Biomedical subjects
Publications and source records attributed to John E O'Toole.
Posterior cervical microendoscopic foraminotomy and discectomy is an effective minimally invasive approach to cervical radiculopathy caused by foraminal osteophytes or lateral disc herniations. This article reviews the technique in detail as well as the advantages over open approaches. Nuances of the technique, including complications and their management, are also explored.
Percutaneous vertebroplasty and kyphoplasty provide minimally invasive options for the management of osteoporotic and osteolytic vertebral compression fractures. These techniques provide substantial pain relief and support without requiring long periods of recumbency, and have an acceptable complication rate. Vertebral augmentation techniques such as vertebroplasty and kyphoplasty provide pain relief and improvement in quality of life in the highly selected patient. Complications can be avoided with careful surgical technique, and good outcomes can be achieved with proper patient selection.
Minimally invasive approaches to spinal tumors have evolved rapidly over the past 15 to 20 years as clinicians seek to avoid the morbidity and long-term dysfunction associated with traditional open surgical procedures. We review the noninvasive, percutaneous, and minimally invasive surgical techniques currently available for the treatment of spinal column and intradural spinal tumors, including minimal access thoracic corpectomy and minimal access intradural tumor surgery. The various advantages and limitations of these approaches as well as their appropriate indications and uses are also presented here. A measured understanding of surgical objectives and iatrogenic effects on patients' quality of life allows the surgeon to implement such minimally invasive approaches in the design of individualized treatment plans that range from pure palliation to definitive cure.
The modern era of minimally invasive spine surgery has its roots in percutaneous techniques developed in the mid-twentieth century. The widespread application of minimally invasive techniques seen today is predicated on technologic developments of only the past 10 years, however. This article reviews the development of minimally invasive spinal surgery as it has evolved for the cervical, thoracic, and lumbar spine. Each new development has sought to equal or improve on the effectiveness demonstrated by comparable open surgical techniques while reducing iatrogenic tissue trauma and resultant postoperative pain and disability, to produce overall better outcomes for patients.
Thoracic microendoscopic discectomy is a safe effective treatment for surgical removal of herniated thoracic intervertebral discs. This approach allows access through a minimally invasive muscle-splitting posterolateral approach that does not place the contents of the thoracic cavity at risk. In the lumbar spine, this approach has been proven effective, with a shorter length of hospital stay, less postoperative pain, decreased blood loss, and shorter recovery time. These same advantages can be expected in the thoracic spine with appropriate patient selection and proper surgical technique.
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STUDY DESIGN: A case of surgical management of dissociated motor loss after decompression of the cervical spine is reported. OBJECTIVES: To present a rationale for surgical treatment of postdecompressive cervical radiculopathy with an illustrative case example. SUMMARY OF BACKGROUND DATA: The unusual complication of radiculopathy after multilevel cervical decompressive procedures is characterized by pain or dissociated motor weakness of the C5 and C6 nerve roots. Conservative management paradigms, including analgesics and steroids, are the rule, but symptoms often persist for many months. There are currently no reports describing foraminotomy as a means of more rapidly alleviating the symptoms of radicular pain and deltoid and biceps brachii weakness seen in the postoperative setting. METHODS: We present a case of bilateral C5 and C6 radiculopathy following multilevel cervical decompression for cervical spondylotic myelopathy, which we treated with posterior foraminotomies. RESULTS: The patient reported complete resolution of his dermatomal pain and demonstrated rapid improvement in upper extremity strength as compared to traditional conservative treatments. The historical experience and pathogenesis regarding this postoperative complication are reviewed. The rationale of root-specific posterior decompression for this debilitating complication is discussed. CONCLUSIONS: Foraminal decompression of the affected nerve roots as demonstrated here has not been described for postdecompressive dissociated motor loss. Such an approach may offer earlier and more complete relief to patients suffering from this unfortunate complication.
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Diffuse bilateral enlargement of the choroid plexus has long been appreciated as a cause of shunt-resistant hydrocephalus in infants, most often secondary to cerebrospinal fluid overproduction. Despite the fact that such lesions have interchangeably been termed 'villous hypertrophy' (VH) or 'bilateral choroid plexus papilloma' (CPP), little attention has been paid to the pathological distinctions that characterize these two entities. We present a case of presumed VH in a 2-week-old female presenting with cerebrospinal fluid production-dependent hydrocephalus that ultimately required bilateral surgical ablation of the choroid plexus. Although the preoperative radiological diagnosis was consistent with VH, postoperative histological analysis suggested bilateral CPP. The neoplastic nature of the lesion was confirmed by specific staining for the proliferation index, showing an MIB-1 labeling index of 4%, characteristic of papilloma. Routine imaging and histological grading of choroid plexus hypertrophy and papilloma have not provided a reliable means of predicting malignant behavior or recurrence after surgical resection. Moreover, none of the previously reported cases of VH in the literature have analyzed pathological specimens for cellular proliferative potential. Therefore, we review the literature on VH and bilateral CPP and discuss the diagnostic and possible prognostic implications of distinguishing these variants by utilizing the MIB-1 marker for the proliferation index.
OBJECTIVE AND IMPORTANCE: Spinal cord schwannomas are intradural nerve sheath tumors that almost universally occupy a dorsolateral, lateral, or ventrolateral position. Therefore, resection of these lesions typically proceeds via a posterior or posterolateral approach. CLINICAL PRESENTATION: We present a case of a midline ventral intradural schwannoma of the cervical spinal cord causing myelopathy. To the best of our knowledge, no previous reports specifically discuss purely midline ventral intradural schwannomas. INTERVENTION: Resection of the tumor was performed via an anterior cervical corpectomy with spinal arthrodesis and fixation. We review possible causes for such an anomalous location for schwannoma as well as the advantages and disadvantages of various surgical strategies for removing the tumor. CONCLUSION: This case exemplifies the usefulness of anterior approaches to the cervical spine in treating unusual intradural spinal cord tumors.