Biomedical subjects
Publications and source records attributed to John K Song.
This article provides an overview of a minimally invasive approach for lumbar discectomy and foraminotomy. The surgical technique is described in detail, and the current literature is reviewed to assess the clinical efficacy of the procedure.
Cervical stenosis and cervical spondylotic myelopathy are common disorders seen by many spine surgeons. Presentation can range from asymptomatic to myelopathy or myeloradiculopathy to lower extremity and gait problems attributed to lumbar disease. Various surgical procedures are practiced in the surgical management of this disease. Posterior cervical laminectomy is a familiar procedure and is the treatment of choice for multilevel disease. With the development of newer instruments and access devices, it has become possible to treat this problem through a minimally invasive approach.
OBJECTIVE: Spinal intradural-extramedullary neoplasms are uncommon lesions that usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes open laminectomy with intradural resection. We describe an alternative minimally invasive surgical technique in a consecutive series of patients undergoing treatment for symptomatic lesions. METHODS: Six patients (four men, two women) presented with symptoms including pain (five out of six) and/or neurological deficit (two out of six) with radiographic evidence of intradural pathology. All patients underwent surgical resection using a minimally invasive, unilateral approach. Pain relief was analyzed using the visual analog scale and magnetic resonance imaging to evaluate the extent of resection. Traditional laminectomy for tumor resection disrupts the muscular, ligamentous, and bony structures of the spine, which may contribute to pain and instability. Minimally invasive resection of intradural tumors offers the option of reducing approach morbidity when resecting these lesions. Using a tubular retractor system (X-Tube, Medtronic Sofamor-Danek, Memphis, TN) and microscopic surgical techniques, we were able to resect different intradural lesions successfully. RESULTS: All patients underwent successful, complete resection of their intradural-extramedullary tumors. The average patient age was 47 years (range, 41-60 yr) with one cervical, one thoracic, and four lumbar lesions. The mean operative time was 247 minutes (range, 180-320 min), the estimated blood loss was 56 mLs (range, 40-75 mLs), and the hospital stay was 57 hours (range, 48-80 h). Histologically, five tumors were determined to be schwannomas and one was identified as a myxopapillary ependymoma. There were no complications associated with this surgical technique. Postoperative magnetic resonance imaging demonstrated complete resection in all cases. CONCLUSION: Intradural-extramedullary neoplasms can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization and disruption to local tissues suggest that, in the hands of an experienced surgeon, this technique may present an alternative to traditional open tumor resection.
STUDY DESIGN: A literature review. OBJECTIVES: To evaluate the mechanisms of action and effectiveness of interspinous distraction devices in managing symptomatic lumbar spinal pathology. SUMMARY OF BACKGROUND DATA: Fusion operations have traditionally been used to manage many disorders of the lumbar spine related to deformity, pain, or instability. Concern over the long-term effects of fusion on adjacent segments has led to the development of the concept of dynamic stabilization. METHODS: A Medline search was performed using the key words "interspinous implants," "interspinous devices," and "lumbar dynamic stabilization." The abstracts of each were reviewed. Relevant articles were reviewed in detail and other appropriate references obtained. In addition, when available, nonpublished manufacturer's information was reviewed. RESULTS: Articles describing the following implants were included in this review: the Minns Device, the Interspinous "U," the Diam, the Wallis Implant, and the X STOP. CONCLUSIONS: These devices continue to be evaluated in clinical trials. Early results suggest a possible role in the management of degenerative disorders of the lumbar spine.
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One of the basic tenets of performing surgery is knowledge of the relevant anatomy. Surgeons incorporate this knowledge along with factors, such as biomechanics and physiology, to develop their operative approaches and procedures. In the diagnosis and management of sacral tumors, the need to be familiar with the anatomy of the sacrum is no less important than knowledge of the pathological entity involved. This article will provide an overview of the embryology and anatomy of the sacrum, along with concepts as applied to surgical intervention.
STUDY DESIGN: The lateral cervical spinal approach is illustrated by a case of neurenteric cyst. OBJECTIVES: To present a case of a neurenteric cyst resected the lateral cervical approach, and to review the approach in detail. SUMMARY OF BACKGROUND DATA: Intradural lesions located anterior to the high cervical spinal cord may present a difficult surgical problem. Neurenteric cysts are unusual lesions found in the brain and spinal cord. This report presents a case of cervical neurenteric cyst causing anterior cord compression that was resected using the lateral cervical approach. METHODS: A 32-year-old woman presented with chronic headaches and worsening nausea, tinnitus, dizziness, and hyperreflexia and clonus in her lower extremities. Magnetic resonance imaging of the cervical spine showed a mass compressing the anterior spinal cord at C3. Pathology showed that this lesion was a neurenteric cyst. The lesion was resected using the lateral cervical approach. RESULTS: At this writing, 36 months after surgery, the patient has continued resolution of her symptoms, and no cyst recurrence has been shown on repeat MRI imaging. She has no evidence of postlaminectomy kyphosis. CONCLUSIONS: The lateral cervical approach is useful for surgeons attempting to resect lateral and anterior intradural lesions of the cervical spine. It also gives excellent cranial-to-caudal access to the thecal sac, spinal cord, and the lesion to be resected. The neck incision preserves cosmesis, and neuromuscular function is maintained. Spinal fusion was avoided in the reported case.