{"id":"ffe67a9c-761e-4c27-8ed5-51d84f6a5d4d","slug":"neurosurgery-concepts-key-perspectives-on-imaging-characteristics-of-spinal-metastases-surgery-for-low-back-pain-anesthesia-for-disc-surgery-and-laminectomy-versus-laminectomy-and-fusion-for-lumba","title":"Neurosurgery concepts: Key perspectives on imaging characteristics of spinal metastases, surgery for low back pain, anesthesia for disc surgery, and laminectomy versus laminectomy and fusion for lumbar spondylolisthesis","authors":["Carlito Lagman","Lawrance K. Chung","Luke Macyszyn","Winward Choy","Zachary A. Smith","Nader S. Dahdaleh","Angela M. Bohnen","Jin M. Cho","Chaim B. Colen","Edward Duckworth","Anand V. Germanwala","Peter Kan","Alexander A. Khalessi","Chae-Yong Kim","Sandi Lam","Gordon Li","Michael Lim","Jonathan H. Sherman","Vincent Y. Wang","Gabriel Zada","Isaac Yang"],"abstract":"Background: This article examines key perspectives on various neurosurgical concepts, including imaging characteristics of spinal metastases, the role of surgery in low back pain, and anesthesia techniques for lumbar spine surgery. The study highlights the importance of understanding imaging patterns to guide surgical planning for spinal metastases. Additionally, it reviews the efficacy of surgical interventions for common causes of low back pain based on recent clinical trials. Methods: The authors conducted a retrospective review of CT images from 66 patients treated for metastatic spine disease, analyzing the imaging characteristics of lesions from breast, prostate, lung, and renal cell carcinomas. They also reviewed data from the Spine Patient Outcomes Research Trials (SPORT) I-III, which included randomized clinical trials assessing surgical efficacy for disc herniation, degenerative spondylolisthesis, and spinal stenosis. Furthermore, a prospective randomized controlled trial was performed comparing general anesthesia and combined epidural/general anesthesia in 88 patients undergoing elective lumbar spine disc surgery. Results: The imaging analysis revealed that 48% of spinal metastases were osteolytic, with breast, lung, and renal cell carcinoma lesions predominantly exhibiting this pattern. The SPORT trials indicated that surgical intervention provided significant improvements in health-related quality of life for patients with disc herniation, degenerative spondylolisthesis, and spinal stenosis, despite high crossover rates. The anesthesia trial found that combined epidural/general anesthesia resulted in less intraoperative blood loss and better postoperative pain control compared to general anesthesia alone. Conclusion: The findings underscore the critical role of imaging in surgical planning for spinal metastases and the effectiveness of surgical interventions for specific low back pain conditions. Additionally, the advantages of combined anesthesia techniques may enhance patient outcomes in lumbar spine surgeries. Future studies should aim to validate these findings in larger cohorts and explore the implications of anesthesia choices in diverse patient populations. Keywords: spinal metastases, low back pain, surgery, anesthesia, CT imaging, clinical trials, osteolytic, osteoblastic","thumbnailUrl":null,"publishDate":"2017-01-19T00:00:00.000Z","doi":"10.4103/2152-7806.198736","categories":["General Neurosurgery","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/ffe67a9c-761e-4c27-8ed5-51d84f6a5d4d/pdf"}