Although thorough preoperative planning is the best method of achieving appropriate levels of lum... more Although thorough preoperative planning is the best method of achieving appropriate levels of lumbar spinal decompression, current methods for intraoperative assessment of the extent of spinal decompression are inadequate. Underdecompression leads to poor clinical outcomes and overdecompression can lead to instability. The purpose of this study is to evaluate the use of multiplanar, fluoroscopic images reconstructed in 3-dimensional format, combined with spinal myelography to intraoperatively assess lumbar spinal decompression. Patients scheduled for lumbar spinal decompression surgery were recruited for intraoperative evaluation using multiplanar imaging and myelography. After performing the minimal necessary decompression of the preoperatively planned areas of spinal stenosis, 13 mL of omnipaque contrast dye was injected into the subarachnoid space. Iso-C sequential fluoroscopic images were acquired and reconstructed into multiplanar images. Images were evaluated for quality, and spinal decompression was evaluated for completeness. The average time for this technique was 13 minutes 42 seconds (range, 9 min 59 s to 19 min 57 s). The average time for injecting the dye was 3 minutes 3 seconds and for assessing the images was 3 minutes 24 seconds. There was a notable decrease in the time required for the technique as the surgeon and staff became more proficient at the procedure. All patients had adequate visualization of the spinal canal and nerve roots. Three patients had additional decompression after review of the images. It is feasible to obtain multiplanar myelograph enhanced C-arm fluoroscopic images in the operating room setting and these are useful for the evaluation of decompression of lumbar spinal stenosis.
Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental ... more Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.
During two cases of lumbar spine surgery with instrumentation, we used intraoperative autologous ... more During two cases of lumbar spine surgery with instrumentation, we used intraoperative autologous transfusion (IAT), resulting in hemolysis during collection and hemoglobinuria and coagulation abnormalities after transfusion. Hemolysis during IAT collection can lead to hemoglobinuria and binding of nitric oxide, leading to vasoconstriction. The literature suggests that stroma from damaged cells and contact of the blood with the IAT device can lead to coagulation abnormalities and other morbidities, including adult respiratory distress syndrome.
In spinal decompression and fusion surgery, a high speed burr is often used to remove bony materi... more In spinal decompression and fusion surgery, a high speed burr is often used to remove bony material. The generated bone shavings are typically washed away and discarded. This study histologically examined the content of burr shavings to determine whether the collected tissue has the potential to augment local autograft. Our findings verified that burr shavings collected during spinal decompression are primarily composed of bone (65%) with blood product (32%). The bone shavings appear to remain viable after burring, as there was no microscopic evidence of damage to the cells. These findings indicate that bone shavings can be easily collected and could be added to local laminectomy bone with minimal cost. This technique is also beneficial given that it does not increase morbidity, as does iliac crest bone graft harvesting. Furthermore, the putty-like consistency of the bone shavings may facilitate the placement of morselized autograft bone. Despite these advantages, collected bone shavings are by no means a substitute for autograft or allograft bone. Their osteogenic potential is not comparable to that of iliac crest bone and the shavings lack the structural scaffolding of allograft bone. This technique, however, provides a resource for augmenting local autograft during spinal fusion, and is not associated with any significant cost or effort. Future studies should compare the clinical and radiographic fusion outcomes of high speed burr bony shavings combined with local laminectomy bone versus either iliac crest autograft or local laminectomy bone used with other bone graft extenders.
Although thorough preoperative planning is the best method of achieving appropriate levels of lum... more Although thorough preoperative planning is the best method of achieving appropriate levels of lumbar spinal decompression, current methods for intraoperative assessment of the extent of spinal decompression are inadequate. Underdecompression leads to poor clinical outcomes and overdecompression can lead to instability. The purpose of this study is to evaluate the use of multiplanar, fluoroscopic images reconstructed in 3-dimensional format, combined with spinal myelography to intraoperatively assess lumbar spinal decompression. Patients scheduled for lumbar spinal decompression surgery were recruited for intraoperative evaluation using multiplanar imaging and myelography. After performing the minimal necessary decompression of the preoperatively planned areas of spinal stenosis, 13 mL of omnipaque contrast dye was injected into the subarachnoid space. Iso-C sequential fluoroscopic images were acquired and reconstructed into multiplanar images. Images were evaluated for quality, and spinal decompression was evaluated for completeness. The average time for this technique was 13 minutes 42 seconds (range, 9 min 59 s to 19 min 57 s). The average time for injecting the dye was 3 minutes 3 seconds and for assessing the images was 3 minutes 24 seconds. There was a notable decrease in the time required for the technique as the surgeon and staff became more proficient at the procedure. All patients had adequate visualization of the spinal canal and nerve roots. Three patients had additional decompression after review of the images. It is feasible to obtain multiplanar myelograph enhanced C-arm fluoroscopic images in the operating room setting and these are useful for the evaluation of decompression of lumbar spinal stenosis.
Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental ... more Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.
During two cases of lumbar spine surgery with instrumentation, we used intraoperative autologous ... more During two cases of lumbar spine surgery with instrumentation, we used intraoperative autologous transfusion (IAT), resulting in hemolysis during collection and hemoglobinuria and coagulation abnormalities after transfusion. Hemolysis during IAT collection can lead to hemoglobinuria and binding of nitric oxide, leading to vasoconstriction. The literature suggests that stroma from damaged cells and contact of the blood with the IAT device can lead to coagulation abnormalities and other morbidities, including adult respiratory distress syndrome.
In spinal decompression and fusion surgery, a high speed burr is often used to remove bony materi... more In spinal decompression and fusion surgery, a high speed burr is often used to remove bony material. The generated bone shavings are typically washed away and discarded. This study histologically examined the content of burr shavings to determine whether the collected tissue has the potential to augment local autograft. Our findings verified that burr shavings collected during spinal decompression are primarily composed of bone (65%) with blood product (32%). The bone shavings appear to remain viable after burring, as there was no microscopic evidence of damage to the cells. These findings indicate that bone shavings can be easily collected and could be added to local laminectomy bone with minimal cost. This technique is also beneficial given that it does not increase morbidity, as does iliac crest bone graft harvesting. Furthermore, the putty-like consistency of the bone shavings may facilitate the placement of morselized autograft bone. Despite these advantages, collected bone shavings are by no means a substitute for autograft or allograft bone. Their osteogenic potential is not comparable to that of iliac crest bone and the shavings lack the structural scaffolding of allograft bone. This technique, however, provides a resource for augmenting local autograft during spinal fusion, and is not associated with any significant cost or effort. Future studies should compare the clinical and radiographic fusion outcomes of high speed burr bony shavings combined with local laminectomy bone versus either iliac crest autograft or local laminectomy bone used with other bone graft extenders.
Uploads
Papers by vikas patel