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Pregnancy-induced changes to spinal anatomy and physiology can increase the complexity of neurosurgical intervention in this population. There are numerous reports focused on the neurosurgical management of intracranial pathology for pregnant patients. However, less is known about the neurosurgical management of acute spinal pathology. This study aims to discuss the management of emergent spinal pathology during late-term pregnancy. This is a case series of acute spinal pathologies in pregnancy. Epidural spinal needle fracture, epidural abscess, disc herniation causing an acute neurological deficit, and potential spine trauma. An extensive literature search relevant to the operative cases was performed to highlight the relevant themes to management. (1) The epidural spinal needle fracture was managed by surgical exploration under local anesthesia. (2) The epidural abscess was managed with laminectomy and surgical evacuation of the infective mass under general anesthesia. (3) The acute disc herniation was managed with laminectomy and discectomy under general anesthesia. All three examples were managed with emergent surgeries with improvement of symptoms. (4) The potential spine trauma was managed nonoperatively. Relevant similar cases from the literature review were summarized and strategies for management were outlined. Several factors such as anesthesia type, positioning, and operation sequencing must be considered when managing acute spinal pathology in late-term pregnant patients, necessitating multi-disciplinary input. However, effective management can result in successful surgical intervention and improvement of symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Lateral anterior column release (ACR) is a minimally invasive option for the correction of sagittal plane deformity. To assemble a homogeneous picture of published research on ACR, an advanced bibliometric analysis was conducted to compile the top-ten most-cited articles on the topic of ACR. Methods: A keyword search using the Thomson Reuters Web of Knowledge was conducted to identify articles discussing the role of lateral ACR. The articles were then ranked based on the total number of citations to identify the ten most-cited articles published. A subjective appraisal of the findings of these articles was conducted to provide a ranked literature review and to examine trends in the study of ACR between 2012 and 2019. Results: The earliest published article on ACR was in 2012 by Deukmedjian et al. Three articles were in vitro biomechanical assessments of ACR, and seven articles were on outcome analyses, which were either case series or case controlled. The most-cited article was a biomechanical study authored by Uribe et al. The article with the highest rate of citations/year was authored by Manwaring et al. Uribe and the European Spine Journal were the most frequently cited author and journal, respectively. Conclusions: The lateral ACR approach has enjoyed significant scholarly attention since its advent. Higher-level analyses with robust control groups, larger sample sizes, and long-term follow-up are necessary to improve our understanding of this approach. [ABSTRACT FROM AUTHOR]

Background: Craniovertebral junction is a complex anatomical location posing unique challenges to the surgical management of its pathologies. We aimed to identify the fifty most-cited articles that are dedicated to this field. Methods: A keyword search using the Thomson Reuters Web of Knowledge was conducted to identify articles relevant to the field of craniovertebral junction surgery. The articles were reviewed based on title, abstract, and methods, if necessary, and then ranked based on the total number of citations to identify the fifty most-cited articles. Characteristics of the articles were determined and analyzed. Results: The earliest top-cited article was published in 1948. When stratified by decade, 1990s was the most productive with 16 articles. The most-cited article was by Anderson and Dalonzo on a classification of odontoid fractures. By citation rate, the most-cited article was by Herms and Melcher who described Goel's technique of atlantoaxial fixation using C1 lateral mass screws and C2 pedicle screws with rod fixation. Atlantoaxial fixation was the most common topic. The United States, Barrow Neurological Institute, and VH Sonntag were the most represented country, institute, and author, respectively. The significant majority of articles were designed as case series providing level IV evidence. Conclusion: Using citation analysis, we have provided a list of the most-cited articles representing important contributions of various authors from many institutions across the world to the field of craniovertebral junction surgery. [ABSTRACT FROM AUTHOR]

Background: Cerebrospinal fluid (CSF) leakage into the epidural space following lumbar puncture (LP) has been documented in pediatric patients, but there have been no reported cases in adults. Case Description: We report an epidural CSF leak in an adult who presented with back pain, positional headache, urinary retention, and constipation following an LP performed as a part of a research study. The patient's magnetic resonance (MR) scan showed an extensive epidural CSF collection. Following placement in a recumbent position for 72 h, the collection fully resolved along with his neurological complaints. Conclusion: Symptomatic epidural CSF collections rarely occur in adults following LPs. Nevertheless, the management remains the same as for pediatric patients; bed rest for 72 h results typically in full resolution of symptoms/signs and regression of the collection on MR studies. [ABSTRACT FROM AUTHOR]