USC Department of Neurological Surgery
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Transforaminal Endoscopic Discectomy to Relieve Sciatica and Delay Fusion in a 31-Year-Old Man with Pars Defects and Low-Grade Spondylolisthesis
NEUROSURGICAL FOCUS Neurosurg Focus 40 (2):E4, 2016 Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis Karthik Madhavan, MD,2 Lee Onn Chieng, BS,2 Christoph P. Hofstetter, MD, PhD,1 and Michael Y. Wang, MD2 1Department of Neurological Surgery, University of Washington, Seattle, Washington; and 2Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization. A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted. -
Regenerative Medicine
Growth Factors and Cellular Therapies in Clinical Musculoskeletal Medicine Douglas E. Hemler, M.D. STAR Spine & Sport Golden, CO June 13, 2016 Regenerative Medicine The term Regenerative Medicine was first coined in 1992 by Leland Kaiser1. Depending on the area of specialization, the definition varies. It is an evolving science that focuses on using components from our own bodies and external technologies to restore and rebuild our own tissues without surgery2. Closely related to Regenerative Medicine is a forward looking approach called Translational Medicine or Translational Science3. As applied to Musculoskeletal Regenerative Medicine, Translational Medicine is the application of scientific disciplines including tissue engineers, molecule biologists, researchers, industry and practicing clinicians who merge their science and experience to develop new approaches to healing tendons and joints. Some aspects of the field are highly complex, confined to laboratories and research institutions such as organ regeneration and embryonic stem cell research. Other areas are ready for clinical application. As defined by the European Society for Translational Medicine (EUSTM) it is an interdisciplinary branch of the biomedical field supported by three main pillars: bench side, bedside and community. The bench to bedside model includes transitioning clinical research to community practice using interactive science and data to benefit the community as a whole. Translational Medicine can be as complex as the research into total organ regeneration, total replacement of blood cell systems following cancer chemotherapy, or the scientific and ethical ramifications of embryonic stem cell research.45 Out of these efforts have come a group of therapies that are being applied by forward looking musculoskeletal practices such as STAR Spine and Sport. -
Spinal Cord Stimulation in Failed Back Surgery Syndrome: Effects on Posture and Gait—A Preliminary 3D Biomechanical Study
Hindawi Pain Research and Management Volume 2017, Article ID 3059891, 9 pages https://doi.org/10.1155/2017/3059891 Research Article Spinal Cord Stimulation in Failed Back Surgery Syndrome: Effects on Posture and Gait—A Preliminary 3D Biomechanical Study L. Brugliera,1 A. De Luca,2 S. Corna,1 M. Bertolotto,3 G. A. Checchia,4 M. Cioni,5 P. Capodaglio,1 and C. Lentino2,4 1 Istituto Auxologico Italiano, Unita` di Riabilitazione Osteoarticolare, Ospedale S Giuseppe, Strada Cadorna 90, Piancavallo, Italy 2Laboratorio Analisi del Movimento Ospedale Santa Corona di Pietra Ligure, Viale 25 Aprile 38, 17027 Pietra Ligure, Italy 3Centro Terapia del Dolore e Cure Palliative, Dipartimento di Riabilitazione, Ospedale Santa Corona di Pietra Ligure, Viale 25 Aprile 38, 17027 Pietra Ligure, Italy 4Struttura Complessa Recupero e Rieducazione Funzionale, Ospedale Santa Corona di Pietra Ligure, Viale 25 Aprile 38, 17027 Pietra Ligure, Italy 5Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Dipartimento di Scienze Biomediche e Biotecnologiche, Universita` degli Studi di Catania, Piazza Universita2,95131Catania,Italy` Correspondence should be addressed to P. Capodaglio; [email protected] Received 30 March 2017; Revised 21 June 2017; Accepted 1 August 2017; Published 25 September 2017 Academic Editor: Emily J. Bartley Copyright © 2017 L. Brugliera et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We studied 8 patients with spinal cord stimulation (SCS) devices which had been previously implanted to treat neuropathic chronic pain secondary to Failed Back Surgery Syndrome. -
Failed Back Syndrome Daniel Aghion, MD, Pradeep Chopra, MD, Adetokunbo A
Failed Back Syndrome Daniel Aghion, MD, Pradeep Chopra, MD, Adetokunbo A. Oyelese, MD, PhD APPROXIMATELY 250,000 SURGERIES with predominant complaints of back to significant nerve root injury (2-3%) for low back pain are performed annu- pain.3 This is because it is usually more because more retraction on the neural ally in the USA.1 Approximately 40% straightforward to identify the source of elements is necessary to gain access to of patients undergoing lumbar surgery pain or “pain generator” on an MRI in the the disc pathology. Conversely, excessive continue to report significant pain after case of a pinched nerve causing radicular bone removal as with a laminectomy, in surgery, and a significant portion of these symptoms than it is to identify the pain which a significant amount of facet joint will result in failed back syndrome (FBS). generator causing low back pain. Thus, removal is performed, may lead to spinal FBS is defined as persistent or recurrent many patients with asymptomatic but instability and pain. chronic pain after one or more surgical abnormal appearing degenerated discs FBS after a lumbar fusion can ensue procedures on the lumbosacral spine. The on MRI or with myofascial pain may be due to extensive instrumentation or fu- incidence of true FBS is as high as 15%. subjected to inappropriate lumbar surgery sion across multiple segments. This can Unfortunately, the diagnosis of FBS does with resulting poor outcomes. result in a ‘flat back syndrome’ or loss not point to the actual cause for treatment of normal lumbar lordosis leading to failure. Multiple factors can contribute to One of the most FBS. -
The Future of Tissue Engineering and Regenerative Medicine in the African Continent
Department of Biomedical Sciences Faculty of Science THE FUTURE OF TISSUE ENGINEERING AND REGENERATIVE MEDICINE IN THE AFRICAN CONTINENT • DR KEOLEBOGILE MOTAUNG • TSHWANE UNIVERSITY OF TECHNOLOGY • DEPARTMENT OF BIOMEDICAL SCIENCES • TSHWANE • SOUTH AFRICA 1 Department of Biomedical Sciences Faculty of Science OUTLINE • Definition of TE and RM • Applications and Benefits • Research work • Challenges • Recommendations to improve gender content and social responsibility of research programmes in Africa that can enhance the effectiveness and sustainability of the development measures needed 2 Department of Biomedical Sciences Faculty of Science QUESTIONS ? How can one create human spare parts that has been damaged? Why do we have to create spare parts? 3 Department of Biomedical Sciences Faculty of Science HOW? TISSUE ENGINEERING AND REGENERATIVE MEDICINE • Is as science of design and manufacture of new tissues for the functional restoration of impaired organs and replacement of lost parts due to cancer, diseases and trauma. • Creation of human spare parts? 4 Department of Biomedical Sciences Faculty of Science WHY? DO WE HAVE TO CREATE HUMAN SPARE PARTS? • Shortage of donor tissues and organs • Survival rates for major organ transplantations are poor despite their high costs and the body's immune system often rejects donated tissue and organs. • Tissue engineering and Regenerative Medicine therefore, has remarkable potential in the medical field to solve these problems 5 Department of Biomedical Sciences Faculty of Science APPLICATIONS: -
Regenerative Medicine Options for Chronic Musculoskeletal Conditions: a Review of the Literature Sean W
Regenerative Medicine Options for Chronic Musculoskeletal Conditions: A Review of the Literature Sean W. Mulvaney, MD1; Paul Tortland, DO2; Brian Shiple, DO3; Kamisha Curtis, MPH4 1 Associate Professor of Medicine, Uniformed Services expected to be over 67 billion dollars in spending on University, Bethesda, MD biologics and cell therapies by 2020 (1). 2 FAOASM, Associate Clinical Professor of Medicine, University of Connecticut, Farmington, CT Specifically, regenerative medicine also stands 3 CAQSM, RMSK, ARDMS; The Center for Sports Medicine & in contrast to treatment modalities that impair Wellness, Glen Mills, PA the body’s ability to facilitate endogenous repair 4 Regenerative and Orthopedic Sports Medicine, Annapolis, MD mechanisms such as anti-inflammatory drugs (2,3); destructive modalities (e.g., radio frequency ablation of nerves, botulinum toxin injections) (4); Abstract and surgical methods that permanently alter the functioning of a joint, including joint fusion, spine egenerative medicine as applied to fixation, and partial or total arthroplasty. When musculoskeletal injuries is a term compared to other allopathic options (including knee used to describe a growing field of R and hip arthroplasty with a 90-day mortality rate of musculoskeletal medicine that concentrates 0.7% in the Western hemisphere) (5), regenerative on evidence-based treatments that focus on medicine treatment modalities have a lower and augment the body’s endogenous repair incidence of adverse events with a growing body of capabilities. These treatments are targeted statistically significant medical literature illustrating at the specific injury site or region of injury both their safety and efficacy (6). by the precise application of autologous, allogeneic or proliferative agents. -
The Bridge Between Transplantation and Regenerative Medicine: Beginning a New Banff Classification of Tissue Engineering Pathology
Received: 28 April 2017 | Revised: 21 November 2017 | Accepted: 24 November 2017 DOI: 10.1111/ajt.14610 PERSONAL VIEWPOINT The bridge between transplantation and regenerative medicine: Beginning a new Banff classification of tissue engineering pathology K. Solez1 | K. C. Fung1 | K. A. Saliba1 | V. L. C. Sheldon2 | A. Petrosyan3 | L. Perin3 | J. F. Burdick4 | W. H. Fissell5 | A. J. Demetris6 | L. D. Cornell7 1Department of Laboratory Medicine and Pathology, Faculty of Medicine and The science of regenerative medicine is arguably older than transplantation—the first Dentistry, University of Alberta, Edmonton, major textbook was published in 1901—and a major regenerative medicine meeting AB, Canada took place in 1988, three years before the first Banff transplant pathology meeting. 2Medical Anthropology Program, Department of Anthropology, Faculty of Arts and However, the subject of regenerative medicine/tissue engineering pathology has Sciences, University of Toronto, Toronto, never received focused attention. Defining and classifying tissue engineering pathol- Ontario, Canada ogy is long overdue. In the next decades, the field of transplantation will enlarge at 3Division of Urology GOFARR Laboratory for Organ Regenerative Research and least tenfold, through a hybrid of tissue engineering combined with existing ap- Cell Therapeutics, Children’s Hospital Los proaches to lessening the organ shortage. Gradually, transplantation pathologists will Angeles, Saban Research Institute, University of Southern California, Los Angeles, CA, USA become tissue- (re- ) engineering pathologists with enhanced skill sets to address con- 4Department of Surgery, Johns Hopkins cerns involving the use of bioengineered organs. We outline ways of categorizing ab- School of Medicine, Baltimore, MD, USA normalities in tissue- engineered organs through traditional light microscopy or other 5Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA modalities including biomarkers. -
Abstracts of the 2018 AANS/CNS Joint Section on Disorders of the Spine
Abstracts of the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves Annual Meeting Orlando, Florida • March 14–17, 2018 (DOI: 10.3171/2018.3.FOC-ASPNabstracts) in the tetraplegic SCI population1. We investigate the combined J.A.N.E. Award Presentation effects of two neuromodulation strategies: transcutaneous electri- cal stimulation (TES) and buspirone pharmacological modulation, 100 Lateral Lumbar Interbody Fusion in the Elderly: A 10 for promoting upper limb motor recovery in chronic cervical SCI Year Experience tetraplegic subjects. Methods: A double-blind study protocol was used to deter- Nitin Agarwal MD; Andrew M Faramand MD; Nima Alan mine the effects of cervical electrical stimulation alone or in com- MD; Zachary J. Tempel MD; D. Kojo Hamilton MD; David O. bination with the monoaminergic agonist buspirone on upper limb Okonkwo MD, PhD; Adam S. Kanter MD motor function in subjects with chronic motor complete (ASIA B) cervical injury (n=6). Voluntary upper limb function was Introduction: Elderly patients, often presenting with multiple evaluated through measures of controlled hand contraction, hand- medical comorbidities, are touted to be at an increased risk of post- grip force production, dexterity measures, and validated clinical operative complications. As such, we describe our perioperative assessment batteries. Subjects underwent pre-intervention assess- outcomes in this cohort of patients over the age of 70 following ment followed by three treatment phases with TES and buspirone standalone LLIF. or placebo. A delayed post-treatment testing period was used to Methods: A retrospective query of a prospectively maintained assess for durable improvement in function. database was performed for patients over the age of 70 who under- Results: All subjects demonstrated improvement in hand went standalone LLIF. -
Most Cited Publications in Cervical Spine Surgery
Most Cited Publications in Cervical Spine Surgery Yu Chao Lee, Francis Brooks, Simon Sandler, Yun-Hom Yau, Michael Selby and Brian Freeman Int J Spine Surg 2017, 11 (3) doi: https://doi.org/10.14444/4019 http://ijssurgery.com/content/11/3/19 This information is current as of October 2, 2021. Email Alerts Receive free email-alerts when new articles cite this article. Sign up at: http://ijssurgery.com/alerts The International Journal ofDownloaded Spine Surgery from http://ijssurgery.com/ by guest on October 2, 2021 2397 Waterbury Circle, Suite 1, Aurora, IL 60504, Phone: +1-630-375-1432 © 2017 ISASS. All Rights Reserved. Most Cited Publications in Cervical Spine Surgery Yu Chao Lee, Francis Brooks, Simon Sandler, Yun-Hom Yau, Michael Selby, Brian Freeman Royal Adelaide Hospital, Adelaide, Australia Abstract Purpose The purpose of this study is to perform a citation analysis on the most frequently cited articles in the topic of cervi- cal spine surgery and report on the top 100 most cited publication in this topic. Methods We used the Thomson Reuters Web of Science to search citations of all articles from 1945 to 2015 relevant to cer- vical spine surgery and ranked them according to the number of citations. The 100 most cited articles that matched the search criteria were further analyzed by number of citations, first author, journal, year of publication, country and institution of origin. Results The top 100 cited articles in the topic of cervical spine surgery were published from 1952-2011. The number of ci- tations ranged from 106 times for the 100th paper to 1206 times for the top paper. -
Nanotechnology in Regenerative Medicine: the Materials Side
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by UPCommons. Portal del coneixement obert de la UPC Review Nanotechnology in regenerative medicine: the materials side Elisabeth Engel, Alexandra Michiardi, Melba Navarro, Damien Lacroix and Josep A. Planell Institute for Bioengineering of Catalonia (IBEC), Department of Materials Science, Technical University of Catalonia, CIBER BBN, Barcelona, Spain Regenerative medicine is an emerging multidisciplinary structures and materials with nanoscale features that can field that aims to restore, maintain or enhance tissues mimic the natural environment of cells, to promote certain and hence organ functions. Regeneration of tissues can functions, such as cell adhesion, cell mobility and cell be achieved by the combination of living cells, which will differentiation. provide biological functionality, and materials, which act Nanomaterials used in biomedical applications include as scaffolds to support cell proliferation. Mammalian nanoparticles for molecules delivery (drugs, growth fac- cells behave in vivo in response to the biological signals tors, DNA), nanofibres for tissue scaffolds, surface modifi- they receive from the surrounding environment, which is cations of implantable materials or nanodevices, such as structured by nanometre-scaled components. Therefore, biosensors. The combination of these elements within materials used in repairing the human body have to tissue engineering (TE) is an excellent example of the reproduce the correct signals that guide the cells great potential of nanotechnology applied to regenerative towards a desirable behaviour. Nanotechnology is not medicine. The ideal goal of regenerative medicine is the in only an excellent tool to produce material structures that vivo regeneration or, alternatively, the in vitro generation mimic the biological ones but also holds the promise of of a complex functional organ consisting of a scaffold made providing efficient delivery systems. -
Cervical Spine Considerations When Anesthetizing Patients with Down Syndrome Tara Hata, M.D.,* Michael M
Ⅵ CLINICAL CONCEPTS AND COMMENTARY Richard B. Weiskopf, M.D., Editor Anesthesiology 2005; 102:680–5 © 2005 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Cervical Spine Considerations When Anesthetizing Patients with Down Syndrome Tara Hata, M.D.,* Michael M. Todd, M.D.† DOWN syndrome (DS) is the most common chromo- sion from the body of the vertebra. The dens passes somal disorder, occurring in 1 of every 600–800 births.1 cephalad immediately behind the anterior arch C1 and is It is characterized by mental retardation, as well as held in place by three ligaments (fig. 1). The transverse craniofacial, upper airway, cardiovascular, and gastroin- ligament (or the transverse component of the cruciate testinal anomalies. One manifestation of DS relevant to ligament) passes from side to side behind the odontoid anesthesiologists is upper cervical spine instability pro- and is anchored to the inside of the C1 ring. The atlan- duced by ligamentous laxity, skeletal anomalies, or both. todental ligament bridges the small space between the This instability can result in neurologic impairment, in- anterior aspect of the odontoid and the posterior aspect cluding quadriplegia. However, there are no evidence- of the anterior arch of C1 (this space is referred to as the based practical guidelines to aid anesthesiologists in car- anterior atlantodental interval [AADI]). The alar liga- ing for these patients. The risk of spinal cord injury ments extend from the dens upward and laterally to the during anesthesia is unknown, as are the preoperative occipital condyles, and the apical ligament extends from factors that might aid in accurately defining the risk in the tip of dens upward to the anterior margin of the specific patients. -
Thoracic Outlet Syndrome Medical Treatment Guidelines
RULE 17, EXHIBIT 3 Thoracic Outlet Syndrome Medical Treatment Guidelines Adopted: December 8, 2014 Effective: February 1, 2015 Adopted: January 9, 1995 Effective: March 2, 1995 Revised: January 8, 1998 Effective: March 15, 1998 Revised: September 29, 2005 Effective: January 1, 2006 Revised: September 12, 2008 Effective: November 1, 2008 Presented by: DIVISION OF WORKERS' COMPENSATION TABLE OF CONTENTS SECTION DESCRIPTION PAGE A. INTRODUCTION .............................................................................................................................. 1 B. GENERAL GUIDELINES PRINCIPLES .......................................................................................... 2 1. APPLICATION OF GUIDELINES ....................................................................................... 2 2. EDUCATION ....................................................................................................................... 2 3. INFORMED DECISION MAKING ....................................................................................... 2 4. TREATMENT PARAMETER DURATION ........................................................................... 2 5. ACTIVE INTERVENTIONS ................................................................................................. 2 6. ACTIVE THERAPEUTIC EXERCISE PROGRAM .............................................................. 3 7. POSITIVE PATIENT RESPONSE ...................................................................................... 3 8. RE-EVALUATE TREATMENT EVERY