75 results on '"Gabriel C. Tender"'
Search Results
2. A Retrospective Review of the Timing of Glasgow Coma Scale Documentation in a Trauma Database: Implications for Patient Care, Research, and Performance Metrics
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Iris E. Hunt, Blake E. Wittenberg, Brooke Kennamer, Clifford L. Crutcher, Gabriel C. Tender, John P. Hunt, and Anthony M. DiGiorgio
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Benchmarking ,Humans ,Glasgow Coma Scale ,Surgery ,Documentation ,Patient Care ,Neurology (clinical) ,Retrospective Studies - Abstract
The Glasgow Coma Scale (GCS) is intended to be an objective, reliable measure of a patient's mental status. It is included as a metric for trauma registries, having implications for performance metrics and research. Our study compared the GCS recorded in the trauma registry (GCS-1) with that recorded in the neurosurgery consultation (GCS-2).This retrospective review compared GCS-1 with GCS-2. The Trauma Injury Severity Score (TRISS) method was used to calculate probability of survival (POS) for patients using both GCS-1 and GCS-2.GCS-1 score significantly differed from GCS-2 score (6.69 vs. 7.84, ± 2.553; P0.001). There were 172 patients (37.55%) with a GCS-1 score of 3 and 87 (19.00%) with a GCS-2 score of 3 (χThe immediate GCS score recorded on patient arrival after trauma differs significantly from the GCS score recorded at later times. This finding significantly altered the probability of survival as calculated by the TRISS methodology. This situation could have profound effects on risk-adjusted benchmarking, assessments of quality of care, and injury severity stratification for research. More studies into the optimal timing of GCS score recording or changes in GCS score and their impact on survival are warranted.
- Published
- 2022
3. Prospective Trial of Sacroiliac Joint Fusion Using 3D-Printed Triangular Titanium Implants: 24-Month Follow-Up
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Philip S Yuan, Harry Lockstadt, Abhineet Chowdhary, Don Kovalsky, Fernando Techy, Julie LaCombe, Vikas V. Patel, Gabriel C. Tender, Andy Kranenburg, Casey Langel, Robert Limoni, Daniel J. Cher, and S Craig Meyer
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Sacroiliac joint ,3d printed ,business.industry ,Evidence and Research [Medical Devices] ,sacroiliac joint arthrodesis ,Biomedical Engineering ,Medicine (miscellaneous) ,Oswestry Disability Index ,sacroiliac joint pain ,medicine.anatomical_structure ,Quality of life ,Prospective trial ,Anesthesia ,medicine ,chronic low back pain ,Prospective cohort study ,business ,Adverse effect ,triangular titanium implants ,Month follow up ,Original Research - Abstract
Vikas Patel,1 Don Kovalsky,2 S Craig Meyer,3 Abhineet Chowdhary,4 Julie LaCombe,4 Harry Lockstadt,5 Fernando Techy,6 Casey Langel,7 Robert Limoni,8 Philip Yuan,9 Andy Kranenburg,10 Daniel Cher,11 Gabriel Tender12 1Department of Orthopedics, University of Colorado, Aurora, CO, USA; 2Orthopaedic Center of Southern Illinois, Mt. Vernon, IL, USA; 3Columbia Orthopaedic Medical Group, Columbia, MO, USA; 4Overlake Medical Center, Bellevue, WA, USA; 5Bluegrass Orthopaedics, Lexington, KY, USA; 6ClinTech Center for Spine Health, Johnstown, CO, USA; 7The B.A.C.K. Center, Melbourne, FL, USA; 8BayCare Clinic Orthopedics & Sports Medicine, Green Bay, WI, USA; 9Memorial Orthopaedic Surgical Group, Long Beach, CA, USA; 10South Oregon Orthopedics, Medford, OR, USA; 11SI-BONE, Inc, Santa Clara, CA, USA; 12Department of Neurosurgery, Louisiana State University, New Orleans, LA, USACorrespondence: Vikas Patel Tel +1 303 724-8936Email Vikas.Patel@CUAnschutz.eduBackground: Strong evidence supports minimally invasive sacroiliac joint (SIJ) fusion using triangular titanium implants (TTI) for chronic SIJ dysfunction.Objective: To report safety and effectiveness of SIJF using a 3D-printed TTI at 24 months.Methods: SIJF with TTI was performed in 51 subjects. Structured follow-up occurred at 3, 6, 12 and 24 months. Both quality of life questionnaires and functional tests were performed at all study visits.Results: 84% of subjects were available for 24-month follow-up. Observed were rapid and persistent improvements in dysfunction due to pain (Oswestry Disability Index [ODI], mean 52.8 at baseline and 28.3 at 24 months, p< 0.0001) and SIJ pain ratings (mean 78.5 at baseline [0â 100 scale] to 21.5 at 24 months). Opioid use for SIJ pain decreased markedly from baseline. Physical function tests impaired by SIJ pain showed persistent improvements compared to baseline. There was no evidence of device breakage, migration or subsidence and few late adverse events occurred attributable to the device.Conclusion: In this prospective study, SIJF using 3D-printed TTI resulted in immediate, marked and persistent improvements in pain and quality of life, with improved physical function, reduced opioid use and a low rate of late device-related adverse events.Level of Evidence: Level II.Keywords: sacroiliac joint pain, sacroiliac joint arthrodesis, chronic low back pain, triangular titanium implants
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- 2021
4. Prospective Trial of Sacroiliac Joint Fusion Using 3D-Printed Triangular Titanium Implants
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Abhineet Chowdhary, Philip S Yuan, Robert Limoni, Harry Lockstadt, Daniel J. Cher, Gabriel C. Tender, Travis J. Hillen, Fernando Techy, Casey Langel, Andy Kranenburg, S Craig Meyer, Vikas V. Patel, and Don Kovalsky
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Sacroiliac joint ,3d printed ,medicine.medical_specialty ,business.industry ,Radiography ,Biomedical Engineering ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,Oswestry Disability Index ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Opioid ,Prospective trial ,Multicenter trial ,Medicine ,Implant ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background Prior trials provide strong evidence supporting minimally invasive sacroiliac joint (SIJ) fusion using triangular titanium implants (TTI) for chronic SIJ dysfunction. Objective To assess the safety and effectiveness of SIJF using a 3D-printed TTI. Methods Fifty-one subjects with carefully diagnosed SIJ dysfunction underwent SIJF with 3D TTI. Subjects completed pain, disability and quality of life questionnaires at baseline and 3, 6 and 12 months postoperatively. Functional tests were performed in the clinic at each visit. Pelvic CT scans were independently evaluated for radiolucency, bridging bone and other endpoints. Results Ninety percent had 12-month follow-up. Dysfunction due to pain (Oswestry Disability Index [ODI]) decreased from 52.8 at baseline to 27.9 at 12 months (p
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- 2020
5. Rupture of a superficial temporal artery pseudoaneurysm following craniotomy
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Kevin Morrow, Jared M Robichaux, Gabriel C. Tender, Jessica Shields, and Clifford L Crutcher
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jscrep/0100 ,medicine.medical_specialty ,AcademicSubjects/MED00910 ,Cerebrospinal fluid leak ,business.industry ,medicine.medical_treatment ,External carotid artery ,Rare entity ,Case Report ,medicine.disease ,Superficial temporal artery ,digestive system ,Surgery ,Pseudoaneurysm ,Aneurysm ,medicine.artery ,cardiovascular system ,medicine ,cardiovascular diseases ,business ,Complication ,Craniotomy - Abstract
Pseudoaneurysm of the superficial temporal artery (STA) is a rare entity that has been reported in the literature after trauma or iatrogenic injuries. We describe a unique case of STA pseudoaneurysm rupture and the clinical sequelae associated with its rupture. We report a case of pseudoaneurysm rupture of the STA that occurred 14 days after craniotomy for cerebrospinal fluid leak repair. We also review the literature, diagnosis and treatment of external carotid artery aneurysms. Rupture of a STA pseudoaneurysm is a previously unreported and serious complication that must be quickly recognized in order to control hemorrhage that may have life threatening complications.
- Published
- 2021
6. Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis
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Anneliese D. Heiner, Joseph Morreale, Gabriel C. Tender, Morgan P. Lorio, Jana R. Montgomery, Frank M. Phillips, and Jim A. Youssef
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Decompression ,Visual analogue scale ,Spinal stenosis ,Context (language use) ,Spinal Cord Diseases ,Myelopathy ,Postoperative Complications ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Neck pain ,business.industry ,Pain scale ,Middle Aged ,Decompression, Surgical ,medicine.disease ,Surgery ,Spinal Fusion ,Meta-analysis ,Cervical Vertebrae ,Female ,Neurology (clinical) ,medicine.symptom ,business - Abstract
BACKGROUND CONTEXT Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc disorders that result in myelopathy or radiculopathy. The annual rate, number, and cost of PCF in the United States has increased. Far fewer studies have been published on PCF outcomes than on anterior cervical fusion (ACF) outcomes, most likely because far fewer PCFs than ACFs are performed. PURPOSE To evaluate the patient-reported and clinical outcomes of adult patients who underwent subaxial posterior cervical fusion with decompression. STUDY DESIGN/SETTING Systematic review and meta-analysis. PATIENT SAMPLE The total number of patients in the 31 articles reviewed and included in the meta-analysis was 1,238 (range 7–166). OUTCOME MEASURES Preoperative to postoperative change in patient-reported outcomes (visual analog scales for arm pain and neck pain, Neck Disability Index, Japanese Orthopaedic Association [JOA] score, modified JOA score, and Nurick pain scale) and rates of fusion, revision, and complications or adverse events. METHODS This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a preapproved protocol. PubMed and Embase databases were searched for articles published from January 2001 through July 2018. Statistical analyses for patient-reported outcomes were performed on the outcomes’ raw mean differences, calculated as postoperative value minus preoperative value from each study. Pooled rates of successful fusion, revision surgery, and complications or adverse events, and their 95% confidence intervals, were also calculated. Two subgroup analyses were performed: one for studies in which only myelopathy or radiculopathy (or both) were stated as surgical indications and the other for studies in which only myelopathy or ossification of the posterior longitudinal ligament (or both) were stated as surgical indications. This study was funded by Providence Medical Technology, Inc. ($32,000). RESULTS Thirty-three articles were included in the systematic review, and 31 articles were included in the meta-analysis. For all surgical indications and for the 2 subgroup analyses, every cumulative change in patient-reported outcome improved. Many of the reported changes in patient-reported outcome also exceeded the minimal clinically important differences. Pooled outcome rates with all surgical indications were 98.25% for successful fusion, 1.09% for revision, and 9.02% for complications or adverse events. Commonly reported complications or adverse events were axial pain, C5 palsy, transient neurological worsening, and wound infection. CONCLUSIONS Posterior cervical fusion with decompression resulted in significant clinical improvement, as indicated by the changes in patient-reported outcomes. Additionally, high fusion rates and low rates of revision and of complications and adverse events were found.
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- 2019
7. The Accuracy of Glasgow Coma Score Documentation in a Trauma Database: Implications for Patient Care and Performance Metrics
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John P. Hunt, Jason D Wilson, Brooke Kennamer, Clifford L Crutcher, Blake E Wittenberg, Clarence S. Greene, Frank Culicchia, Adam Podet, Gabriel C. Tender, and Anthony M DiGiorgio
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business.industry ,Glasgow Coma Scale ,Quality measurement ,medicine.disease ,Patient care ,symbols.namesake ,Pharmacy (field) ,Documentation ,symbols ,Medicine ,Surgery ,Neurology (clinical) ,Medical emergency ,business ,Trauma surgery ,Fisher's exact test - Published
- 2019
8. Do We Need Standing Scoliosis Films for One or Two-Level Lumbar Fusions?
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Caroline Davidson and Gabriel C. Tender
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Orthodontics ,Lumbar ,business.industry ,medicine ,Surgery ,Neurology (clinical) ,Scoliosis ,medicine.disease ,business - Published
- 2019
9. Minimally invasive lateral transiliac sacroiliac joint fusion using 3D-printed triangular titanium implants
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Robert Limoni, Vikas V. Patel, Fernando Techy, James B. Billys, Abhineet Chowdhary, Philip S Yuan, Andy Kranenburg, Daniel J. Cher, S Craig Meyer, Don Kovalsky, Harry Lockstadt, and Gabriel C. Tender
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Sacroiliac joint ,medicine.medical_specialty ,3d printed ,business.industry ,Pelvic pain ,Arthrodesis ,medicine.medical_treatment ,Biomedical Engineering ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,Buttock Pain ,Osteoarthritis ,medicine.disease ,Surgery ,Oswestry Disability Index ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Multicenter trial ,medicine ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background: Minimally invasive sacroiliac joint (SIJ) fusion (SIJF) has become an increasingly accepted surgical option for chronic SI joint dysfunction, a prevalent cause of chronic low back/buttock pain. Objective: To report clinical and functional outcomes of SIJF using 3D-printed triangular titanium implants (TTI) for patients with chronic SI joint dysfunction. Methods: A total of 28 subjects with SIJ dysfunction at 8 centers underwent SIJF with 3D TTI and had scheduled follow-up to 6 months (NCT03122899). Results: Mean preoperative SIJ pain score was 79.1 and mean preoperative Oswestry Disability Index (ODI) was 49.9. At 6 months, pain scores decreased by 51 points and ODI decreased by 23.6 points (both p
- Published
- 2019
10. Change in Policy Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital
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Gabriel C. Tender, Anthony M DiGiorgio, Michael S Virk, Clifford L Crutcher, Praveen V. Mummaneni, Zhide Fang, Frank Culicchia, Jason D Wilson, Adam Podet, and Jonathan Lloyd Fisher
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Adult ,Male ,Waiting time ,Operating Rooms ,medicine.medical_specialty ,Demographics ,Neurosurgery ,Personnel Staffing and Scheduling ,Medicare ,Tertiary care ,Neurosurgical Procedures ,Academic institution ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Vulnerable population ,Academic Medical Centers ,Medically Uninsured ,Brain Neoplasms ,Medicaid ,business.industry ,General surgery ,Interrupted Time Series Analysis ,Length of Stay ,Middle Aged ,Overlapping surgery ,Organizational Policy ,United States ,Wait time ,Neurosurgeons ,Spinal Injuries ,030220 oncology & carcinogenesis ,Female ,Surgery ,Spondylosis ,Neurology (clinical) ,business ,Spinal Cord Compression ,Safety-net Providers ,030217 neurology & neurosurgery - Abstract
Background The practice of surgeons running overlapping operating rooms has recently come under scrutiny. Objective To examine the impact of hospital policy allowing overlapping rooms in the case of patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. Methods The neurosurgery service at the hospital being studied transitioned from routinely allowing 1 room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Demographics, indication, case type, complications, outcomes, and total charges were tracked. Results There were 59 urgent cases in period 1 and 63 in period 2. In the case of these patients, the length of stay was significantly decreased in period 2 (13.09 d vs 19.52; P = .006). The time from admission to surgery (wait time) was also significantly decreased in period 2 (5.12 d vs 7.00; P = .04). Total charges also trended towards less in period 2 (${\$}$150 942 vs ${\$}$200 075; P = .05). Surgical complications were no different between the groups (16.9% vs 14.3%; P = .59), but medical complications were significantly decreased in period 2 (14.3% vs 30.5%; P = .009). Significantly more patients were discharged to home in period 2 (69.8% vs 42.4%; P = .003). Conclusion As a matter of policy, allowing overlapping rooms significantly reduces the length of stay in the case of a vulnerable population in need of urgent surgery at a single safety-net academic institution. This may be due to a reduction in medical complications in these patients.
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- 2019
11. Management of cerebrospinal fluid leak from cervical gunshot wounds with external ventricular drainage: a small case series
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Lindsay Lasseigne, Frank Culicchia, Clifford L Crutcher, Jessica Shields, Gabriel C. Tender, John M. Wilson, and Kevin Morrow
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Ventriculostomy ,Surgical repair ,jscrep/0100 ,medicine.medical_specialty ,Leak ,Cerebrospinal fluid leak ,AcademicSubjects/MED00910 ,business.industry ,medicine.medical_treatment ,medicine.disease ,humanities ,Surgery ,body regions ,Cerebrospinal fluid ,Lumbar ,medicine.anatomical_structure ,medicine ,Spinal canal ,Case Series ,business ,External ventricular drain - Abstract
Historically, the surgical management of gunshot wounds to the spine has been controversial. Repair of a persistent cerebrospinal fluid (CSF) leak is a generally agreed upon indication. The management of such CSF leaks typically involves lumbar drainage or direct surgical repair. Here, the authors report two cases of CSF diversion with an external ventricular drain (EVD) in patients with cervical gunshot wounds. Both patients had spinal canal obliteration or physiologic myelographic block at or below the level of injury. To the best of the author’s knowledge, these are the first two reports of successful EVD treatment of persistent CSF leaks related cervical gunshot wounds. The authors also propose a CSF treatment algorithm for cervical gunshot wounds that includes EVD.
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- 2020
12. Minimally invasive lateral corpectomy for thoracolumbar traumatic burst fractures
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Gabriel C. Tender, Jared M Robichaux, Kevin Morrow, Anthony M DiGiorgio, Adam Podet, and Jessica Shields
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Thoracic Vertebrae ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,Prospective Studies ,Corpectomy ,Spinal cord injury ,Aged ,Retrospective Studies ,Lumbar Vertebrae ,business.industry ,Significant difference ,Treatment options ,Thoracolumbar spine ,General Medicine ,Middle Aged ,medicine.disease ,Posterior decompression ,Surgery ,Chest tube placement ,Operative time ,Spinal Fractures ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
OBJECTIVEThe need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures.METHODSBetween 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications.RESULTSPatients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients).CONCLUSIONSThe minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.
- Published
- 2020
13. Minimally Invasive Management of Civilian Gunshot Wounds to the Lumbar Spine: A Case Series and Technical Report
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Anthony M DiGiorgio, Kevin Morrow, John M. Wilson, Clifford L Crutcher, Gabriel C. Tender, Erin S. Fannin, and Jessica Shields
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musculoskeletal diseases ,medicine.medical_specialty ,Decompression ,0211 other engineering and technologies ,Aftercare ,02 engineering and technology ,Lumbar vertebrae ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,medicine ,Humans ,021110 strategic, defence & security studies ,Lumbar Vertebrae ,business.industry ,Trauma center ,Cauda equina ,medicine.disease ,Patient Discharge ,Surgery ,Retractor ,medicine.anatomical_structure ,Abdomen ,Wounds, Gunshot ,Neurology (clinical) ,Gunshot wound ,business ,030217 neurology & neurosurgery - Abstract
Background Treatment of penetrating gunshot wounds (GSW) to the spine remains controversial. The decision to operate is often based on surgeon preference and experience. We present a case series of 7 patients who underwent minimally invasive thoracolumbar/sacral decompression and bullet removal at a level 1 trauma center. Objective To describe the use of minimally invasive techniques to achieve decompression and bullet removal for GSW to the spine. Methods From 2010 to 2017, 7 patients with spinal GSW underwent minimally invasive decompression and bullet removal at an academic level 1 trauma center. Results Patient ages ranged from 20 to 55 yr (mean: 31 yr). The mechanisms of injury were GSW to the abdomen/pelvis (n = 6) and direct GSW to the spine (n = 1). Based on the neurological examination, the injuries were characterized as complete (n = 1) or incomplete (n = 6). Decompression and bullet removal were performed using a tubular retractor system. All patients with incomplete injuries who had postdischarge follow-up demonstrated some neurologic recovery. There were no postoperative wound infections, cerebrospinal fluid (CSF) fistulas, or other complications related to the procedure. Conclusion Minimally invasive decompression and bullet removal is a safe technique that may help reduce the risk of postoperative infections and CSF fistulas in patients with GSW to the lumbar spine compared to the standard open technique. This approach appears to be particularly beneficial in patients with incomplete injuries and neuropathic pain refractory to medical treatment.
- Published
- 2019
14. The Impact of Drug and Alcohol Intoxication on Glasgow Coma Scale Assessment in Patients with Traumatic Brain Injury
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Frank Culicchia, Brooke Kennamer, Alan J. Velander, John P. Hunt, Jason D Wilson, Gabriel C. Tender, Clarence S. Greene, Anthony M DiGiorgio, Clifford L Crutcher, and Blake Wittenberg
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Drug ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,Traumatic brain injury ,Substance-Related Disorders ,media_common.quotation_subject ,Neurosurgical Procedures ,Head trauma ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Blunt ,Alcohol intoxication ,Head Injuries, Closed ,Brain Injuries, Traumatic ,medicine ,Humans ,In patient ,Glasgow Coma Scale ,Prospective Studies ,Registries ,Child ,media_common ,Aged ,Aged, 80 and over ,business.industry ,Infant, Newborn ,Infant ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,United States ,Hematoma, Subdural ,030220 oncology & carcinogenesis ,Anesthesia ,Child, Preschool ,Surgery ,Female ,sense organs ,Neurology (clinical) ,Neurosurgery ,business ,Alcoholic Intoxication ,030217 neurology & neurosurgery - Abstract
The effect of intoxicating substances on assessment of Glasgow Coma Scale (GCS) in the trauma setting has not been completely elucidated.A trauma registry was queried for patients with blunt head trauma in 2013-2017. Initial GCS score and toxicology screening from the database were reviewed. Next recorded GCS score from the neurosurgery evaluation and change in GCS score (ΔGCS) were compared.We reviewed 468 patients. In 217 (46.4%) patients, no toxic substances were found, whereas1 toxic substance was found in 104 (22.2%) patients. Alcohol level above the legal limit was found in 109 (23.3%) patients, marijuana was found in 105 (22.4%) patients, benzodiazepines were found in 94 (20.1%) patients, opiates were found in 48 (10.3%) patients, and cocaine was found in 41 (8.8%) patients. Mean change in GCS score was significantly higher in impaired patients compared with patients with a negative screening test (1.74 ± 2.4 vs. 0.75 ± 2.7, P0.001); this is despite both groups having a similar initial GCS score (6.23 ± 3.86 in impaired group vs. 6.47 ± 3.52 in sober group, P = 0.677). Initial GCS score was 3 in 187 patients, of whom 150 had a positive toxicology screen. Change in GCS score was significantly higher in the impaired group (2.75 ± 2.7 vs. 1.19 ± 1.8, P 0.001).Intoxicating substances can confound GCS assessment in trauma patients. This can have effects on patient care as well as performance metrics and predictive analytics. These patients should be screened, and intoxicating substances should be reversed or allowed to wear off before GCS score is recorded for benchmarking or quality reporting.
- Published
- 2019
15. Traumatic cervical spine injury during sexual activity
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Caroline Davidson, Clifford L Crutcher, and Gabriel C. Tender
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Neck pain ,medicine.medical_specialty ,business.industry ,030232 urology & nephrology ,Extreme position ,Case Report ,Cervical spine injury ,medicine.disease ,Cervical spine ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,medicine.symptom ,Surgical treatment ,business ,Spinal cord injury ,030217 neurology & neurosurgery - Abstract
Sexual activity is unlikely to result in spinal injuries. We present the first case of a cervical fracture-subluxation and spinal cord injury following sexual activity. This 31-year-old female presented to the emergency room with neck pain and quadriparesis, following sexual activity in an extreme position. Imaging revealed a hyperflexion cervical fracture-subluxation injury, requiring reduction by traction, followed by circumferential surgical fixation. At 6 months postoperatively, she reported baseline return of function. This case demonstrates that sex-induced spinal injuries are possible and may require urgent surgical treatment.
- Published
- 2019
16. L5 spinal nerve function after L5-S1 high-grade spondylolisthesis reduction: Two case reports
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Daniel Serban, Gabriel C. Tender, Niki Calina, and Mihaela Florea
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030222 orthopedics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Sagittal balance ,High grade spondylolisthesis ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Neurology ,Spinal nerve ,medicine ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Reduction (orthopedic surgery) - Published
- 2017
17. A case series of penetrating spinal trauma: comparisons to blunt trauma, surgical indications, and outcomes
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Casey P Spinelli, Clifford L Crutcher, Gabriel C. Tender, Anthony M DiGiorgio, Kevin Morrow, Adam Podet, Jason D Wilson, and Lindsay Lasseigne
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Adult ,Male ,Patient Transfer ,medicine.medical_specialty ,Adolescent ,Alcohol Drinking ,Cauda Equina ,Databases, Factual ,Neurological examination ,Wounds, Penetrating ,Comorbidity ,Wounds, Nonpenetrating ,Insurance Coverage ,Neurosurgical Procedures ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Blunt ,Injury Severity Score ,Epidemiology ,medicine ,Ethnicity ,Humans ,Hospital Mortality ,Spinal Cord Injuries ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Length of Stay ,Middle Aged ,Surgery ,Treatment Outcome ,Blunt trauma ,Spinal Injuries ,Concomitant ,Spinal Fractures ,Spine injury ,Female ,Wounds, Gunshot ,Neurology (clinical) ,Complication ,business ,030217 neurology & neurosurgery - Abstract
OBJECTIVEWhile blunt spinal trauma accounts for the majority of spine trauma, penetrating injuries affect a substantial number of patients. The goal of this study was to examine the epidemiology of penetrating spine injuries compared with blunt injuries and review the operative interventions and outcomes in the penetrating spine injury group.METHODSThe prospectively maintained trauma database was queried for spinal fractures from 2012 to 2018. Charts from patients with penetrating spine trauma were reviewed.RESULTSA total of 1130 patients were evaluated for traumatic spinal fractures; 154 injuries (13.6%) were secondary to penetrating injuries. Patients with penetrating injuries were significantly younger (29.2 years vs 44.1 years, p < 0.001), more likely male (87.7% vs 69.2%, p < 0.001), and more commonly African American (80.5% vs 33.3%, p < 0.05). When comparing primary insurers, the penetrating group had a significantly higher percentage of patients covered by Medicaid (60.4% vs 32.6%, p < 0.05) or prison (3.9% vs 0.1%, p < 0.05) or being uninsured (17.5% vs 10.3%, p < 0.05). The penetrating group had a higher Injury Severity Score on admission (20.2 vs 15.6, p < 0.001) and longer hospital length of stay (20.1 days vs 10.3 days, p < 0.001) and were less likely to be discharged home (51.3% vs 65.1%, p < 0.05). Of the penetrating injuries, 142 (92.2%) were due to firearms. Sixty-three patients (40.9%) with penetrating injuries had a concomitant spinal cord or cauda equina injury. Of those, 44 (69.8%) had an American Spinal Injury Association Impairment Scale (AIS) grade of A. Ten patients (15.9%) improved at least 1 AIS grade, while 2 patients (3.2%) declined at least 1 AIS grade. Nine patients with penetrating injuries underwent neurosurgical intervention: 5 for spinal instability, 4 for compressive lesions with declining neurological examination results, and 2 for infectious concerns, with some patients having multiple indications. Patients undergoing neurosurgical intervention did not show a significantly greater change in AIS grade than those who did not. No patient experienced a complication directly related to neurosurgical intervention.CONCLUSIONSPenetrating spinal trauma affects a younger, more publicly funded cohort than blunt spinal trauma. These patients utilize more healthcare resources and are more severely injured. Surgery is undertaken for limiting progression of neurological deficit, stabilization, or infection control.
- Published
- 2018
18. Primary pain generator identification by CT-SPECT in patients with degenerative spinal disease
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Caroline Davidson, Jared M Robichaux, Jessica Shields, Joe Park, Gabriel C. Tender, Anthony M DiGiorgio, and Clifford L Crutcher
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Visual Analog Scale ,Visual analogue scale ,medicine.medical_treatment ,Intervertebral Disc Degeneration ,Spinal disease ,Multimodal Imaging ,Spine pain ,030218 nuclear medicine & medical imaging ,Diagnostic modalities ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Preoperative Care ,Humans ,Medicine ,In patient ,Aged ,Retrospective Studies ,Aged, 80 and over ,Tomography, Emission-Computed, Single-Photon ,Vertebroplasty ,Lumbar Vertebrae ,Neck Pain ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Spinal pain ,Spinal Fusion ,Scoliosis ,Back Pain ,Spinal fusion ,Cervical Vertebrae ,Female ,Surgery ,Neurology (clinical) ,Radiology ,Spondylolisthesis ,Tomography, X-Ray Computed ,business ,Algorithms ,030217 neurology & neurosurgery ,Diskectomy - Abstract
OBJECTIVEAxial spinal pain generators are difficult to identify using current diagnostic modalities. Merging CT with SPECT (CT-SPECT) scans allows for accurate identification of areas with increased osteoblastic activity, which may reflect pain generators. In this study, the authors aimed to evaluate the degree of pain improvement in patients who underwent surgery, addressing primary pain generators identified by CT-SPECT.METHODSThe authors retrospectively reviewed all patients with chronic axial spine pain who underwent diagnostic CT-SPECT at their institution and analyzed pain improvement in those who underwent surgical treatment in order to determine whether CT-SPECT correctly identified the primary pain generator.RESULTSA total of 315 patients underwent diagnostic CT-SPECT between January 2014 and August 2018. Forty-eight patients underwent either cervical or lumbar fusion; there were 26 women (16 cervical, 10 lumbar) and 22 men (9 cervical, 13 lumbar). The overall axial spinal pain, as assessed through self-reporting of visual analog scale scores at 6 months postoperatively, improved from 9.04 ± 1.4 to 4.34 ± 2.3 (p = 0.026), with cervical fusion patients improving from 8.8 ± 1.8 to 3.92 ± 2.2 (p = 0.019) and lumbar fusion patients improving from 9.35 ± 0.7 to 4.87 ± 2.3 (p = 0.008).CONCLUSIONSCT-SPECT may offer a diagnostic advantage over current imaging modalities in identifying the primary pain generator in patients with axial spinal pain.
- Published
- 2019
19. The increasing frequency of intravenous drug abuse-associated spinal epidural abscesses: a case series
- Author
-
Gabriel C. Tender, Clifford L Crutcher, Rachel Stein, Jared M Robichaux, Anthony M DiGiorgio, and Kevin Morrow
- Subjects
Adult ,Male ,Methicillin-Resistant Staphylococcus aureus ,Pediatrics ,medicine.medical_specialty ,Epidural abscess ,Decompression ,Arthrodesis ,medicine.medical_treatment ,Disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,Substance Abuse, Intravenous ,Aged ,business.industry ,Mortality rate ,Sequela ,General Medicine ,Middle Aged ,Staphylococcal Infections ,medicine.disease ,Decompression, Surgical ,Pseudarthrosis ,Epidural Abscess ,Research Design ,Surgery ,Female ,Neurology (clinical) ,business ,Complication ,030217 neurology & neurosurgery - Abstract
OBJECTIVEFew studies have been published specifically examining intravenous drug abuse (IVDA)–associated spinal epidural abscesses (SEAs), an unfortunate sequela of the opioid crisis in the United States. Here, the authors examined a series of patients with IVDA-associated SEAs in order to shed light on this challenging disease entity.METHODSThis study is a retrospective chart review of patients presenting with IVDA-associated SEAs at the authors’ institution from 2013 to 2018, spanning the statewide implementation of opioid-prescribing restrictions.RESULTSA total of 45 patients presented with IVDA-associated SEAs; 46.5% presented with a neurological deficit. Thirty-one patients underwent surgery for neurological deficit, failure of medical therapy, or both. Nineteen surgical patients underwent a fusion procedure along with decompression. The complication rate was 41.9%, and the mortality rate was 6.7%. The average length of stay was 27.6 days. Patients who underwent surgery within 24 hours of onset of neurological symptoms trended toward more improvement in their American Spinal Cord Association Impairment Scale grade than those who did not (0.5 vs −0.2, p = 0.068). Methicillin-resistant Staphylococcus aureus was isolated as the causative pathogen in 57.8% of patients. Twenty-three patients (51.5%) kept their scheduled clinic follow-up appointments. Of the fusion patients with adequate follow-up, 5 showed bony arthrodesis and 3 had pseudarthrosis. The rate of IVDA-associated SEAs increased after opioid-prescribing restrictions were put in place, from 0.54 cases per month to 1.15 cases per month (p = 0.017).CONCLUSIONSPatients with IVDA-associated SEAs are challenging to treat, with high complication rates and poor follow-up. This disease is increasing in frequency, and opioid-prescribing restrictions did not slow that rise. Community outreach to promote prevention, early medical attention, and medication compliance would benefit this largely publicly funded patient population.
- Published
- 2018
20. Peroneal Nerve Repair of a 9 Year Old: Return of Motor Function after 2 Years
- Author
-
Jasmine Kudji, Oren Tessler, Gabriel C. Tender, and Lynn Bourn
- Subjects
Peroneal nerve injury ,medicine.medical_specialty ,Deep peroneal nerve ,business.industry ,Motor end plates ,lcsh:Surgery ,Motor nerve ,Sural nerve ,Case Report ,lcsh:RD1-811 ,Motor function ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Nerve repair ,business ,030217 neurology & neurosurgery - Abstract
Supplemental Digital Content is available in the text., Summary: Major factors that influence functional nerve recovery, postrepair, are length of the nerve defect, type of injury, operative technique, time until treatment, and age of the patient. We present a severe motor nerve defect in a complicated peroneal nerve injury in a 9-year-old that showed functional return after a delayed period of 23 months with sural nerve cable grafting. This case revealed the increased resiliency and regenerative capacity of motor end plates in young patients. In conclusion, autograft for a deep peroneal nerve repair, by means of sural nerve graft, proved to be an acceptable option in children.
- Published
- 2018
21. The Effects of Agrin Isoforms on Diabetic Neuropathic Pain in a Rat Streptozotocin Model
- Author
-
Qin Li, Diana M. Erasso, Frank Culicchia, Jian Guo Cui, Salahadin Abdi, Gabriel C. Tender, and Jiusheng Yan
- Subjects
0301 basic medicine ,Male ,Pain Threshold ,medicine.medical_specialty ,Time Factors ,Population ,Action Potentials ,Inhibitory postsynaptic potential ,Streptozocin ,Diabetes Mellitus, Experimental ,Rats, Sprague-Dawley ,03 medical and health sciences ,0302 clinical medicine ,Diabetic Neuropathies ,Internal medicine ,Diabetes mellitus ,medicine ,Animals ,Agrin ,GABAergic Neurons ,education ,education.field_of_study ,Analgesics ,Behavior, Animal ,business.industry ,Spinal cord ,Streptozotocin ,medicine.disease ,030104 developmental biology ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Endocrinology ,Inhibitory Postsynaptic Potentials ,Spinal Cord ,Hyperalgesia ,Neuropathic pain ,GABAergic ,Neuralgia ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
BACKGROUND Diabetes mellitus affects 9.3% of the US population and increases risks of surgery and complications. Diabetic neuropathic pain (DNP), one of the main consequences of diabetes mellitus, is extremely difficult to treat. Current medications yield limited benefits and/or have severe adverse effects. Therefore, new, effective treatment is needed. METHODS Streptozotocin at 55 mg/kg was injected intraperitoneally in rats to induce diabetes mellitus. Diabetic rats exhibiting neuropathic pain underwent intrathecal injection of purified agrin proteins at various doses and were then tested for tactile allodynia to evaluate whether DNP was inhibited. The agrin effects were also analyzed with patch-clamp recording on spinal cord slices. RESULTS Fifty-kilo Dalton agrin (Agr50) at 0.2 and 2 ng suppressed DNP when given intrathecally, while 25- and 75-kDa agrin (Agr25, Agr75) had little effect. The suppressive effect of Agr50 lasted 4 hours after a single bolus injection. The difference in effects of Agr50 on mean withdrawal threshold (4.6 ± 2.2 g before treatment to 26 ± 0 g after treatment) compared with that of Agr25 (4.9 ± 2.0 g to 4.9 ± 2.0 g) and Agr75 (5.3 ± 2.3 g to 9.2 ± 2.5 g) was highly significant (P < .01). On spinal cord slices, Agr50 increased spontaneous GABAergic current activities, suggesting increased spontaneous inhibitory postsynaptic currents and action potential firing rate from GABA neurons, whereas Agr25 and Agr75 had no such effect. CONCLUSIONS Agr50 had a potent suppressive effect on DNP and increased spontaneous inhibitory postsynaptic currents and action potential firing rate from GABA neurons. Therefore, Agr50 may provide a potential therapy for DNP.
- Published
- 2018
22. Percutaneous Facet Screws
- Author
-
Malcolm Daniel Eggart, Gabriel C. Tender, Silvia Gesheva, and Clifford L Crutcher
- Subjects
musculoskeletal diseases ,Orthodontics ,Fixation (surgical) ,Percutaneous ,Skin incision ,business.industry ,Soft tissue ,Medicine ,Anterior approach ,musculoskeletal system ,Pedicle screw ,business - Abstract
This technique is useful mostly at L4–5 and L5–S1 as supplemental fixation after an anterior approach (ALIF or AxiaLIF) and has the advantage of a minimal midline skin incision and soft tissue disruption. While biomechanically not as strong as the pedicle screw/rod constructs, the facet screws are mostly designed to block rotation.
- Published
- 2018
23. Minimally Invasive Transforaminal Lumbar Interbody Fusion
- Author
-
Anthony M DiGiorgio, Gabriel C. Tender, Daniel Serban, and Niki Calina
- Subjects
medicine.medical_specialty ,Lumbar ,Lumbar interbody fusion ,business.industry ,medicine ,business ,Surgery - Abstract
Minimally invasive transforaminal lumbar interbody fusion (MI TLIF) is one of the most commonly performed minimally invasive spine operations in the United States. It is also quite difficult to master, since anatomical and pathological variations are common, and the learning surgeon must perform a large number of cases before being able to claim proficiency. Nonetheless, this procedure can be used at all lumbar levels and is probably the most important to learn.
- Published
- 2018
24. Sacro-Iliac Joint Fusion
- Author
-
Alexis Waguespack, Gabriel C. Tender, Anthony M DiGiorgio, Clifford L Crutcher, and Remi Nader
- Subjects
Fixation (surgical) ,medicine.medical_specialty ,business.industry ,Sacro-iliac joint ,Arthrodesis ,medicine.medical_treatment ,medicine ,Joint fusion ,In patient ,Potential source ,Back pain radiating ,business ,Surgery - Abstract
The minimally invasive sacro-iliac joint fusion is a relatively new technique that has been shown to achieve good results. The SI joint is a recently recognized potential pain generator and the diagnosis requires a specific algorithm. The surgeon should always think of this potential source of pain in patients with back pain radiating to one of the legs and no concordant spinal pathology. While there are multiple available systems to perform this arthrodesis, they all aim to achieve at least three points of fixation through the joint.
- Published
- 2018
25. Percutaneous Pedicle Screw/Rod Fixation
- Author
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Niki Calina, Anthony M DiGiorgio, Gabriel C. Tender, Daniel Serban, and Lindsay Lasseigne
- Subjects
Fixation (surgical) ,Posterior fixation ,Materials science ,Percutaneous ,Pedicle screw ,Bevel ,Biomedical engineering - Abstract
Percutaneous instrumented posterior fixation with pedicle screws and rods is frequently used. The insertion of the percutaneous pedicle screws is identical among the various platforms, whereas insertion of the rod can be done in three different ways, depending on the system utilized. The target entry point is at the junction of the lateral facet and the transverse process (or ala, for S1). We prefer to use beveled Jamshidi needles, since they provide better directional insertion.
- Published
- 2018
26. Introduction to Minimally Invasive Spine Surgery
- Author
-
Gabriel C. Tender, Anthony M DiGiorgio, and Daniel Serban
- Subjects
medicine.medical_specialty ,Standard of care ,business.industry ,General surgery ,Medicine ,Operative time ,Minimally invasive spine surgery ,business ,Spinal surgery - Abstract
Minimally invasive spine surgery started at the turn of the century and many predicted it would soon become the standard of care. Nonetheless, almost twenty years later, these techniques are used in less than 20% of the procedures performed in the United States. While certainly multifactorial, some of the reasons for this slow adoption include the difficult learning curve, as well as the initially increased operative time (and thus decreased surgical volume and revenue) for the seasoned “open” surgeon who tries to convert to the new minimally invasive techniques. The goal of this book is to share almost 20 years of experience in teaching (and sometimes learning) the minimally invasive spinal surgery techniques to those who understand the benefits and want to embrace a better option for their patients.
- Published
- 2018
27. The Presacral Approach (AxiaLIF)
- Author
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Gabriel C. Tender, Mihaela Florea, Silvia Gesheva, and John Gachiani
- Subjects
Facet (geometry) ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Laminectomy ,medicine.disease ,Spondylolisthesis ,Surgery ,Discectomy ,Presacral space ,Medicine ,business ,Pedicle screw ,Reduction (orthopedic surgery) - Abstract
The presacral approach (AxiaLIF) offers a minimally invasive fusion option for the L5-S1 (or the L4-L5 and L5-S1) discs, taking advantage of the presacral space and transsacral trajectory. Supplemental posterior stabilization with either percutaneous facet or pedicle screws is indicated, in order to limit rotation. This technique is particularly useful in patients with low-grade spondylolisthesis, after reduction with the percutaneous pedicle screws, and in patients with collapsed discs following a previous laminectomy and discectomy.
- Published
- 2018
28. Lumbar Retroperitoneal Transpsoas Corpectomy
- Author
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Yasser Badr, Gabriel C. Tender, Anthony M DiGiorgio, Durga R. Sure, and Clifford L Crutcher
- Subjects
Vertebral body ,medicine.medical_specialty ,Fixation (surgical) ,Lumbar ,business.industry ,medicine.medical_treatment ,Discectomy ,medicine ,Corpectomy ,business ,Pedicle screw ,Surgery - Abstract
The lumbar retroperitoneal transpsoas corpectomy technique is probably the most difficult minimally invasive technique to learn. The approach is similar to the discectomy technique, but has to be extended to span the two discs, above and below the pathologic vertebral body. Supplemental fixation with either a lateral plate or posterior pedicle screws is recommended.
- Published
- 2018
29. Lateral Lumbar Interbody Fusion
- Author
-
Niki Calina, Daniel Serban, Lindsay Lasseigne, Gabriel C. Tender, and Mihaela Florea
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Percutaneous ,business.industry ,medicine.medical_treatment ,Dissection (medical) ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Lumbar interbody fusion ,Spinal fusion ,medicine ,business ,030217 neurology & neurosurgery - Abstract
Minimally invasive lateral retroperitoneal transpsoas approach for lumbar interbody fusion is the fastest growing type of minimally invasive spinal fusion in the United States. We prefer to perform the psoas dissection under direct visualization, in order to protect sensory nerves not detected by neuromonitoring, and insert the widest cage possible, typically 22 mm. We use either lateral plating or posterior percutaneous instrumentation to increase stability and maximize fusion rates.
- Published
- 2018
30. Thoracic Lateral Retropleural Discectomy
- Author
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Gabriel C. Tender, Kara A. Parikh, Daniel Serban, Mihaela Florea, and Adriana Constantinescu
- Subjects
musculoskeletal diseases ,medicine.anatomical_structure ,business.industry ,Thoracic spine ,Discectomy ,medicine.medical_treatment ,Dura mater ,medicine ,Anatomy ,business ,Thoracic disc ,Lateral approach - Abstract
Thoracic disc herniations can be very difficult to treat, particularly when calcified. Since the dural sac cannot be retracted, posterior access to central disc herniations is difficult or impossible without inflicting neurological deficits. The lateral approach offers the advantage of direct access to the disc herniations, whether central or paracentral, as well as their interface with the dura mater. A minimally invasive approach offers the same exposure and access, while minimizing morbidity. The minimally invasive lateral transthoracic retropleural approach can be performed throughout the thoracic spine below T5.
- Published
- 2018
31. Coccidioidomycosis for Neurosurgeons
- Author
-
Gabriel C. Tender
- Subjects
medicine.medical_specialty ,Antifungal Agents ,Coccidioidomycosis ,Neurosurgeons ,business.industry ,Osteomyelitis ,General surgery ,Medicine ,Surgery ,Neurology (clinical) ,business ,medicine.disease - Published
- 2017
32. Primary pain generator identification by CT–SPECT in a patient with low back pain: a case report
- Author
-
Adriana Constantinescu, Andrew Conger, Anthony M DiGiorgio, and Gabriel C. Tender
- Subjects
Male ,medicine.medical_specialty ,Single Photon Emission Computed Tomography Computed Tomography ,Population ,Case Report ,Degenerative spine ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Refractory ,medicine ,Humans ,Low back pain ,In patient ,030212 general & internal medicine ,Primary pain generator ,education ,Aged ,Medicine(all) ,education.field_of_study ,Lumbar Vertebrae ,CT–SPECT ,medicine.diagnostic_test ,Biochemistry, Genetics and Molecular Biology(all) ,business.industry ,Magnetic resonance imaging ,General Medicine ,Magnetic Resonance Imaging ,Surgery ,Spinal Fusion ,Treatment Outcome ,Lumbar spine ,medicine.symptom ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery ,Emission computed tomography - Abstract
Background Chronic low back pain is one of the most common conditions encountered in the middle-age population. Identifying the primary pain generator is notoriously difficult. The computed tomography–single-photon emission computed tomography (CT–SPECT) is emerging as a new diagnostic modality for this purpose. Case presentation This 68-year-old Caucasian male presented with intractable low back pain refractory to maximal conservative treatment, including medication and extensive physical therapy. The lumbar computed tomography, magnetic resonance imaging, and flexion–extension X-rays showed advanced degenerative changes throughout the lumbar spine, but no single level significantly worse than the others. The CT–SPECT showed markedly increased uptake at the L1–2 disc level and only minimal uptake at the other levels. The patient underwent a minimally invasive lateral L1–2 fusion with near-complete resolution of his low back pain. Conclusions The CT–SPECT may provide a unique tool in establishing the primary pain generator in patients with degenerative spine disease.
- Published
- 2017
33. A modified, less invasive posterior subscapular approach to the brachial plexus: case report and technical note
- Author
-
Clifford L Crutcher nd, David G. Kline, and Gabriel C. Tender
- Subjects
medicine.medical_specialty ,Less invasive ,Neurosurgical Procedures ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Brachial Plexus ,Thoracic outlet syndrome ,business.industry ,Rhomboid minor muscle ,Technical note ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,body regions ,Retractor ,Scapula ,Dissection ,Thoracic Outlet Syndrome ,030220 oncology & carcinogenesis ,Brachial Plexopathy ,Female ,Neurology (clinical) ,business ,Brachial plexus ,030217 neurology & neurosurgery - Abstract
The traditional posterior subscapular approach offers excellent exposure of the lower brachial plexus and has been successfully used in patients with recurrent thoracic outlet syndrome after an anterior operation, brachial plexus tumors involving the proximal roots, and postirradiation brachial plexopathy, among others. However, this approach also carries some morbidity, mostly related to the extensive muscle dissection of the trapezius, rhomboids, and levator scapulae. In this article, the authors present the surgical technique and video illustration of a modified, less invasive posterior subscapular approach, using a small, self-retaining retractor and only a partial trapezius and rhomboid minor muscle dissection. This approach is likely to result in decreased postoperative morbidity and a shorter hospital stay.
- Published
- 2017
34. Standard versus Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Prospective Randomized Study
- Author
-
Gabriel C. Tender, Anthony M DiGiorgio, and Daniel Serban
- Subjects
Adult ,Male ,medicine.medical_specialty ,Article Subject ,Adolescent ,Immunology ,lcsh:Medicine ,Applied Microbiology and Biotechnology ,Microbiology ,Iliac crest ,General Biochemistry, Genetics and Molecular Biology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Lumbar interbody fusion ,law ,Genetics ,medicine ,Humans ,Prospective randomized study ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Molecular Biology ,Aged ,General Immunology and Microbiology ,business.industry ,lcsh:R ,Postoperative complication ,Cell Biology ,General Medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Spondylolisthesis ,Surgery ,Oswestry Disability Index ,Pseudarthrosis ,medicine.anatomical_structure ,Spinal Fusion ,Radiological weapon ,Clinical Study ,Molecular Medicine ,Operative time ,Female ,business ,030217 neurology & neurosurgery - Abstract
Introduction Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S) technique is a transforaminal lumbar interbody fusion (TLIF). Newer, minimally invasive (MI) techniques seem to provide similar results with less morbidity. However, prospective studies comparing S versus MI TLIF are rare. Case description Patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis (grade 1 or 2) were enrolled, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. Iliac crest graft, polyether ether ketone (PEEK) interbody cages, and pedicle screw-rod constructs were used in both groups. The primary outcome measure was the Oswestry Disability Index (ODI) improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Complications were also recorded. Results and Conclusions Forty patients were enrolled in each group. There was no crossover between groups. The age was 50.12+/-11.09 years in the S TLIF group and 51.3+/-9.36 years in the MI TLIF group. There were 23 and 24 females in the S and MI TLIF group, respectively. The mean operative time and estimated blood loss in the S versus MI TLIF group were 297+/-101 versus 323 +/-85 minutes and 417+/-211 versus 351+/-198 ml, respectively. There were 4 transfusions in the S TLIF and 3 transfusions in the MI TLIF group. The patients were discharged after surgery at 4.12+/-0.88 days for the S TLIF group and 1.92+/-0.52 days for the MI TLIF group. The ODI improved from 37+/-6 to 11+/-6 in the S TLIF group (ODI difference: 26+/-7) and from 38+/-7 to 11+/-6 in the MI TLIF group (ODI difference: 26+/-8). The fusion was considered solid (Grade I) in 36 (90%) and partial (Grade II) in 4 (10%) patients at 1 year. There were no reoperations for pseudarthrosis or any other postoperative complication. There were 2 superficial wound infections in the standard TLIF group, which resolved with oral antibiotic treatment alone. Take home message In this prospective randomized study, the standard and minimally invasive TLIF in patients with symptomatic spondylolisthesis provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. Both surgical techniques yielded good results at 1 year.
- Published
- 2016
35. The Role of Nerve Growth Factor in Neuropathic Pain Inhibition Produced by Resiniferatoxin Treatment in the Dorsal Root Ganglia
- Author
-
Yuan Yuan Li, Gabriel C. Tender, and Jian Guo Cui
- Subjects
Pain Threshold ,Agonist ,medicine.drug_class ,Resiniferatoxin ,TRPV1 ,Nerve Tissue Proteins ,Stimulation ,Receptors, Nerve Growth Factor ,Tropomyosin receptor kinase A ,Pharmacology ,Rats, Sprague-Dawley ,chemistry.chemical_compound ,Ganglia, Spinal ,Nerve Growth Factor ,medicine ,Animals ,Receptor, trkA ,Cells, Cultured ,Analgesics ,business.industry ,Neural Inhibition ,Sciatic nerve injury ,medicine.disease ,Rats ,Nerve growth factor ,nervous system ,chemistry ,Anesthesia ,Neuropathic pain ,Neuralgia ,Surgery ,Neurology (clinical) ,Diterpenes ,business ,Signal Transduction - Abstract
Background Resiniferatoxin (RTX), an excitotoxic agonist for vanilloid receptor 1, is a promising candidate for intractable pain treatment. Objective We evaluated the effects of RTX, applied to dorsal root ganglia (DRG) at high doses (1200 ng), in sensory-motor function and nerve growth factor (NGF) alterations in a photochemical sciatic nerve injury rat model. Methods Following RTX injection into the L3-6 DRG at high doses and behavioral evaluation, the rats were sacrificed and the DRG were tested by immunohistochemistry and mRNA analysis for NGF and its' receptors, tyrosine kinase A (TrkA) and p75. The correlation between neuropathic pain and NGF, TrkA, and p75 expression was analyzed. Results The treated rats had preserved touch, cold, pain, and high-heat sensations, and exhibited hypoalgesia to low-heat stimulation. After RTX treatment, TrkA and p75 altered their expressions from one neuronal type to another in the DRG. NGF and p75 expression changed from the small-size neurons in neuropathic rat DRG to the large- and medium-size neurons in non-neuropathic and RTX-treated animals, concomitantly with neuropathic pain suppression. TrkA was expressed in the small-size neurons in neuropathic rat DRG, and was drastically reduced in all size neurons after RTX treatment. NGF, TrkA, and p75 mRNA expression supported these phenotypic changes in the DRG. Conclusion The pathway of NGF-TrkA expressed in the small-size neurons, associated with neuropathic pain, was shifted to the NGF-p75 pathway expressed in the large-size neurons after RTX treatment, in association with neuropathic pain inhibition. These findings may play an important role in clinical trial designs.
- Published
- 2013
36. Actinomycotic Brain Abscess and Subdural Empyema of Odontogenic Origin: Case Report and Review of the Literature
- Author
-
Christopher J. Haggerty and Gabriel C. Tender
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Brain Abscess ,Actinomycosis ,Tonsillar crypts ,Maxilla ,medicine ,Humans ,Aged ,Subdural empyema ,Empyema, Subdural ,biology ,Focal Infection, Dental ,business.industry ,Actinomycetaceae ,Bone Diseases, Infectious ,medicine.disease ,biology.organism_classification ,Actinomyces israelii ,Empyema ,Anti-Bacterial Agents ,Root Canal Therapy ,Incisor ,Radiography ,stomatognathic diseases ,Treatment Outcome ,medicine.anatomical_structure ,Otorhinolaryngology ,Surgery ,Periapical Abscess ,Oral Surgery ,business ,Craniotomy ,Actinomyces - Abstract
v a Actinomyces are gram-positive, nonacid-fast, branching filamentous prokaryotic microorganisms with anaerobic or microaerophilic requirements. Actinoyces species are part of the normal flora of the ropharyngeal cavity, specifically concentrated in he tonsillar crypts, the surface of carious teeth, and he gingival pocket. Actinomycosis is rarely a athologic concern because of the organism’s low irulence and does not appear to be an opportunistic isease because there is no specific predisposition oward immunocompromised individuals. Diect trauma, tooth extraction, root canal therapy, and eriodontal or periapical abscesses compromise the ntegrity of the oral mucosa and are believed to be the ost common mechanisms of pathogenesis. The principal bacteria in humans is Actinomyces israelii, a normal inhabitant of the oral cavity. Other members of the Actinomycetaceae family that are involved in human pathogenesis include A viscosus (40%), A naeslundii (5%), A odontolyticus (2%), and A meyeri (1%). Cervicofacial actinomycosis presnts as a chronic suppurative infection that typically gnores traditional fascial planes and is associated ith multiple fistulae tracts. The granulation-type leions harbor colonies of actinomyces and other baceria and promote a significant inflammatory response n the surrounding tissues. If the disease follows a ong-term course, the inflammation leads to fibrosis nd scar tissue formation, which in turn decreases xygen perfusion and creates an anaerobic environ
- Published
- 2012
37. 303 Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion
- Author
-
Anthony M DiGiorgio and Gabriel C. Tender
- Subjects
medicine.medical_specialty ,Blood transfusion ,business.industry ,medicine.medical_treatment ,Repeat Surgery ,medicine.disease ,Spondylolisthesis ,Surgery ,Oswestry Disability Index ,Pseudarthrosis ,Lumbar interbody fusion ,Spinal fusion ,medicine ,Prospective randomized study ,Neurology (clinical) ,business - Published
- 2017
38. Brain-derived neurotrophic factor redistribution in the dorsal root ganglia correlates with neuropathic pain inhibition after resiniferatoxin treatment
- Author
-
Yuan Yuan Li, Gabriel C. Tender, and Jian Guo Cui
- Subjects
Male ,medicine.medical_specialty ,TRPV1 ,Resiniferatoxin ,TRPV Cation Channels ,Tropomyosin receptor kinase B ,Rats, Sprague-Dawley ,chemistry.chemical_compound ,Neurotrophic factors ,Ganglia, Spinal ,Physical Stimulation ,Internal medicine ,medicine ,Animals ,Orthopedics and Sports Medicine ,Pain Measurement ,Neurons ,Brain-derived neurotrophic factor ,business.industry ,Brain-Derived Neurotrophic Factor ,Sciatic nerve injury ,medicine.disease ,Immunohistochemistry ,Sciatic Nerve ,Rats ,Up-Regulation ,Endocrinology ,Nociception ,nervous system ,chemistry ,Hyperalgesia ,Anesthesia ,Neuropathic pain ,Neuralgia ,Surgery ,Neurology (clinical) ,Diterpenes ,business - Abstract
Background context Brain-derived neurotrophic factor (BDNF) and its cognate receptor, the tyrosine kinase B (TrkB), are normally expressed in neurons and implicated in multiple pathological conditions. Brain-derived neurotrophic factor is produced in the central nervous system microglia in response to noxious stimuli and appear to potentiate central sensitization. Resiniferatoxin (RTX) is an excitotoxic agonist of the vanilloid receptor 1 (VR1), a cation channel protein considered an integrator for nociception. Resiniferatoxin, administered into the dorsal root ganglia (DRG), selectively eliminates the VR1-positive neurons and improves tactile allodynia in a neuropathic pain rat model. Purpose The goal of the present study was to evaluate the role of BDNF in RTX-induced neuropathic pain suppression. Study design The study design was a sciatic nerve injury animal model with intraganglionic RTX injection. Methods Resiniferatoxin was injected into the DRG of the L3–L6 spinal nerves after the rats displayed tactile allodynia and thermal hyperalgesia produced by a photochemical injury to the sciatic nerve. Behavioral testing and immunohistochemical and mRNA analysis of the DRG were performed to determine BDNF's role in pain modulation. Results Brain-derived neurotrophic factor expression in the DRG of neuropathic rats was upregulated in the small- and medium-size neurons, whereas the upregulation was observed in the large-size neurons of non-neuropathic rat DRG. A high-dose RTX injection in the DRG of neuropathic rats led to elimination of both thermal hyperalgesia and tactile allodynia and also upregulated BDNF in the large-size neurons, similar to the nonallodynic rats. Tyrosine kinase B changes mirrored the BDNF ones. Conclusion Resiniferatoxin injection in the DRG of neuropathic rats upregulates BDNF expression in the same pattern as in the large-size neurons of non-neuropathic rats. Therefore, BDNF upregulation may have pain suppressive effects. These effects are likely mediated by TrkB.
- Published
- 2010
39. Minimally Invasive Transforaminal Lumbar Interbody Fusion: Technical Note
- Author
-
Gabriel C. Tender and John K. Ratliff
- Subjects
medicine.medical_specialty ,Surgical approach ,business.industry ,Technical note ,Low back pain ,Surgery ,Lumbar interbody fusion ,Medicine ,Medical physics ,Neurology (clinical) ,medicine.symptom ,Technical skills ,business - Abstract
Minimally invasive techniques for lumbar interbody fusion have become increasingly popular recently. A limi- tation of these procedures is the restricted field of view, which requires a thorough understanding of the three-dimensional spinal landmarks and appropriate technical skills. We outline the operative steps used in said cases and provide illustrative video and figures.
- Published
- 2009
40. SUBMUSCULAR TRANSPOSITION OF THE ULNAR NERVE FOR THE TREATMENT OF CUBITAL TUNNEL SYNDROME
- Author
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Julius Fernandez, Rashid M. Janjua, Gabriel C. Tender, and David G. Kline
- Subjects
medicine.medical_specialty ,Flexor Carpi Ulnaris ,business.industry ,Transposition (telecommunications) ,Flexor carpi ulnaris muscle ,Cubital Tunnel Syndrome ,Anatomy ,Decompression, Surgical ,musculoskeletal system ,Pronator teres muscle ,medicine.disease ,Neurosurgical Procedures ,Median nerve ,Ulnar neuropathy ,Surgery ,body regions ,Medical Illustration ,Humans ,Medicine ,Occipital nerve stimulation ,Neurology (clinical) ,business ,Ulnar nerve ,Ulnar Nerve - Abstract
THE ULNAR NERVE is compressed at the cubical notch in patients with cubital tunnel syndrome. To definitively alleviate this compression, the nerve can be transposed under the pronator teres and flexor carpi ulnaris muscles. This procedure is also known as medianization of the ulnar nerve because it then courses parallel to the median nerve. In the current article the procedure is described in a step-by-step fashion.
- Published
- 2008
41. Traumatic spondyloptosis of the thoracolumbar spine
- Author
-
James S. Harrop, Gabriel C. Tender, Bryan Lebude, Sanjay Yadla, Ashwini Sharan, Alexander R. Vaccaro, John K. Ratliff, and Alan S. Hilibrand
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Thoracic Vertebrae ,Central nervous system disease ,medicine ,Humans ,Spinal cord injury ,Rachis ,Retrospective Studies ,Lumbar Vertebrae ,business.industry ,Neurological status ,Thoracolumbar spine ,Retrospective cohort study ,General Medicine ,medicine.disease ,Spondylolisthesis ,Surgery ,Spinal Fusion ,Spinal Injuries ,Spinal fusion ,Female ,business - Abstract
Object Traumatic Grade V thoracolumbar spondylolisthesis, or traumatic spondyloptosis (severe translation injuries), are uncommon spinal injuries. To the best of the authors' knowledge, this article represents the first reported case series of these unique spinal lesions. Methods The authors undertook a retrospective review of a tertiary care regional spinal cord injury patient population treated over a 10-year period (1997–2007). They analyzed data regarding age, sex, mechanism of injury, neurological status, and treatment. Results Five patients were identified (3 men and 2 women) with ages ranging from 17 to 44 years. All patients had sustained high-energy closed spinal injuries: 3 motor vehicle accidents, 1 injured in a building collapse, and 1 hurt by a fallen steel beam. Four patients, all with sagittal-plane spondyloptosis, had a complete neurological deficit (American Spinal Injury Association [ASIA] Grade A), and 1, with coronal-plane spondyloptosis, presented with an incomplete neurological deficit (ASIA Grade C). Four patients had sustained concurrent multisystem trauma. All patients underwent surgery: an isolated posterior fusion in 2 and combined posterior-anterior fusion in 3. Only the patient with an incomplete neurological deficit (coronal-plane spondyloptosis) recovered neurological function postoperatively. Conclusions Traumatic thoracolumbar junction spondyloptosis is rare. Surgical reconstruction and stabilization allow for early mobilization and rehabilitation. In the present series, a patient with coronal-plane spondyloptosis presented with preserved neurological function. This may be due to the result of differences in resultant neurological compression due to displacement mechanics compared with sagittally displaced injuries.
- Published
- 2008
42. Spinal intradural arteriovenous fistulas acquired in late adulthood: absent spinal venous drainage in pathogenesis and pathophysiology
- Author
-
Edward H. Oldfield, Gabriel C. Tender, and Alexander O. Vortmeyer
- Subjects
Male ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Anterior spinal artery ,Arteriovenous fistula ,Myelopathy ,Lumbar ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Age of Onset ,Myelography ,Aged ,Central Nervous System Vascular Malformations ,Lumbar Vertebrae ,medicine.diagnostic_test ,business.industry ,Lumbar puncture ,Angiography ,Arteriovenous malformation ,General Medicine ,Middle Aged ,medicine.disease ,Spinal Artery ,Surgery ,Spinal Cord ,business - Abstract
✓ Intradural spinal arteriovenous fistulas (AVFs), a subtype of spinal arteriovenous malformation in which there is a direct communication between a spinal artery and a vein on the cord surface or in the subarachnoid space, are generally considered to be congenital lesions caused by maldevelopment of the embryonic vascular system. The authors present the cases of two patients with acquired AVFs of the terminal filum. In each patient an AVF between the distal segment of the anterior spinal artery and its accompanying vein on the terminal filum developed within 1 year of repeated lumbar myelography that had demonstrated no evidence of abnormal vascularity. In both patients spinal arteriography demonstrated the absence of medullary venous drainage in the thoracolumbar region, which, combined with the arterialized venous input from the AVF, permitted the development of venous congestion and myelopathy. The involved segment of the terminal filum was excised; in vitro microarteriography and the histopathological examination demonstrated a single, simple arteriovenous connection in both patients. The findings in these cases indicate that intradural AVF can spontaneously arise in later life. The development of these lesions and/or their clinical manifestation may require not only the presence of the AVF, but also deficiency of medullary spinal venous drainage. The epidemiology and anatomy of intradural AVFs are compatible with an acquired origin in many cases.
- Published
- 2005
43. Unilateral removal of pars interarticularis
- Author
-
Richard V Baratta, Gabriel C. Tender, and Rand M Voorhies
- Subjects
Adult ,Male ,medicine.medical_specialty ,Nerve root ,Visual analogue scale ,medicine.medical_treatment ,Spinal Stenosis ,Lumbar ,Pars interarticularis ,medicine ,Back pain ,Humans ,Prospective Studies ,Radiculopathy ,Aged ,Pain Measurement ,Lumbar Vertebrae ,business.industry ,Nerve Compression Syndromes ,General Medicine ,Middle Aged ,Decompression, Surgical ,medicine.disease ,Spondylolisthesis ,Surgery ,Treatment Outcome ,McGill Pain Questionnaire ,Facetectomy ,Female ,medicine.symptom ,business ,Low Back Pain ,Intervertebral Disc Displacement - Abstract
Object. Lumbar radiculopathy secondary to foraminal entrapment can be treated by unilateral removal of the overlying pars interarticularis. The authors prospectively evaluated the outcome after this procedure. Methods. Thirty-six consecutive patients underwent unilateral resection of the pars interarticularis between August 1999 and July 2002. In 18 patients acute foraminal disc herniations compressed the nerve root against the superior pedicle; in the other 18 foraminal stenosis was secondary to degenerative changes. All patients, at each visit, completed the following questionnaires: visual analog scale for overall, leg, and back pain; the Prolo Functional Economic Rating scale; and the Pain Rating Index (PRI) of the Short-Form McGill Pain Questionnaire. At 1 year, leg pain improved in 33 patients (91%). Low-back pain appeared or worsened in eight patients (22%; one in the acute herniation group and seven in the chronic degenerative group). Only one patient required lumbar fusion for pain. The Prolo economic and function scores improved in 21 (58%) and 27 (75%) patients, respectively. The PRI scores improved in 30 cases (83%). No spondylolisthesis was observed at any level at which resection had been performed. Conclusions. Unilateral removal of the pars interarticularis is effective in relieving lumbar radicular symptoms in patients with intraforaminal entrapment. The incidence of low-back pain in patients with acute foraminal disc herniations does not increase as a result of this procedure. In patients with degenerative foraminal stenosis, unilateral resection of the pars interarticularis may be a better alternative to facetectomy and segmental fusion. This procedure may be a useful tool in spine surgery.
- Published
- 2005
44. Gilliatt-Sumner Hand Revisited: A 25-year Experience
- Author
-
Ajith J. Thomas, David G. Kline, Najeeb Thomas, and Gabriel C. Tender
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Neural Conduction ,Action Potentials ,Time ,Life Change Events ,Intraoperative Period ,medicine ,Humans ,Child ,Aged ,Retrospective Studies ,Thoracic outlet syndrome ,Neurons ,Plexus ,Cervical rib ,Vascular disease ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Thoracic Outlet Syndrome ,Treatment Outcome ,medicine.anatomical_structure ,Spinal nerve ,Upper limb ,Female ,Neurology (clinical) ,business ,Motor Deficit ,Brachial plexus - Abstract
OBJECTIVE: Thirty-three patients with true neurogenic thoracic outlet syndrome, or Gilliatt-Sumner hand, underwent surgical treatment at Louisiana State University during a 25-year period. This study retrospectively evaluated the outcome referable to pain and motor function in these patients. METHODS: All patients had the typical Gilliatt-Sumner hand, secondary to compression of C8, T1, and/or lower trunk. Nineteen patients underwent an anterior supraclavicular approach, and 15 patients underwent a posterior subscapular approach to the brachial plexus. Nerve action potential recordings showed plexus involvement close to the spine, at the level of the junction of the spinal nerves to the lower trunk. RESULTS: Pain, present in 22 patients, improved in 21. Mild motor deficit improved in 12 of 14 patients. Severe motor deficit improved partially in 14 of 20 patients. CONCLUSION: The diagnosis of true neurogenic thoracic outlet syndrome provides a clear operative indication. Surgical decompression needs to involve the medial portion of the plexus, and especially the spinal nerves. An anterior supraclavicular approach is preferred in most cases. If there is a large cervical rib or there has been a prior anterior operation, then a posterior subscapular approach is indicated.
- Published
- 2004
45. Vascularized temporalis muscle flap for the treatment of otorrhea
- Author
-
Peter Rigby, Scott C. Kutz, Gabriel C. Tender, and Deepak Awasthi
- Subjects
Adult ,Male ,Microsurgery ,medicine.medical_specialty ,Adolescent ,Dura mater ,Temporalis muscle ,Temporalis muscle flap ,Surgical Flaps ,Brain herniation ,Humans ,Medicine ,Child ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cerebrospinal Fluid Otorrhea ,business.industry ,Cerebral Spinal Fluid ,Medial side ,Technical note ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Middle fossa ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Tomography, X-Ray Computed ,business ,Follow-Up Studies - Abstract
✓ The surgical treatment for cerebral spinal fluid (CSF) fistulas provides closure of the bone and dural defects and prevents the recurrence of brain herniation and CSF fistula. The two main approaches used are the transmastoid and middle fossa ones. The authors review the results of performing a modified middle fossa approach with a vascularized temporalis muscle flap to create a barrier between the repaired dural and bone defects. Fifteen consecutive cases of CSF fistulas treated at the authors' institution were retrospectively reviewed. All patients presented with otorrhea. Eleven patients had previously undergone ear surgery. A middle fossa approach was followed in all cases. The authors used a thin but watertight and vascularly preserved temporalis muscle flap that had been dissected from the medial side of the temporalis muscle and was laid intracranially on the floor of the middle fossa, between the repaired dura mater and petrous bone. The median follow-up period was 2.5 years. None of the patients experienced recurrence of otorrhea or meningitis. There was no complication related to the intracranial temporalis muscle flap (for example, seizures or increased intracranial pressure caused by muscle swelling). One patient developed hydrocephalus, which resolved after the placement of a ventriculoperitoneal shunt 2 months later. The thin, vascularized muscle flap created an excellent barrier against the recurrence of CSF fistulas and also avoided the risk of increased intracranial pressure caused by muscle swelling. This technique is particularly useful in refractory cases.
- Published
- 2003
46. 114 Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital
- Author
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Praveen V. Mummaneni, Michael S Virk, Jason D Wilson, Clifford L Crutcher, Adam Podet, Jonathan Lloyd Fisher, Anthony M DiGiorgio, and Gabriel C. Tender
- Subjects
Waiting time ,business.industry ,Safety net ,medicine ,Surgery ,Neurology (clinical) ,Medical emergency ,medicine.disease ,Overlapping surgery ,business ,Medicaid ,Insurance coverage - Published
- 2017
47. The effects of lumbar facet dowels on joint stiffness: a biomechanical study
- Author
-
Jayme, Trahan, Eric, Morales, Erich O, Richter, and Gabriel C, Tender
- Subjects
Original Research - Abstract
Facet joint arthrosis may play a significant role in low back pain generation. The placement of facet dowels is a percutaneous treatment that aims to fuse the facets and increase joint stiffness. In this cadaveric study, we evaluated spine stiffness after facet dowel insertion in combination with several surgical procedures and determined which motions promote dowel migration.Six fresh frozen lumbar spines were tested in flexion-extension, lateral bending, and axial rotation. Spine stiffness was determined for the intact specimens, after L4 laminectomy, and after bilateral L4-L5 facet dowel placement, respectively. One specimen underwent a unilateral transforaminal lumbar interbody fusion (TLIF) construct and another underwent extreme lateral interbody fusion (XLIF) graft (22 mm) placement, followed by placement of facet dowels. Afterwards, the specimens were subjected to 10,000 cycles of fatigue testing in flexion-extension or axial rotation.The overall decrease in stiffness after laminectomy was 4.6%. Facet dowel placement increased overall stiffness by 7.2%. The greatest increase was seen with axial rotation (13%), compared to flexion, extension, and lateral bending (9.5%, 2.3%, and 5.6%, respectively). The TLIF and XLIF plus dowel construct increased specimen stiffness to 266% and 163% of baseline, respectively. After fatigue testing, dowel migration was detected by computed tomography in the 2 uninstrumented specimens undergoing axial rotation cycling.Facet dowels increase the stiffness of the motion segment to which they are applied and can be used in conjunction with laminectomy procedures to increase the stiffness of the joint. However, dowel migration can occur after axial rotation movements. Hybrid TLIF or XLIF plus facet dowel constructs have significantly higher stiffness than noninstrumented ones and may prevent dowel migration.
- Published
- 2014
48. Agrin requires specific proteins to selectively activate γ-aminobutyric acid neurons for pain suppression
- Author
-
Gabriel C. Tender, Roy C. Levitt, Jian Guo Cui, and Diana M. Erasso
- Subjects
Male ,Pain Threshold ,Neurofilament ,Time Factors ,Inhibitory postsynaptic potential ,Adenoviridae ,Rats, Sprague-Dawley ,chemistry.chemical_compound ,Developmental Neuroscience ,medicine ,Excitatory Amino Acid Agonists ,Animals ,Quisqualic acid ,Agrin ,Spinal cord injury ,Injections, Spinal ,Spinal Cord Injuries ,gamma-Aminobutyric Acid ,Pain Measurement ,Quisqualic Acid ,Sciatic nerve injury ,medicine.disease ,Spinal cord ,Cell biology ,Rats ,Molecular Weight ,Disease Models, Animal ,medicine.anatomical_structure ,nervous system ,Neurology ,chemistry ,Gene Expression Regulation ,Hyperalgesia ,Neuropathic pain ,Neuralgia ,Neuroscience - Abstract
Agrin, a heparan sulfate proteoglycan functioning as a neuro-muscular junction inducer, has been shown to inhibit neuropathic pain in sciatic nerve injury rat models, via phosphorylation of N-Methyl- d -aspartate receptor NR1 subunits in gamma-aminobutyric acid neurons. However, its effects on spinal cord injury-induced neuropathic pain, a debilitating syndrome frequently encountered after various spine traumas, are unknown. In the present investigation, we studied the 50 kDa agrin isoform effects in a quisqualic acid dorsal horn injection rat model mimicking spinal cord injury-induced neuropathic pain. Our results indicate that 50 kDa agrin decreased only in the dorsal horn of neuropathic animals and increased 50 kDa agrin expression in the dorsal horn, via intra-spinal injection of adeno-associated virus serum type two, suppressed spinal cord injury-induced neuropathic pain. Also, the reason why 50 kDa agrin only activates the N-Methyl- d -aspartate receptor NR1 subunits in the GABA neurons, but not in sensory neurons, is unknown. Using immunoprecipitation and Western-blot analysis, two dimensional gel separation, and mass spectrometry, we identified several specific proteins in the reaction protein complex, such as neurofilament 200 and mitofusin 2, that are required for the activation of the NR1 subunits of gamma-aminobutyric acid inhibitory neurons by 50 kDa agrin. These findings indicate that 50 kDa agrin is a promising agent for neuropathic pain treatment.
- Published
- 2014
49. Primary cervical spine carcinoid tumor in a woman with arm paresthesias and weakness: a case report
- Author
-
Daniel Serban, Gabriel C. Tender, and Mohan Narayanan
- Subjects
Stenosis ,Medicine(all) ,medicine.medical_specialty ,Pathology ,medicine.diagnostic_test ,business.industry ,Carcinoid tumors ,medicine.medical_treatment ,Central nervous system ,Case Report ,Magnetic resonance imaging ,General Medicine ,Spinal cord ,medicine.disease ,Carcinoid ,Neuroendocrine ,medicine.anatomical_structure ,Surgical oncology ,Cervical spine ,Medicine ,Radiology ,Differential diagnosis ,Corpectomy ,business ,Intervertebral foramen - Abstract
Introduction Carcinoid tumors are neuroendocrine neoplasms derived from the enterochromaffin cells. Central nervous system involvement is rare and has been reported either as metastases to the brain and spine or primary tumors involving the sacrococcygeal spine. We report the first case of a primary carcinoid tumor of the cervical spine. Case presentation A 50-year-old African-American woman presented with a 4-month history of numbness, paresthesias, and mild left-hand weakness. Magnetic resonance imaging of her cervical spine revealed a homogenously enhancing extradural mass, indenting the cervical cord and expanding the left neural foramen at C7–T1. A C7 corpectomy, en bloc resection of the tumor, and anterior C6–T1 fusion were performed to decompress the spinal cord and nerves and provide stability. Postoperative histopathologic examination and immunohistochemical analysis were consistent with carcinoid tumor. There has been no recurrence at the 6-year follow-up visit. Conclusions Primary cervical carcinoid tumor is extremely rare, but should be included in the differential diagnosis of enhancing expansile extradural masses compressing the spinal cord and nerves. Surgical resection may provide a definitive cure.
- Published
- 2013
50. Genitofemoral nerve protection during the lateral retroperitoneal transpsoas approach
- Author
-
Daniel Serban and Gabriel C. Tender
- Subjects
Adult ,Male ,medicine.medical_specialty ,Weakness ,Intervertebral Disc Degeneration ,Genitofemoral nerve ,Lumbar ,Femoral nerve ,Surveys and Questionnaires ,medicine ,Retroperitoneal space ,Humans ,Minimally Invasive Surgical Procedures ,Aged ,Pain Measurement ,Retrospective Studies ,Femoral Neuropathy ,business.industry ,Perioperative ,Middle Aged ,Surgery ,Dissection ,medicine.anatomical_structure ,Spinal Fusion ,Occipital nerve stimulation ,Female ,Neurology (clinical) ,medicine.symptom ,Spondylolisthesis ,business - Abstract
BACKGROUND The minimally invasive lateral retroperitoneal approach for lumbar fusions is a novel technique with good results, but also with significant sensory and motor complications. OBJECTIVE To present the early results of a modified surgical technique, in which the psoas muscle is dissected under direct visualization. METHODS Thirteen consecutive patients with L4-5 or L3-4 pathology were prospectively followed after being treated using a minimally invasive lateral approach with direct exposure of the psoas muscle before dissection. There were 7 woman and 6 men with a mean age of 52.3 years. Perioperative parameters like operative time, estimated blood loss, and length of stay, were noted. Pain, paresthesia, and motor weakness, as well as any other complications, were evaluated at 2 weeks and 3 months postoperatively. RESULTS The mean operative time, estimated blood loss, and length of stay were 163 minutes, 126 mL, and 3 days, respectively. One patient exhibited anterior thigh pain and paresthesia at 2 weeks, both of which resolved by 3 months. Two patients experienced superficial wound infections that healed with antibiotics. The genitofemoral nerve was identified and protected in 7 patients; in 4 patients, it had a more posterior anatomic location than expected. The femoral nerve was not exposed or detected in the operative field by neuromonitoring, nor were there any symptoms related to a femoral nerve injury in any patient. CONCLUSION Dissection of the psoas muscle under direct visualization during the minimally invasive lateral approach may provide increased safety to the genitofemoral and femoral nerves.
- Published
- 2013
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