A report of two cases

Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life Surgical interbody fusion of degenerative levels is an effective treatment option to stablize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF) The indications may include: discogenic/facetogenic low back pain, neurogenic claudication, radiculopathy due to foraminal stenosis, lumbar degenerative spinal deformity including symptomatic spondylolisthesis and degenerative scoliosis In general, traditional posterior approaches are frequently used with acceptable fusion rates and low complication rates, however they are limited by thecal sac and nerve root retraction, along with iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band Minimally invasive (MIS) posterior approaches have evolved in an attempt to reduce approach related complications Anterior approaches avoid the spinal canal, cauda equina and nerve roots, however have issues with approach related abdominal and vascular complications In addition, lateral and OLIF techniques have potential risks to the lumbar plexus and psoas muscle The present study aims firstly to comprehensively review the available literature and evidence for different lumbar interbody fusion (LIF) techniques Secondly, we propose a set of recommendations and guidelines for the indications for interbody fusion options Thirdly, this article provides a description of each approach, and illustrates the potential benefits and disadvantages of each technique with reference to indication and spine level performed

Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF.

Clinicopathologic correlates of solitary fibrous tumors.

Spirulina is a species of filamentous cyanobacteria that has long been used as a food supplement. In particular, Spirulina platensis and Spirulina maxima are the most important. Thanks to a high protein and vitamin content, Spirulina is used as a nutraceutical food supplement, although its other potential health benefits have attracted much attention. Oxidative stress and dysfunctional immunity cause many diseases in humans, including atherosclerosis, cardiac hypertrophy, heart failure, and hypertension. Thus, the antioxidant, immunomodulatory, and anti-inflammatory activities of these microalgae may play an important role in human health. Here, we discuss the antioxidant, immunomodulatory, and anti-inflammatory activities of Spirulina in both animals and humans, along with the underlying mechanisms. In addition, its commercial and regulatory status in different countries is discussed as well. Spirulina activates cellular antioxidant enzymes, inhibits lipid peroxidation and DNA damage, scavenges free radicals, and increases the activity of superoxide dismutase and catalase. Notably, there appears to be a threshold level above which Spirulina will taper off the antioxidant activity. Clinical trials show that Spirulina prevents skeletal muscle damage under conditions of exercise-induced oxidative stress and can stimulate the production of antibodies and up- or downregulate the expression of cytokine-encoding genes to induce immunomodulatory and anti-inflammatory responses. The molecular mechanism(s) by which Spirulina induces these activities is unclear, but phycocyanin and β-carotene are important molecules. Moreover, Spirulina effectively regulates the ERK1/2, JNK, p38, and IκB pathways. This review provides new insight into the potential therapeutic applications of Spirulina and may provide new ideas for future studies.

The antioxidant, immunomodulatory, and anti-inflammatory activities of Spirulina: an overview

Introduction Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN (STN). Etiology and pathophysiology Demyelination of primary sensory trigeminal afferents in the root entry zone is the predominant pathophysiological mechanism. Most likely, demyelination paves the way for generation of ectopic impulses and ephaptic crosstalk. In a significant proportion of the patients, the demyelination is caused by a neurovascular conflict with morphological changes such as compression of the trigeminal root. However, there are also other unknown etiological factors, as only half of the CTN patients have morphological changes. STN is caused by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve. Differential diagnosis and treatment Important differential diagnoses include trigeminal autonomic cephalalgias, posttraumatic or postherpetic pain and other facial pains. First line treatment is prophylactic medication with sodium channel blockers, and second line treatment is neurosurgical intervention. Future perspectives Future studies should focus on genetics, unexplored etiological factors, sensory function, the neurosurgical outcome and complications, combination and neuromodulation treatment as well as development of new drugs with better tolerability.

https://journals.sagepub.com/doi/pdf/10.1177/0333102416687280

Trigeminal neuralgia – diagnosis and treatment:

The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrodesis has been shown to increase given placement of bone graft along the weight-bearing axis. The fusion rate across the disc space is further enhanced with the placement of posterior pedicle screw–rod constructs and the application of an osteoinductive material. The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.

/pdf/comparison-of-low-back-fusion-techniques-transforaminal-236f9tsv1a.pdf

Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches.

Extradural arachnoid cysts in the spine are rare and are seldom a cause of spinal cord compression. They are thought to arise from congenital defects in the dura mater, and they almost always communicate with the intrathecal subarachnoid space through a small defect in the dura. The mainstay of treatment in patients with neurological symptoms is surgical removal of the cyst together with ligation of the communicating pedicle and closure of the dural defect. In the present paper the authors review the literature and discuss the clinical and pathological features, mechanisms of pathogenesis, neuroimaging characteristics, and surgical management of spinal extradural arachnoid cysts. The surgical technique for removal of these lesions is illustrated in a patient with a large thoracolumbar spinal extradural arachnoid cyst causing neurogenic claudication.

/pdf/spinal-extradural-arachnoid-cysts-clinical-radiological-and-q7xu5rq48r.pdf

Spinal extradural arachnoid cysts: clinical, radiological, and surgical features

Hyponatremia is frequently encountered in patients who have undergone neurosurgery for intracranial processes. Making an accurate diagnosis between the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting (CSW) in patients in whom hyponatremia develops is important because treatment differs greatly between the conditions. The SIADH is a volume-expanded condition, whereas CSW is a volume-contracted state that involves renal loss of sodium. Treatment for patients with SIADH is fluid restriction and treatment for patients with CSW is generally salt and water replacement. In this review, the authors discuss the differential diagnosis of hyponatremia, distinguish SIADH from CSW, and highlight the diagnosis and management of hyponatremia, which is commonly encountered in patients who have undergone neurosurgery, specifically those with traumatic brain injury, aneurysmal subarachnoid hemorrhage, recent transsphenoidal surgery for pituitary tumors, and postoperative cranial vault reconstruction for craniosynostosis.

/pdf/hyponatremia-in-the-neurosurgical-patient-diagnosis-and-6mbv7sa7ar.pdf

Hyponatremia in the neurosurgical patient: diagnosis and management

Object. Cranial reconstruction after skull base surgery is important for restoration of function and cosmesis. The authors describe their experience with the Medpor porous polyethylene implant for cosmetic cranioplasty and reconstruction after skull base surgery. Methods. Medpor, a biocompatible implant, is flexible and can be contoured to facilitate surgical reconstruction of small to medium ( 8 cm) convexity or cranial base defects resulting from a variety of skull base approaches. This method provides similar cosmetic results to standard alloplast cranioplasty while decreasing operating time. The porous nature of the material allows ingrowth of soft tissue and bone to increase implant strength and decrease the risk of infection. This material can also be used safely in reconstructio n of the cranium and skull base adjacent to the paranasal sinuses. Conclusions. The authors have used the Medpor porous polyethylene implant in 611 standard cranial and skull base procedures and have achieved excellent cosmetic results and no implant-relat ed complications

/pdf/porous-polyethylene-implant-for-cranioplasty-and-skull-base-40qhuvilgt.pdf

Porous polyethylene implant for cranioplasty and skull base reconstruction

Since the earliest recorded history of medicine, physicians have been challenged by the difficulty in relieving the great pain experienced by individuals suffering from trigeminal neuralgia (TN). The nature of the pain and the events that incite it have been well described, but effective treatments with acceptable levels of side effects remained elusive until the latter part of the 20th century. As a result, many theories about the origins of TN have been proposed, along with numerous treatment modalities. The pathophysiological causes of TN remain incompletely understood, but the medical and surgical treatment techniques currently used offer effective ways to relieve this extremely painful condition. In this historical review the authors discuss the initial descriptions of tic douloureux, Fothergill disease, and TN, along with various therapeutic interventions and their refinements.

/pdf/historical-perspectives-on-the-diagnosis-and-treatment-of-ww449yia3o.pdf

Chad D Cole

Papers

Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches.

Spinal extradural arachnoid cysts: clinical, radiological, and surgical features

Hyponatremia in the neurosurgical patient: diagnosis and management

Porous polyethylene implant for cranioplasty and skull base reconstruction

Historical perspectives on the diagnosis and treatment of trigeminal neuralgia.