Two-level reverse Bohlman transsoseous approach for treatment of symptomatic pseudarthrosis

Clinical Efficacy of Endoscopic Infratentorial Supracerebellar Approach for Pineal Region Tumors: A Retrospective Case-Control Study

Tumors in the pineal region are deep, with complex surrounding anatomy, adjacent to important blood vessels and nerve structures, and surgical resection is difficult and risky. In this paper, we reviewed the literature to understand the epidemiology and clinical manifestations of pineal region tumors in the country and study the clinical indications, related problems, and successful experiences of patients with pineal region tumors treated by the transtentorial-superior approach. The clinical data of 80 patients with pineal region tumors were selected as the retrospective research objects and divided into the control group and the treatment group, with 40 cases in each group, according to the random number table method. The control group was treated using the endoscopic transtentorial approach (Poppen approach), while the treatment group was treated with the endoscopic supratentorial approach (Krause approach). The inflammatory factors, inflammatory stress response, postoperative neurological dysfunction, clinical efficacy, and poor prognosis were observed and compared between the two groups. Tumor resection and recurrence were used to compare the clinical outcomes of tumors in the pineal region. The extent of surgical resection was 100% higher in both groups, and the treatment group was comparable to the control group. The prognosis of patients after the operation was poor. Nausea and vomiting, visual disturbance, upper vision paralysis, and ataxia in the treatment group were significantly lower than those in the control group, with no statistical significance (P > 0.05). At the same time, the bone window can be reduced to reduce trauma and provide a certain reference for patients to choose a safe and complete resection method.

Efficacy of Reverse and Modified Bohlman Technique for Lumbar Spondylolisthesis: A Systematic Review of the Literature

OBJECTIVE

High grade lumbar spondylolisthesis (HGLS) remains a challenging surgical entity, and there is no current consensus regarding optimal surgical approach. The purpose of this study was to systematically review the literature for studies utilizing the Reverse or Modified Bohlman technique for the treatment of HGLS to assess its safety and efficacy.

METHODS

The authors perform a literature search of PubMed/MEDLINE electronic databases from their inception according to the PRISMA guidelines.

RESULTS

A total of 8 studies were included. The studies comprised a total of 43 patients, with mean age of 41.4 ± 19.8 (9-83) years. The mean follow-up was 38.2 ± 41.7 (3-137) months. Most patients (81.4%) were classified as having grade III or higher spondylolisthesis. The most common presenting symptom was back pain (93%), followed by radiculopathy in roughly half of patients (41.9%). Majority of patients (93%) experienced complete resolution of symptoms as well as successful fusion (90.7%) on follow-up. Complications included cage/graft failure (7%), nerve injury (7%), wound infection (7%), pseudoarthrosis (2.3%), epidural hematoma (2.3%), and deep vein thrombosis (2.3%). Revision surgery was required in 4 (9.3%) patients. Slip percentage (60.2% versus 43.2%, p<0.0001) and slip angle (17.1° versus 6.4°, p<0.001) both decreased significantly following surgery.

CONCLUSIONS

Our data demonstrate Reverse and Modified Bohlman techniques appear to be effective in both improving slip angle/percentage and relieving symptoms with low risk of complications. These findings are limited by the small sample size of patients. The authors recommend larger series before formal recommendations can be made.

High-Grade Spondylolisthesis in Adults: Current Concepts in Evaluation and Management

Background

Information regarding the treatment of high-grade spondylolisthesis (HGS) in adults has been previously described; however, previous descriptions of the evaluation and surgical management of HGS do not represent more recent and now established approaches. The purpose of the current review is to discuss current concepts in the evaluation and management of patients with HGS.

Methods

Literature review.

Results

HGS is diagnosed in up to 11.3% of adults with spondylolisthesis and typically presents as nonspecific lower back pain. Regarding evaluation, a thorough history and physical examination should be performed, which may help predict the presence of HGS. Diagnostic imaging, and specifically the use of spino-pelvic parameters, are now commonly implicated in guiding treatment course and prognosis. When surgical intervention is indicated, surgical approaches include in situ fusion variations, reduction and partial reduction with fusion, and vertebrectomy. Although the majority of studies suggest improvements with these approaches, the literature is limited by a low level of evidence with regards to the superiority of one technique when compared with others.

Conclusions

HGS is a unique cause of low back pain in adults that carries considerable morbidity, but rarely presents with neurologic symptoms. Although the definitions, classifications, and methods of diagnosis of this spinal deformity have been established and accepted, the ideal surgical management of this deformity remains highly debated. Fusion in situ techniques are often technically easier to perform and provide lower risk of neurologic complications, whereas reduction and fusion techniques offer greater restoration of global spino-pelvic balance. Preoperative spino-pelvic parameters may have utility in assisting in procedural selection; however, future, higher-quality and longer-term studies are warranted to determine the optimal surgical intervention among the widely available techniques currently used, and to better define the indications for these interventions.