the destabilizing effects of laminectomy and facetectomy.

Transforaminal Endoscopic Foraminoplasty and Discectomy for the Treatment of a Thoracic Disc Herniation

Transforaminal endoscopic spine surgery has emerged internationally as a minimally invasive technique that can be performed in an awake patient in the outpatient setting. Advances in high-definition endoscopic camera technologies as well as the availability of specialty graspers, reamers, drills, and other instruments that can be used down a working channel endoscope have made a myriad of spine diseases accessible to the minimally invasive spine surgeon. The major challenge inherent in the surgical treatment of thoracic disc disease is that the disc herniation is often ventral to the spinal cord. The transforaminal approach and the angled endoscopic camera are an ideal combination for creating a technical advantage to accessing thoracic disc disease.

Transforaminal endoscopic surgery under local analgesia for ventral epidural thoracic spinal tumor: Case report

Operative management for ventral epidural spinal tumors typcally involves either a costotransversectomy approach or, less requently, a trans-thoracic approach that requires a corpectomy nd fusion. Transforaminal endoscopic spine surgery has been eported for the treatment of lumbar herniated discs (including far ateral and extruded), lumbar spondylolisthesis, lumbar juxtafacet ysts, lumbar discitis and even in the treatment neuropathic pain aused by a T11 colon metastases [1–7]. We report here the first ase of a ventral thoracic epidural spine tumor surgically treated ith a complete endoscopic spinal procedure via the foramen in an wake patient.

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.

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.

Cerebral Epidural Abscess Secondary to Blastomyces Masquerading as an Epidermoid Tumor

Abstract There have been infrequent reports of isolated central nervous system blastomycosis. We report a case of intracranial epidural abscess secondary to Blastomyces dermatitidis in a patient residing in Rhode Island with a history of remote travel to an endemic area. The clinical, radiographic, and pathologic features of this unique case are reviewed.

Glossopharyngeal Neuralgia in the Rehabilitation Patient

The International Headache Society Guidelines define glossopharyngeal neuralgia as a “severe transient stabbing pain experienced in the ear, base of the tongue, tonsillar fossa, or beneath the angle of the jaw” [25]. The glossopharyngeal nerve serves autonomic, motor, and sensory functions; compromise of this nerve along its course can cause neuralgia. Compression by blood vessels and tumors are known to cause this condition. Glossopharyngeal neuralgia affects adults and can be mistakenly diagnosed as trigeminal neuralgia, but tests can be used to differentiate these conditions. Treatment consists mainly of pharmacologic management, but surgical procedures can be used to treat medically refractory cases.

Transforaminal Endoscopic Surgery for the Treatment of Pain in the Rehabilitation Patient

Percutaneous, minimally invasive, transforaminal endoscopic spine surgery can address various pathologies, including degenerative disc disease, while incurring the least amount of damage to soft tissues and bony structures that contribute to biomechanical stability of the spine. Patients undergoing this procedure require only conscious sedation and are able to provide the surgeon with accurate and instantaneous feedback regarding their radicular symptoms. They are able to ambulate immediately postoperatively and do not require hospitalization. The development of techniques and advances in equipment design has allowed surgeons to apply this procedure to multiple indications.

Lower Extremity Peripheral Neuropathies in the Rehabilitation Patient

Lower extremity neuropathies can occur proximally, at the level of the lumbosacral plexus. Points of compression occur due to anatomical structures encountered through the course of each nerve, such as muscles and bones. Treatment can vary from conservative measures, to more invasive surgical interventions.