- How clean is clean enough? An observational pilot study to assess central sterilization processing efficacy with adenosine triphosphate levels. [Journal Article]Am J Infect Control 2019AJ
- CONCLUSIONS: This study suggests that the current cleaning process is adequate for the instruments tested. Ongoing quality assessment would be beneficial to validate other instruments.
- Surgical Rescue Technique for Incomplete Burr Hole Using a Small Bone Piece and the Craniotome. [Journal Article]World Neurosurg 2019; 130:106-109WN
- CONCLUSIONS: Application of the unlocked craniotome on the small bone piece can easily complete the burr hole. Less bone deficit is caused compared with making a new burr hole. In addition, time is saved without changing the attachment, and the burr hole is completed safely. This small bone piece method is effective to recover an incomplete burr hole.
- Quantitative and qualitative analyses of spinal canal encroachment during cervical laminectomy using the kerrison rongeur versus High-Speed burr. [Journal Article]Br J Neurosurg 2019; 33(2):131-134BJ
- CONCLUSIONS: When performing a trough laminotomy, the high-speed burr results in less canal encroachment compared to 1 mm or 2 mm Kerrison rongeurs. In the setting of a stenotic spinal canal, spine surgeons should consider using the burr to perform laminectomy to minimize the degree of canal encroachment.
- [Efficacy and safety of applying ultrasonic osteotome in cervical expansive open-door laminoplasty]. [Journal Article]Beijing Da Xue Xue Bao Yi Xue Ban 2018; 50(6):1092-1097BD
- CONCLUSIONS: Applying ultrasonic osteotome in patients undergoing cervical expansive open-door laminoplasty is both safe and effective. Compared with the rongeur, ultrasonic osteotome can cause the delayed union of the hinge bone, but it reduces the blood loss in operation, volume of postoperative drainage and days of remaining the drainage tube.
- Iatrogenic Lumbar Artery Injury in Spine Surgery: A Literature Review. [Review]World Neurosurg 2019; 122:266-271WN
- CONCLUSIONS: Attention should be given to the surgical procedures that are likely to cause ILAI, such as percutaneous vertebroplasty/percutaneous kyphoplasty, vertebral biopsy, pedicle screw implantation, discectomy, transforaminal endoscopic operation, and intervertebral foramen decompression. Once a diagnosis of ILAI has been confirmed, selective endovascular transarterial embolization is the preferred treatment.
- Heterotrophic Ossification of the Flexor Retinaculum in a Patient with Ankylosing Spondylitis. [Case Reports]Asian J Neurosurg 2018 Jul-Sep; 13(3):921-922AJ
- Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. This syndrome has various etiologies of which heterotopic ossification of the flexor retinaculum is a rare cause. Ankylosing spondylitis (AS) is a systemic, progressive inflammatory disease of unknown etiology that mainly affects the axial skeleton and rarely causes peripheral neurological symptoms. A 48-year-old woman present…
Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. This syndrome has various etiologies of which heterotopic ossification of the flexor retinaculum is a rare cause. Ankylosing spondylitis (AS) is a systemic, progressive inflammatory disease of unknown etiology that mainly affects the axial skeleton and rarely causes peripheral neurological symptoms. A 48-year-old woman presented with numbness and pain in her right hand. Ten years earlier, she was diagnosed with AS. Electrodiagnostic evaluation revealed severe median nerve compression at the right wrist. The patient underwent surgery for severe CTS. During the operation, the flexor retinaculum could not be incised due to marked stiffness. Ossification of the flexor retinaculum was seen, and the retinaculum was partially excised with an osteotome and Kerrison rongeur. The patient's complaints resolved almost totally after the operation. AS is a common systemic inflammatory disease that can produce heterotopic ossification of the flexor retinaculum. Preoperative wrist computed tomography should be obtained in patients with CTS and AS.
- Suitability of Administrative Databases for Durotomy Incidence Assessment: Comparison to the Incidence Associated With Bone-Removal Devices, Calculated Using a Systemic Literature Review and Clinical Data. [Journal Article]Int J Spine Surg 2018; 12(4):498-509IJ
- CONCLUSIONS: Hospital administrative databases seem to show a lower-than-reasonable incidence of durotomy, suggesting possible underreporting. Researchers should therefore use this tool with caution. Reduction of the absolute durotomy incidence by approximately 2.5% can be achieved by improving the safety of bone-removal devices.
- The Effect of Radioscapholunate Fusion With and Without Distal Scaphoid and Triquetrum Excision on Capitolunate Contact Pressures. [Journal Article]J Hand Surg Am 2019; 44(5):420.e1-420.e7JH
- CONCLUSIONS: A DSE performed at the time of RSL fusion results in increased midcarpal joint contact force and area, with resultant contact pressures unchanged. Triquetrectomy, which has been previously shown to improve range of motion, did not increase contact forces in the capitolunate joint.If a surgeon is contemplating performing an RSL arthrodesis with DSE, we recommend adding a triquetrectomy to improve motion because this does not add to the potentially deleterious effects of increased midcarpal contact force.
- Origins of eponymous instruments in spine surgery. [Journal Article]J Neurosurg Spine 2018; 29(6):696-703JN
- Every day, spine surgeons call for instruments named after surgical pioneers. Few know the designers or the histories behind their instruments. In this paper the authors provide a historical perspective on the Penfield dissector, Leksell rongeur, Hibbs retractor, Woodson elevator, Kerrison rongeur, McCulloch retractor, Caspar pin retractor system, and Cloward handheld retractor, and a biographica…
Every day, spine surgeons call for instruments named after surgical pioneers. Few know the designers or the histories behind their instruments. In this paper the authors provide a historical perspective on the Penfield dissector, Leksell rongeur, Hibbs retractor, Woodson elevator, Kerrison rongeur, McCulloch retractor, Caspar pin retractor system, and Cloward handheld retractor, and a biographical review of their inventors. Historical data were obtained by searching the HathiTrust Digital Library, PubMed, Google Scholar, Google Books, and Google, and personal communications with relatives, colleagues, and foundations of the surgeon-designers. The authors found that the Penfield dissectors filled a need for delicate tools for manipulating the brain and that the Leksell rongeur increased surgical efficiency during war-related laminectomies. Hibbs' retractor facilitated his spine fusion technique. Woodson was both a dentist and a physician whose instrument was adopted by spine surgeons. Kerrison rongeurs were developed in otology to decompress bone near the facial nerve. The McCulloch, Caspar, and Cloward retractors helped improve exposure during the emergence of new techniques, i.e., microdiscectomy and anterior cervical discectomy and fusion. The histories behind these eponymous instruments remind us that innovation sometimes begins in other specialties and demonstrate the role of innovation in improving patient care.
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- Minimally Invasive Proximal Interphalangeal Joint Arthrodesis Using Headless Screw: Surgical Technique. [Journal Article]Tech Hand Up Extrem Surg 2018; 22(2):39-42TH
- Proximal interphalangeal (PIP) joint arthritis causes debilitating hand pain and instability leading to significant functional impairment. Arthrodesis remains the gold standard for treatment of PIP arthritis. We present a minimally invasive PIP arthrodesis that provides rigid fixation with a headless compression screw. Seven patients who presented to the senior author with PIP joint arthritis und…
Proximal interphalangeal (PIP) joint arthritis causes debilitating hand pain and instability leading to significant functional impairment. Arthrodesis remains the gold standard for treatment of PIP arthritis. We present a minimally invasive PIP arthrodesis that provides rigid fixation with a headless compression screw. Seven patients who presented to the senior author with PIP joint arthritis underwent PIP arthrodesis by minimally invasive technique. A 1 cm transverse incision is made over the PIP joint, incising skin, central band, and articular capsule. PIP joint is flexed to expose the articular surface. Articular surfaces are prepared with a fine tipped rongeur, exposing subchondral bone until flat surfaces are obtained. Under fluoroscopy a guide wire for cannulated headless screw (3.0, 2.4, or 2.0 mm) is inserted in an antegrade manner. It progresses from the center of the proximal phalangeal articular surface until it exits through the dorsal cortex and the distal end lies within the subchondral bone. This is the most critical step of the procedure because the guide wire angle determines the degree of flexion of the fusion. A 5 mmincision is made over the guide wire and the wire is advanced through the center of the medullary canal of the middle phalanx. The wire is then overdrilled, length is measured, and a headless compression screws is inserted. Reevaluate alignment after insertion of the screws because malrotation may be induced by torque during compression. Six consecutive patients underwent the procedure by the senior author. All patients healed the arthrodesis without complications and hardware removal was not needed. Minimally invasive PIP joint arthrodesis is a safe and viable procedure. Critical portions of the procedure include placing the wire at the angle of the desired angle of fusion and avoiding malrotation during screw insertion.