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Article: Safety of Anterior Cervical Disc Arthroplasty in the Ambulatory Setting: an Eastern European Experience.

Klimko, Artsiom / Bouros, Dragos / Mindea, Isabella / Mindea, Stefan

2022 Volume 17, Issue 1, Page(s) 14–19

Abstract: Aim: ...

Abstract	Aim:
Language	English
Publishing date	2022-06-20
Publishing country	Romania
Document type	Editorial
ZDB-ID	2399972-X
ISSN	2069-6116 ; 1841-9038
ISSN (online)	2069-6116
ISSN	1841-9038
DOI	10.26574/maedica.2022.17.1.14
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Article ; Online: Minimally invasive lateral interbody fusion for the treatment of rostral adjacent-segment lumbar degenerative stenosis without supplemental pedicle screw fixation.

Wang, Michael Y / Vasudevan, Ram / Mindea, Stefan A

Journal of neurosurgery. Spine

2014 Volume 21, Issue 6, Page(s) 861–866

Abstract: Object: Adjacent-segment degeneration and stenosis are common in patients who have undergone previous lumbar fusion. Treatment typically involves a revision posterior approach, which requires management of postoperative scar tissue and previously ... ...

Abstract	Object: Adjacent-segment degeneration and stenosis are common in patients who have undergone previous lumbar fusion. Treatment typically involves a revision posterior approach, which requires management of postoperative scar tissue and previously implanted instrumentation. A minimally invasive lateral approach allows the surgeon to potentially reduce the risk of these hazards. The technique relies on indirect decompression to treat central and foraminal stenosis and placement of a graft with a large surface area to promote robust fusion and stability in concert with the surrounding tensioned ligaments. The goal in this study was to determine if lateral interbody fusion without supplemental pedicle screws is effective in treating adjacent-segment disease. Methods: For a 30-month study period at two institutions, the authors obtained all cases of lumbar fusion with new back and leg pain due to adjacent-segment stenosis and spondylosis failing conservative measures. All patients had undergone minimally invasive lateral interbody fusion from the side of greater leg pain without supplemental pedicle screw fixation. Patients were excluded from the study if they had undergone surgery for a nondegenerative etiology such as infection or trauma. They were also excluded if the intervention involved supplemental posterior instrumented fusion with transpedicular screws. Postoperative metrics included numeric pain scale (NPS) scores for leg and back pain. All patients underwent dynamic radiographs and CT scanning to assess stability and fusion after surgery. Results: During the 30-month study period, 21 patients (43% female) were successfully treated using minimally invasive lateral interbody fusion without the need for subsequent posterior transpedicular fixation. The mean patient age was 61 years (range 37-87 years). Four patients had two adjacent levels fused, while the remainder had single-level surgery. All patients underwent surgery without conversion to a traditional open technique, and recombinant human bone morphogenetic protein-2 was used in the interbody space in all cases. The mean follow-up was 23.6 months. The mean operative time was 86 minutes, and the mean blood loss was 93 ml. There were no major intraoperative complications, but one patient underwent subsequent direct decompression in a delayed fashion. The leg pain NPS score improved from a mean of 6.3 to 1.9 (p < 0.01), and the back pain NPS score improved from a mean of 7.5 to 2.9 (p < 0.01). Intervertebral settling averaged 1.7 mm. All patients had bridging bone on CT scanning at the last follow-up, indicating solid bony fusion. Conclusions: Adjacent-segment stenosis and spondylosis can be treated with a number of different operative techniques. Lateral interbody fusion provides an attractive alternative with reduced blood loss and complications, as there is no need to re-explore a previous laminectomy site. In this limited series a minimally invasive lateral approach provided high fusion rates when performed with osteobiological adjuvants.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cicatrix/etiology ; Decompression, Surgical/adverse effects ; Decompression, Surgical/instrumentation ; Decompression, Surgical/methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Degeneration/diagnostic imaging ; Intervertebral Disc Degeneration/surgery ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/methods ; Pedicle Screws ; Radiography ; Retrospective Studies ; Spinal Fusion/adverse effects ; Spinal Fusion/instrumentation ; Spinal Fusion/methods ; Spinal Stenosis/diagnostic imaging ; Spinal Stenosis/surgery ; Spondylosis/diagnostic imaging ; Spondylosis/surgery ; Treatment Outcome
Language	English
Publishing date	2014-12
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2158643-3
ISSN	1547-5646 ; 1547-5654
ISSN (online)	1547-5646
ISSN	1547-5654
DOI	10.3171/2014.8.SPINE13841
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Article ; Online: Inclusion of asymptomatic degenerative discs in a two-level anterior cervical discectomy and fusion: a decision analysis.

Boakye, Maxwell / Mindea, Stefan

World neurosurgery

2012 Volume 78, Issue 3-4, Page(s) 339–343

Abstract: Objective: To perform a decision analysis model to compare single-level fusion versus two-level fusion in patients with an asymptomatic disc adjacent to a symptomatic disc.: Methods: Probabilities and utilities of alternative outcomes in the decision ...

Abstract	Objective: To perform a decision analysis model to compare single-level fusion versus two-level fusion in patients with an asymptomatic disc adjacent to a symptomatic disc. Methods: Probabilities and utilities of alternative outcomes in the decision tree were assigned based on systematic review of the literature and expert opinion. Rollback analysis determined the optimal treatment. Sensitivity analyses and Monte Carlo simulations were performed to identify effects of varying model parameters. Results: Rollback analysis provided expected values of 0.92 versus 0.84 in favor of observation as the optimal decision. Sensitivity analysis identified the probability of developing adjacent segment disease (ASD) and the likelihood of surgery given a diagnosis of ASD as the most critical parameters influencing the decision. Observation was the preferred strategy at all values of probability of ASD < 100%. At a probability of ASD of 100%, fusion was the preferred strategy only when the probability of surgery for ASD was ≥ 66% or the utility assigned to successful nonoperative management was ≤ 0.84. Conclusions: Observation was the preferred strategy for management of asymptomatic adjacent degenerative discs (AADDs) given the probabilities and utilities used in the decision analysis model. The study was limited by unavailability of precise estimates of the probability of development of ASD and the probability of surgery after diagnosis of ASD, the most critical factors influencing the decision. However, the conclusions were robust given wide ranges used for these parameters in the sensitivity analysis.
MeSH term(s)	Computer Simulation/standards ; Decision Support Techniques ; Diskectomy/methods ; Diskectomy/standards ; Humans ; Intervertebral Disc Degeneration/pathology ; Intervertebral Disc Degeneration/surgery ; Middle Aged ; Spinal Fusion/methods ; Spinal Fusion/standards ; Spondylosis/pathology ; Spondylosis/surgery
Language	English
Publishing date	2012-09
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2011.11.035
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Article ; Online: A novel computer algorithm allows for volumetric and cross-sectional area analysis of indirect decompression following transpsoas lumbar arthrodesis despite variations in MRI technique.

Gates, Timothy A / Vasudevan, Ram R / Miller, Kai J / Stamatopoulou, Vasiliki / Mindea, Stefan A

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2014 Volume 21, Issue 3, Page(s) 499–502

Abstract: Many patients present for neurosurgical spine evaluation with MRI studies conducted at facilities outside of the treating medical center. These images often vary widely in technique, for example, variation in slice thickness, number of slices, and gantry ...

Abstract	Many patients present for neurosurgical spine evaluation with MRI studies conducted at facilities outside of the treating medical center. These images often vary widely in technique, for example, variation in slice thickness, number of slices, and gantry angle. While these images may be sufficient in conjunction with a physical exam to make surgical evaluations, we have found they are often incapable of being used for objective post-operative volumetric comparisons. In order to overcome this, we created a computer program that compensates for these variations in MRI technique. For this study, we examined patients who had undergone outside MRI pre-operatively and were deemed appropriate for a lateral retroperitoneal transpsoas lumbar interbody arthrodesis procedure. Volumetric analysis was performed on sagittal and axial T2-weighted pre- and post-operative MRI. The percentage change of central canal volume and foraminal area was calculated for each level. The authors identified five levels with MRI sufficient for volumetric analysis and eight levels (16 foramina) sufficient for foraminal cross-sectional analysis. Through use of our computer algorithm, average central canal volume and foraminal cross-sectional area was calculated to increase by 32.8% and 67.6% respectively following the procedure. These results are consistent with previous study findings and support the idea that restoration of the anterior column via a lateral approach can result in significant indirect decompression of the neural elements. Additionally, the novel algorithm created and used for this study suggests that it can achieve quick measurement and comparison of MRI studies despite variations in pre- and post-operative technique.
MeSH term(s)	Algorithms ; Arthrodesis/methods ; Decompression, Surgical/methods ; Humans ; Image Interpretation, Computer-Assisted/methods ; Lumbar Vertebrae/surgery ; Magnetic Resonance Imaging/methods ; Minimally Invasive Surgical Procedures
Language	English
Publishing date	2014-03
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2013.05.007
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Zs.A 3999: Show issues

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Article ; Online: Experience with intraoperative navigation and imaging during endoscopic transnasal spinal approaches to the foramen magnum and odontoid.

Choudhri, Omar / Mindea, Stefan A / Feroze, Abdullah / Soudry, Ethan / Chang, Steven D / Nayak, Jayakar V

Neurosurgical focus

2014 Volume 36, Issue 3, Page(s) E4

Abstract: Object: In this study the authors share their experience using intraoperative spinal navigation and imaging for endoscopic transnasal approaches to the odontoid in 5 patients undergoing C1-2 surgery for basilar invagination at Stanford Hospital and ... ...

Abstract	Object: In this study the authors share their experience using intraoperative spinal navigation and imaging for endoscopic transnasal approaches to the odontoid in 5 patients undergoing C1-2 surgery for basilar invagination at Stanford Hospital and Clinics from 2010 to 2013. Methods: Of these 5 patients undergoing C1-2 surgery for basilar invagination, 4 underwent a 2-tiered anterior C1-2 resection with posterior occipitocervical fusion during a first stage surgery, followed by endoscopic endonasal odontoidectomy in a separate setting. Intraoperative stereotactic navigation was performed using a surgical navigation system in all cases. Navigation accuracy, characterized as target registration error, ranged between 0.8 mm and 2 mm, with an average of 1.2 mm. Intraoperative imaging using a CT scanner was also performed in 2 patients. Results: Endoscopic decompression of the brainstem was achieved in all patients, and no intraoperative complications were encountered. All patients were extubated within 24 hours after surgery and were able to swallow within 48 hours. After appropriate initial reconstruction of the defect at the craniocervical junction, no postoperative CSF leakage, arterial injury, or need for reoperation was encountered; 1 patient developed mild postoperative velopharyngeal insufficiency that resolved by the 6-month follow-up evaluation. There were no deaths and no patients required tracheostomy placement. The average inpatient stay after surgery varied between 72 and 96 hours, without extended intensive care unit stays for any patient. Conclusions: Technologies such as intraoperative CT scanning and merged MRI/CT can provide the surgeon with detailed, virtual real-time information about the extent of complex endoscopic vertebral segment resection and brainstem decompression and lessens the prospect of revision or secondary procedures in this challenging surgical corridor. Moreover, patients experience limited morbidity and can tolerate early oral intake after transnasal endoscopic odontoidectomy. Essential to the successful undertaking of these endoscopic adventures is 1) an understanding of the endoscopic nasal, skull base, and neurovascular anatomy; 2) advanced and extended-length instrumentation including navigation; and 3) a team approach between experienced rhinologists and spine surgeons comfortable with endoscopic skull base techniques.
MeSH term(s)	Aged ; Aged, 80 and over ; Decompression, Surgical/methods ; Endoscopy/methods ; Female ; Foramen Magnum/surgery ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Monitoring, Intraoperative ; Neuronavigation/methods ; Odontoid Process/surgery ; Reoperation ; Spinal Fusion/methods
Language	English
Publishing date	2014-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2014.1.FOCUS13533
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Article ; Online: Recombinant human bone morphogenetic protein-2-induced radiculitis in elective minimally invasive transforaminal lumbar interbody fusions: a series review.

Mindea, Stefan A / Shih, Patrick / Song, John K

Spine

2009 Volume 34, Issue 14, Page(s) 1480–4; discussion 1485

Abstract: Study design: Retrospective single center analysis.: Objective: The purpose of our study is to quantify the development of a postoperative radiculitis in our minimally invasive transforaminal lumbar interbody fusion patient population.: Summary of ... ...

Abstract	Study design: Retrospective single center analysis. Objective: The purpose of our study is to quantify the development of a postoperative radiculitis in our minimally invasive transforaminal lumbar interbody fusion patient population. Summary of background data: The application of recombinant human Bone Morphogenetic Protein-2 (BMP) in spinal surgery has allowed for greater success in spinal fusions. This has led to the FDA approving its use in anterior lumbar interbody fusion. However, its well-recognized benefits have generated its "off-label" use in the cervical, thoracic, and lumbar spine. Despite its benefits, the adverse effects of its inflammatory properties are just starting to get recognized. Some clear adverse reactions have been documented in the literature in the cervical spine. However, we feel that these inflammatory properties may be present in the lumbar spine as well. Methods: We performed a retrospective chart review of 43 patients who had undergone a minimally invasive transforaminal lumbar interbody fusions. Thirty-five of these patients had BMP and 8 patients did not have BMP. We documented whether there was a preoperative radiculopathy present and whether a radiculopathy was present postoperative. We reviewed radiographic postoperative imaging to establish a structural cause for any radiculopathy. If new or increasing radicular symptoms were present, we attempted to assess the duration of these symptoms. Results: Our analysis, showed that 0 of the 8 patients of the non-BMP group had new radicular symptoms that were not attributed to structural causes. In the BMP group, 4 of the 35 patients (11.4%) had new radicular symptoms without structural etiology. Conclusion: Our analysis suggest that patients undergoing minimally invasive transforaminal lumbar interbody fusions procedures have a higher incidence of developing new radicular symptoms that could be attributed to BMP.
MeSH term(s)	Adult ; Aged ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins/adverse effects ; Bone Morphogenetic Proteins/therapeutic use ; Female ; Humans ; Lumbar Vertebrae/diagnostic imaging ; Lumbar Vertebrae/surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Radiculopathy/chemically induced ; Radiculopathy/diagnosis ; Recombinant Proteins/adverse effects ; Recombinant Proteins/therapeutic use ; Retrospective Studies ; Spinal Fusion/methods ; Tomography, X-Ray Computed ; Transforming Growth Factor beta/adverse effects ; Transforming Growth Factor beta/therapeutic use
Chemical Substances	Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; Recombinant Proteins ; Transforming Growth Factor beta ; recombinant human bone morphogenetic protein-2
Language	English
Publishing date	2009-06-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	752024-4
ISSN	1528-1159 ; 0362-2436
ISSN (online)	1528-1159
ISSN	0362-2436
DOI	10.1097/BRS.0b013e3181a396a1
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Article ; Online: Unruptured arteriovenous malformation in a patient presenting with obstructive hydrocephalus. Case report and review of the literature.

Mindea, Stefan A / Yang, Benson P / Batjer, H Hunt

Neurosurgical focus

2007 Volume 22, Issue 4, Page(s) E11

Abstract: The authors report on a patient harboring an unruptured cortical arteriovenous malformation (AVM), who had presented with obstructive hydrocephalus due to compression of the cerebral aqueduct by a large venous varix. Although patients with ruptured AVMs ... ...

Abstract	The authors report on a patient harboring an unruptured cortical arteriovenous malformation (AVM), who had presented with obstructive hydrocephalus due to compression of the cerebral aqueduct by a large venous varix. Although patients with ruptured AVMs are known to either present with or later suffer from obstructive hydrocephalus, those with unruptured AVMs who present in this manner are quite rare. Moreover, hydrocephalus caused by a venous varix draining an AVM, to our knowledge, has never been previously reported in the literature. This report serves to illustrate two primary points, namely, that tortuous venous varices draining AVMs can result in obstructive hydrocephalus and that this unusual circumstance can be fostered in the setting of venous outflow obstruction.
MeSH term(s)	Cerebral Angiography ; Cerebral Veins/physiopathology ; Constriction, Pathologic/diagnostic imaging ; Humans ; Hydrocephalus/etiology ; Intracranial Arteriovenous Malformations/complications ; Intracranial Arteriovenous Malformations/diagnostic imaging ; Male ; Middle Aged ; Regional Blood Flow ; Tomography, X-Ray Computed ; Varicose Veins/complications ; Varicose Veins/diagnostic imaging ; Varicose Veins/physiopathology
Language	English
Publishing date	2007-04-15
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/foc.2007.22.4.13
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Article: Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis.

Burns, Terry C / Mindea, Stefan A / Pendharkar, Arjun V / Lapustea, Nicolae B / Irime, Ioana / Nayak, Jayakar V

Journal of neurological surgery reports

2015 Volume 76, Issue 1, Page(s) e37–42

Abstract: Ventral epidural abscess with osteomyelitis at the craniocervical junction is a rare occurrence that typically mandates spinal cord decompression via a transoral approach. However, given the potential for morbidity with transoral surgery, especially in ... ...

Abstract	Ventral epidural abscess with osteomyelitis at the craniocervical junction is a rare occurrence that typically mandates spinal cord decompression via a transoral approach. However, given the potential for morbidity with transoral surgery, especially in the setting of immunosuppression, together with the advent of extended endonasal techniques, the transnasal approach could be attractive for selected patients. We present two cases of ventral epidural abscess and osteomyelitis at the craniocervical junction involving C1/C2 that were successfully treated via the endoscopic transnasal approach. Both were treated in staged procedures involving posterior cervical fusion followed by endoscopic transnasal resection of the ventral C1 arch and odontoid process for decompression of the ventral spinal cord and medulla. Dural repairs were successfully performed using multilayered, onlay techniques where required. Both patients tolerated surgery exceedingly well, had brief postoperative hospital stays, and recovered uneventfully to their neurologic baselines. Postoperative magnetic resonance imaging confirmed complete decompression of the foramen magnum and upper C-spine. These cases illustrate the advantages and low morbidity of the endonasal endoscopic approach to the craniocervical junction in the setting of frank skull base infection and immunosuppression, representing to our knowledge a unique application of this technique to osteomyelitis and epidural abscess at the craniocervical junction.
Language	English
Publishing date	2015-01-16
Publishing country	Germany
Document type	Case Reports
ZDB-ID	2653397-2
ISSN	2193-6366 ; 2193-6358
ISSN (online)	2193-6366
ISSN	2193-6358
DOI	10.1055/s-0034-1395492
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Zs.A 6973: Show issues

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Article ; Online: The management of cranial injuries in antiquity and beyond.

Kshettry, Varun R / Mindea, Stefan A / Batjer, H Hunt

Neurosurgical focus

2007 Volume 23, Issue 1, Page(s) E8

Abstract: Cranial injuries were among the earliest neurosurgical problems faced by ancient physicians and surgeons. In this review, the authors trace the development of neurosurgical theory and practice for the treatment of cranial injuries beginning from the ... ...

Abstract	Cranial injuries were among the earliest neurosurgical problems faced by ancient physicians and surgeons. In this review, the authors trace the development of neurosurgical theory and practice for the treatment of cranial injuries beginning from the earliest ancient evidence available to the collapse of the Greco-Roman civilizations. The earliest neurosurgical procedure was trephination, which modern scientists believe was used to treat skull fractures in some civilizations. The Egyptian papyri of Edwin Smith provide a thorough description of 27 head injuries with astute observations of clinical signs and symptoms, but little information on the treatment of these injuries. Hippocrates offered the first classification of skull fractures and discussion of which types required trephining, in addition to refining this technique. Hippocrates was also the first to understand the basis of increased intracranial pressure. After Hippocrates, the physicians of the Alexandrian school provided further insight into the clinical evaluation of patients with head trauma, including the rudiments of a Glasgow Coma Scale. Finally, Galen of Pergamon, a physician to fallen gladiators, substantially contributed to the understanding of the neuroanatomy and physiology. He also described his own classification system for skull fractures and further refined the surgical technique of trephination. From the study of these important ancient figures, it is clearly evident that the knowledge and experience gained from the management of cranial injuries has laid the foundation not only for how these injuries are managed today, but also for the development of the field of neurosurgery.
MeSH term(s)	Craniocerebral Trauma/history ; Craniocerebral Trauma/surgery ; History, Ancient ; Humans ; Manuscripts, Medical as Topic/history ; Medical Illustration/history ; Neurosurgery/history ; Neurosurgery/methods ; Sculpture/history
Language	English
Publishing date	2007
Publishing country	United States
Document type	Historical Article ; Journal Article ; Portraits ; Review
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/foc.2007.23.1.8
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Article: Spontaneous intracranial hypotension secondary to anterior thoracic osteophyte: Resolution after primary dural repair via posterior approach.

Veeravagu, Anand / Gupta, Gaurav / Jiang, Bowen / Berta, Scott C / Mindea, Stefan A / Chang, Steven D

International journal of surgery case reports

2012 Volume 4, Issue 1, Page(s) 26–29

Abstract: Introduction: Spontaneous intracranial hypotension (SIH) is an uncommon syndrome widely attributed to CSF hypovolemia, typically secondary to spontaneous CSF leak. Although commonly associated with postural headache and variable neurological symptoms, ... ...

Abstract	Introduction: Spontaneous intracranial hypotension (SIH) is an uncommon syndrome widely attributed to CSF hypovolemia, typically secondary to spontaneous CSF leak. Although commonly associated with postural headache and variable neurological symptoms, one of the most severe consequences of SIH is bilateral subdural hematomas with resultant neurological deterioration. Presentation of case: We present the case of a patient diagnosed with SIH secondary to an anteriorly positioned thoracic osteophyte with resultant dural disruption, who after multiple attempts at nonsurgical management developed bilateral subdural hematomas necessitating emergent surgical intervention. The patient underwent a unilateral posterior repair of his osteophyte with successful anterior decompression. At 36months follow up, the patient reported completely resolved headaches with no focal neurological deficits. Discussion: We outline our posterior approach to repair of the dural defect and review the management algorithm for the treatment of patients with SIH. We also examine the current hypotheses as to the origin, pathophysiology, diagnosis and treatment of this syndrome. Conclusion: A posterior approach was utilized to repair the dural defect caused by an anterior thoracic osteophyte in a patient with severe SIH complicated by bilateral subdural hematomas. This approach minimizes morbidity compared to an anterior approach and allowed for removal of the osteophyte and repair of the dural defect.
Language	English
Publishing date	2012-08-02
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2012.06.009
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