Leon Wiltse Memorial Hospital

IntroductionDespite various recommended treatments, no effective therapy has been established for the satisfactory rehabilitation of subacute and chronic debilitating facial palsy. To address this, we evaluated the safety and efficacy of a novel therapeutic approach that combines repeated differential facial nerve blocks with facial nerve stimulation using a hypodermic needle.MethodsWe retrospectively reviewed 47 patients (acute, n = 4; subacute, n = 3; chronic, n = 40) who were treated at a private pain clinic between January 2017 and December 2023. Patients with persistent facial palsy who were unresponsive to conventional therapies underwent repeated sessions of bilateral facial nerve block following hypodermic needle stimulation of the facial nerves and branches. Facial function was assessed using the House–Brackmann and Sunnybrook grading systems.ResultsMore than 85% of patients showed significant improvements in facial symmetry and function. In the chronic group, Sunnybrook scores improved from 42 to 78 (P < 0.01), and House-Brackmann grades improved from IV–V to I–II. In the acute and subacute groups, both grading scores showed significant improvement. Transient bruising was noted as a minor adverse event, and the clinical improvement remained stable after treatment.ConclusionsOur novel integrative treatment is demonstrated to be a safe and effective option for treating intractable subacute and chronic facial palsy.

The cervicothoracic junction (CTJ) presents a surgical challenge due to its transitional nature from mobile to rigid segments. Therefore, the biomechanical characteristics of this transitional zone must be taken into consideration during instrumentation. This study aimed to determine the efficacy of the cervical pedicle screw placement (CPS) combined with 5.5-mm single-diameter rods in treating various challenging diseases at the CTJ. From March 2018 to February 2022, a total of 42 patients (male = 25; female = 17) underwent posterior cervical spinal surgery crossing the CTJ with or without an anterior approach by a single surgeon. The mean patient age was 58.6 years (range, 16-81 years). In all the included cohorts, only the Legacy® pedicle screw system (Medtronic Sofamor Danek, Inc., Memphis, TN, USA) was used for the placement of pedicle screws on the cervical and thoracic vertebrae at the CTJ. This study describes the detailed indications and results of the treatment for 5 disease categories. CPS combined with 5.5-mm single-diameter rods provides biomechanical stability for the treatment of challenging conditions, such as trauma, benign or malignant tumors, or deformities in the CTJ.

ObjectiveThe first-line treatment for pyogenic spondylitis is conservative management with immobilization and systemic antibiotic therapy. However, in cases where conservative treatment fails or neurological deficits and spinal instability are present, surgical intervention is required. Surgical treatment helps manage spondylitis by decompressing neural structures through abscess drainage and maintaining spinal stability. It includes simple decompression via abscess removal, debridement of inflamed and necrotic tissues, and reconstruction with fixation. This study aims to analyze the risk factors associated with clinical outcomes in patients undergoing simple drainage followed by instrumented fusion.MethodsWe retrospectively evaluated patients who underwent surgical treatment with intravenous antibiotics for pyogenic spondylitis at our hospital between March 2010 and November 2021. We categorized the study group into a group that underwent simple decompression and drainage and a group that was followed up until fusion. We compared the basic demographics, laboratory data, and radiological findings between the two groups.ResultsOverall, 88 patients (50 males and 38 females) with a mean age of 63.8 years were included in this study. Of the 88 patients, 71 underwent simple abscess drainage and 17 underwent instrumented fusion. In the univariate logistic regression analysis based on demographic data, longer duration of antibiotic use (p=0.021), body signal change (p=0.001), facet inflammation (p=0.003), disc abscess (p<0.001), psoas abscess (p=0.003), disc space bone erosion (p=0.006), and hypertension (p=0.024) were significant risk factors for necessitation of fusion surgery after decompression and drainage surgery. Multivariate logistic regression analysis based on these risk factors revealed that the longer the period of total antibiotic use after decompression and drainage (p=0.019), the higher the risk of fusion surgery, as well as a higher risk of body signal change.ConclusionWhen planning surgical treatment for pyogenic spondylitis, close observation is required because the necessity for instrumented fusion surgery increases when antibiotic use is prolonged or body signal changes are confirmed on magnetic resonance imaging.

Study DesignTechnical case report.PurposeTo present a novel navigation-assisted transforaminal unilateral biportal endoscopy (UBE) lumbar discectomy technique for managing upper lumbar disc herniation.Overview of LiteratureUpper lumbar disc herniation is significantly less common than lower lumbar disc herniation, accounting for only 1%–2% of cases. However, treatment is more challenging and is associated with worse outcomes. Anatomical differences between the upper and lower lumbar spine complicate the standard interlaminar approach using UBE, making it insufficient for complete removal of herniated discs. Integrating endoscopic spine surgery with intraoperative navigation provides three-dimensional computer-reconstructed visual data, thereby enhancing the feasibility of the technique.MethodsThe UBE approach targeted the ventral part of the superior articular process in the transforaminal UBE setup, specifically for upper lumbar disc herniation, with an approach angle of approximately 30º on the axial plane. Intraoperative navigation was employed to improve puncture accuracy for this relatively unfamiliar surgical technique. Navigation-assisted transforaminal UBE lumbar discectomy was performed on four patients presenting with back or leg discomfort due to disc herniation at the L1–L2 or L2–L3 levels.ResultsAll patients experienced symptom relief and were discharged on postoperative day 2.ConclusionsTransforaminal UBE lumbar discectomy is a viable therapeutic option for upper lumbar paracentral disc herniation, which is typically associated with poor prognosis. Integrating navigation integration into this novel approach enhances precision and safety.

The upper lumbar region has distinctive anatomical characteristics that contribute to the challenges of performing discectomy. We introduce far-lateral transforaminal unilateral biportal endoscopic (UBE) lumbar discectomy for central or paracentral disc herniations in the upper lumbar region. We conducted retrospective review of the patients who underwent a far-lateral transforaminal UBE lumbar discectomy at our institution from January 2018 to September 2024. The electronic medical records, operative records, and radiologic images of the patients were reviewed. A total of 27 patients underwent far-lateral transforaminal UBE lumbar discectomy for central or paracentral disc herniations in the upper lumbar region. The patient had a mean age of 54.0 ± 13.7 years. Operation was performed at the L1-2 level in 3 patients (11.1%), L2-3 in 9 patients (33.3%), and L3-4 in 15 patients (55.6%). The patients were followed-up for a mean of 27.7 ± 19.3 months. The Oswestry Disability Index was significantly decreased from 36.3 ± 6.8 preoperatively to 3.7 ± 3.3 at last follow-up (p < 0.001). The visual analogue scale (VAS) back was significantly decreased from 7.8 ± 0.9 preoperatively to 3.1 ± 0.6 postoperative day 2 (p < 0.001). The VAS leg was significantly decreased from 8.1 ± 0.8 preoperatively to 2.3 ± 0.7 postoperative day 2 (p < 0.001). The far-lateral transforaminal UBE lumbar discectomy would be a viable surgical option for upper lumbar disc herniations.

This study aimed to evaluate the treatment of spinal stenosis with spondylolisthesis using bilateral-contralateral unilateral biportal endoscopic (UBE) decompression to minimize facet joint damage. We retrospectively evaluated 42 patients with grade 1 spondylolisthesis who underwent bilateral-contralateral UBE decompression between July 2018 and September 2019. To identify segmental instability, static and dynamic images from preoperative and postoperative procedures and final follow-up radiographs were reviewed. Lateral radiograph slippage ratio, sagittal motion, and facet joint preservation were evaluated. Clinical assessments were conducted using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. The average final follow-up period was 26.5 ± 1.3 months. The average preoperative slip percentage was 15.70% ± 5.25%, which worsened to 18.80% ± 5.41% at the final follow-up (p < 0.005). The facet joint preservation rate was 95.6% ± 4.1% on the contralateral side. Improvements in the VAS scores (leg pain: from 7.9 ± 2.2 to 3.1 ± 0.7; p < 0.005; back pain: from 7.2 ± 3.0 to 2.8 ± 1.0; p < 0.005) were observed at the final follow-up. The mean preoperative ODI was 26.19 ± 3.42, which improved to 9.6 ± 1.0 (p < 0.005). Thirteen patients exhibited delayed focal segmental instability following decompression. Despite the absence of symptoms or improvement with conservative treatment in the majority of patients with delayed instability, two patients required fusion surgery to address the instability. Additionally, 2 patients developed facet synovial cysts, while 2 experienced spinous process fractures. Bilateral decompression with a contralateral UBE approach could be an effective and alternative treatment method to reduce instability in spinal stenosis with grade 1 spondylolisthesis.

Background In multilevel posterior lumbar interbody fusion (PLIF) with posterior screw fixation, obtaining sufficient lumbar lordosis (LL) is difficult, especially in patients with osteoporosis. We performed intraoperative table modification (TM) using gravitational dropping of the patient’s lumbar spine, to improve restoration of LL. Methods We retrospectively reviewed the medical records of patients who underwent three- or four-level PLIF between 2005 and 2019. One hundred eleven patients were enrolled, with 96 patients receiving non-TM-PLIF and 15 patients receiving TM-PLIF. Radiological parameters, including segmental lordosis (SL), LL, sacral slope (SS), pelvic incidence, and pelvic tilt, were measured. Clinical outcomes were measured using a visual analogue scale (VAS) for the back and leg preoperatively and at the last follow-up. Additionally, the correlation between the bone mineral density (BMD) and the radiological parameters was calculated for TM-PLIF. We performed propensity score matching between the groups to control the baseline difference. Results We found a statistically better correction between immediate and last follow-up postoperative SL (p = 0.04), as well as between preoperative and last follow-up SL (p < 0.01) in the TM-PLIF group compared to that in the non-TM-PLIF group. VAS for the back and leg were not significantly different between the two groups. Additionally, the efficacy of lordosis correction in the TM-PLIF group showed a statistically significant negative correlation between BMD and the SS change both before and after the surgery (rho = −0.60, p = 0.02). Conclusion Whilst further study is required to conclusively establish its efficacy, TM-PLIF (table modification using gravitational dropping) shows potential advantages for restoring and maintaining LL in multilevel lumbar fusion, particularly in cases with low BMD.