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Thorsten Ernstberger - One of the best experts on this subject based on the ideXlab platform.

  • Score Evaluation of MRI Sequence Type Related Artifacts after Interbody Fusion with Metallic Implants-A Spine Specimen Study
    Open Journal of Medical Imaging, 2012
    Co-Authors: Thorsten Ernstberger, G. Buchhorn, Gabert Heidrich
    Abstract:

    Introduction: According to Anterior Spine Fusion intervertebral disc spacers made of titanium or cobalt-chromium alloys are of special interest. With regard to postoperative problems implant related artifacts can lead to a decreased MRI evaluation. The focus of this study was to compare the respective implant artifact range dependend on different MRI sequences. To simplify artifact evaluation we introduced in this study a new developed 0-1-2 score. Material and Methods: We performed an MRI artifact evaluation of 2 different metallic intervertebral disc spacers (cobalt-chromiumand titanium alloy). A carcass porcine Spine was employed. Considering 12 defined spinal regions of interest we evaluated the respective implant artifact properties independent from the total artifact volume by using a new developed 0-1-2 score. The artifact range was documented for 15 different MRI-sequences. Results: For the titanium spacer as well as the cobalt-chromium-spacer an MRI evaluation of the implant/disc space situation could not be carried out. In contrast to the cobalt chromium spacer the titanium spacer allowed a good differentiation of the spinal canal opposite to the implant. Optimal MRI imaging results for both metallic intervertebral disc spacers could be achieved considering TSE sequences. Conclusion: A comparison of these two metallic spacers showed in all examined sequences clear advantages in favour of the titanium spacer. The best MRI representation of both tested implants by reducing implant related artifacts could be achieved with fast spin echo (TSE) sequences. In spite of the use of TSE sequences a variability of susceptibility artifacts has to be included with regard to implant shape and material. With regard to the results of this study the easy use of a new developed artifact score represented a useful help to compare implant related MRI artifact properties independent from the actual implant related total artifact volume.

  • Score based assessment of implant-related post Fusion MRI artifacts focused on different interbody disc spacers: An in vitro study
    Open Journal of Clinical Diagnostics, 2012
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich, H.m. Klinger, Mike H. Baums
    Abstract:

    Interbody disc spacers for Anterior Spine Fusion are made of different materials, such as titanium alloys or carbon fiber reinforced polymers (CFRP). Implant-related susceptibility artifacts can decrease the quality of MRI scans. This cadaveric study aimed to demonstrate the extent that implant-related MRI artifacting affects the post Fusion differentiation of the spinal canal (SC) and intervertebral disc space (IDS). In 6 cadaveric porcine Spines, we evaluated the post-im- plantation MRI scans of a titanium and CFRP spacer that differed in shape and surface qualities. A spacer made of human cortical bone was used as a control. A defined evaluation unit was divided into regions of interest (ROI) to characterize the SC and IDS. Considering 15 different MRI sequences read independently by an interobserver-validated team of specialists artifact-affected image quality of the median MRI slice was rated on a modified score of 0-1-2-3. A maximum score of 15 points for the SC and 9 points for the IDS (100%) was possible. Turbo spin echo sequences produced the best scores for both spacers and the control. Only the control achieved a score of 100%. For the IDS the titanium and CFRP spacer maximally scored 0% and 74%, for the SC 80% and 99%, respectively. By using favored T1 TSE sequences the CFRP-spacer represented clear advantages in post Fusion spinal imaging. Independent of artifact dimensions the used scoring system allowed us to create an implant-related ranking of MRI scan quality in reference to the bone control.

  • Imaging characteristics of metallic interbody spacers: in vitro score evaluation of susceptibility artifacts considering different MRI sequences
    Journal of Biomedical Science and Engineering, 2010
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich, G. Buchhorn
    Abstract:

    Aim: Intervertebral spacers for Anterior Spine Fusion are made of different materials, such as titanium, carbon or cobalt-chrome, which can affect the post- Fusion MRI scans. Implant-related susceptibility artifacts can decrease the quality of MRI scans, thwar- ting proper evaluation. This cadaver study aimed to demonstrate the extent that implant-related MRI artifacting affects the post-Fusion evaluation of intervertebral spacers. Methods: In a cadaveric porcine Spine, we evaluated the post-implantation MRI scans of 2 metallic intervertebral spacers (TiAL6V4, CoCrMo) that differed in shape, material, surface qualities and implantation technique. A spacer made of human cortical bone was used as a control. The median sagittal MRI slice was divided into 12 regions of interest (ROI). Results: No significant differences were found on 15 different MRI sequences read independently by an interobserver-validated team of specialists (P>0.05). Artifact-affected image quality was rated on a score of 0-1-2. A maximum score of 24 points (100%) was possible. Turbo spin echo sequences produced the best scores for all spacers and the control. Only the control achieved a score of 100%. The titanium and cobalt-chrome spacers scored 62.5% and 50%, respectively. Conclusions: Our scoring system allowed us to create an implant-related rank- ing of MRI scan quality in reference to the control that was independent of artifact dimensions. Even with turbo spin echo sequences, the susceptibility artifacts produced by the metallic spacers showed a high degree of variability. Despite optimum sequen- cing, implant design and material are relevant factors in MRI artifacting.

  • Implant-related MRI artifacts of determined interbody test spacers: artifact calculations due to implant parameters in a porcine Spine model
    Health, 2009
    Co-Authors: Thorsten Ernstberger
    Abstract:

    Aim: Intervertebral spacers for Anterior Spine Fusion are made of different materials, which can affect the post-Fusion MRI scans. Suscep- tibility artifacts specially for implants made of titanium alloys can decrease the image quality. This study focused on the influence of deter-mined implant parameters like shape and implant volume in MRI artifacting independent from se-lected MRI-sequences. Methods: In this study the post-implantation MRI scans of determined cuboids and cylinders were evaluated. All in-terbody test implants were made of titanium alloys. MRI scans were carried out by using T1 TSE sequences. The total artifact volume (TAV) of all examined implants were calculated for sta-tistical t-test correlation and implant volume (IV)/TAV-relation. Results: Considering all ex-amined test implants with an increasing implant size the TAV became significant larger (p

  • postFusion magnetic resonance imaging artifacts caused by a titanium cobalt chromium molybdenum and carbon intervertebral disc spacer
    Journal of Spinal Disorders & Techniques, 2007
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich
    Abstract:

    : Intervertebral spacers for Anterior Spine Fusion are made of different materials, such as titanium and CoCrMo-alloys or carbon fiber reinforced polymers (CFRP). Implant-related susceptibility artifacts can decrease the quality of magnetic resonance imaging (MRI) scans. This cadaveric study aimed to demonstrate the extent that implant-related MRI artifacting affects the postFusion differentiation of the spinal canal (SC) and intervertebral disc space (IDS). In 6 cadaveric porcine Spines, we evaluated the postimplantation MRI scans of a titanium, CoCrMo-spacer and CFRP-spacer that differed in shape and surface qualities. A spacer made of human cortical bone was used as a control. A defined evaluation unit was divided into regions of interest (ROI) to characterize the SC and IDS. Considering 15 different MRI sequences read independently by an interobserver-validated team of specialists artifact-affected image quality of the median MRI slice was rated on a score of 0-1-2-3. A maximum score of 15 points for the SC and 9 points for the IDS (100%) was possible. Turbo spin echo sequences produced the best scores for both spacers and the control. Only the control achieved a score of 100%. For the IDS the CoCrMo-spacer, titanium and CFRP-spacer maximally scored 0%, 0% and 74%, for the SC 60%, 80% and 99%, respectively. By using favored T1 TSE sequences the CFRP-spacer represented clear advantages in postFusion spinal imaging. Independent of artifact dimensions the used scoring system allowed us to create an implant-related ranking of MRI scan quality in reference to the bone control.

Gabert Heidrich - One of the best experts on this subject based on the ideXlab platform.

  • Score based assessment of implant-related post Fusion MRI artifacts focused on different interbody disc spacers: An in vitro study
    Open Journal of Clinical Diagnostics, 2012
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich, H.m. Klinger, Mike H. Baums
    Abstract:

    Interbody disc spacers for Anterior Spine Fusion are made of different materials, such as titanium alloys or carbon fiber reinforced polymers (CFRP). Implant-related susceptibility artifacts can decrease the quality of MRI scans. This cadaveric study aimed to demonstrate the extent that implant-related MRI artifacting affects the post Fusion differentiation of the spinal canal (SC) and intervertebral disc space (IDS). In 6 cadaveric porcine Spines, we evaluated the post-im- plantation MRI scans of a titanium and CFRP spacer that differed in shape and surface qualities. A spacer made of human cortical bone was used as a control. A defined evaluation unit was divided into regions of interest (ROI) to characterize the SC and IDS. Considering 15 different MRI sequences read independently by an interobserver-validated team of specialists artifact-affected image quality of the median MRI slice was rated on a modified score of 0-1-2-3. A maximum score of 15 points for the SC and 9 points for the IDS (100%) was possible. Turbo spin echo sequences produced the best scores for both spacers and the control. Only the control achieved a score of 100%. For the IDS the titanium and CFRP spacer maximally scored 0% and 74%, for the SC 80% and 99%, respectively. By using favored T1 TSE sequences the CFRP-spacer represented clear advantages in post Fusion spinal imaging. Independent of artifact dimensions the used scoring system allowed us to create an implant-related ranking of MRI scan quality in reference to the bone control.

  • Score Evaluation of MRI Sequence Type Related Artifacts after Interbody Fusion with Metallic Implants-A Spine Specimen Study
    Open Journal of Medical Imaging, 2012
    Co-Authors: Thorsten Ernstberger, G. Buchhorn, Gabert Heidrich
    Abstract:

    Introduction: According to Anterior Spine Fusion intervertebral disc spacers made of titanium or cobalt-chromium alloys are of special interest. With regard to postoperative problems implant related artifacts can lead to a decreased MRI evaluation. The focus of this study was to compare the respective implant artifact range dependend on different MRI sequences. To simplify artifact evaluation we introduced in this study a new developed 0-1-2 score. Material and Methods: We performed an MRI artifact evaluation of 2 different metallic intervertebral disc spacers (cobalt-chromiumand titanium alloy). A carcass porcine Spine was employed. Considering 12 defined spinal regions of interest we evaluated the respective implant artifact properties independent from the total artifact volume by using a new developed 0-1-2 score. The artifact range was documented for 15 different MRI-sequences. Results: For the titanium spacer as well as the cobalt-chromium-spacer an MRI evaluation of the implant/disc space situation could not be carried out. In contrast to the cobalt chromium spacer the titanium spacer allowed a good differentiation of the spinal canal opposite to the implant. Optimal MRI imaging results for both metallic intervertebral disc spacers could be achieved considering TSE sequences. Conclusion: A comparison of these two metallic spacers showed in all examined sequences clear advantages in favour of the titanium spacer. The best MRI representation of both tested implants by reducing implant related artifacts could be achieved with fast spin echo (TSE) sequences. In spite of the use of TSE sequences a variability of susceptibility artifacts has to be included with regard to implant shape and material. With regard to the results of this study the easy use of a new developed artifact score represented a useful help to compare implant related MRI artifact properties independent from the actual implant related total artifact volume.

  • Imaging characteristics of metallic interbody spacers: in vitro score evaluation of susceptibility artifacts considering different MRI sequences
    Journal of Biomedical Science and Engineering, 2010
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich, G. Buchhorn
    Abstract:

    Aim: Intervertebral spacers for Anterior Spine Fusion are made of different materials, such as titanium, carbon or cobalt-chrome, which can affect the post- Fusion MRI scans. Implant-related susceptibility artifacts can decrease the quality of MRI scans, thwar- ting proper evaluation. This cadaver study aimed to demonstrate the extent that implant-related MRI artifacting affects the post-Fusion evaluation of intervertebral spacers. Methods: In a cadaveric porcine Spine, we evaluated the post-implantation MRI scans of 2 metallic intervertebral spacers (TiAL6V4, CoCrMo) that differed in shape, material, surface qualities and implantation technique. A spacer made of human cortical bone was used as a control. The median sagittal MRI slice was divided into 12 regions of interest (ROI). Results: No significant differences were found on 15 different MRI sequences read independently by an interobserver-validated team of specialists (P>0.05). Artifact-affected image quality was rated on a score of 0-1-2. A maximum score of 24 points (100%) was possible. Turbo spin echo sequences produced the best scores for all spacers and the control. Only the control achieved a score of 100%. The titanium and cobalt-chrome spacers scored 62.5% and 50%, respectively. Conclusions: Our scoring system allowed us to create an implant-related rank- ing of MRI scan quality in reference to the control that was independent of artifact dimensions. Even with turbo spin echo sequences, the susceptibility artifacts produced by the metallic spacers showed a high degree of variability. Despite optimum sequen- cing, implant design and material are relevant factors in MRI artifacting.

  • postFusion magnetic resonance imaging artifacts caused by a titanium cobalt chromium molybdenum and carbon intervertebral disc spacer
    Journal of Spinal Disorders & Techniques, 2007
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich
    Abstract:

    : Intervertebral spacers for Anterior Spine Fusion are made of different materials, such as titanium and CoCrMo-alloys or carbon fiber reinforced polymers (CFRP). Implant-related susceptibility artifacts can decrease the quality of magnetic resonance imaging (MRI) scans. This cadaveric study aimed to demonstrate the extent that implant-related MRI artifacting affects the postFusion differentiation of the spinal canal (SC) and intervertebral disc space (IDS). In 6 cadaveric porcine Spines, we evaluated the postimplantation MRI scans of a titanium, CoCrMo-spacer and CFRP-spacer that differed in shape and surface qualities. A spacer made of human cortical bone was used as a control. A defined evaluation unit was divided into regions of interest (ROI) to characterize the SC and IDS. Considering 15 different MRI sequences read independently by an interobserver-validated team of specialists artifact-affected image quality of the median MRI slice was rated on a score of 0-1-2-3. A maximum score of 15 points for the SC and 9 points for the IDS (100%) was possible. Turbo spin echo sequences produced the best scores for both spacers and the control. Only the control achieved a score of 100%. For the IDS the CoCrMo-spacer, titanium and CFRP-spacer maximally scored 0%, 0% and 74%, for the SC 60%, 80% and 99%, respectively. By using favored T1 TSE sequences the CFRP-spacer represented clear advantages in postFusion spinal imaging. Independent of artifact dimensions the used scoring system allowed us to create an implant-related ranking of MRI scan quality in reference to the bone control.

  • Implant detectibility of intervertebral disc spacers in post Fusion MRI: evaluation of the MRI scan quality by using a scoring system—an in vitro study
    Neuroradiology, 2007
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich, W. Schultz, Eckhardt Grabbe
    Abstract:

    Introduction Intervertebral spacers for Anterior Spine Fusion are made of different materials, such as titanium and cobalt chromium alloys and carbon fiber-reinforced polymers. Implant-related susceptibility artifacts can decrease the quality of MRI scans. The aim of this cadaveric study was to demonstrate the extent that implant-related MRI artifacting affects the postFusion differentiation of determined regions of interest (ROIs). Methods In six cadaveric porcine Spines, we evaluated the postimplantation MRI scans of a titanium, cobalt-chromium and carbon spacer that differed in shape and surface qualities. A spacer made of human cortical bone was used as a control. A defined evaluation unit was divided into ROIs to characterize the spinal canal as well as the intervertebral disc space. Considering 15 different MRI sequences read independently by an interobserver-validated team of specialists the artifact-affected image quality of the median MRI slice was rated on a score of 0–3. A maximum score of 18 points (100%) for the determined ROIs was possible. Results Turbo spin echo sequences produced the best scores for all spacers and the control. Only the control achieved a score of 100%. For the determined ROI maximum scores for the cobalt-chromium, titanium and carbon spacers were 24%, 32% and 84%, respectively. Conclusion By using favored T1 TSE sequences the carbon spacer showed a clear advantage in postFusion spinal imaging. Independent of artifact dimensions, the scoring system used allowed us to create an implant-related ranking of MRI scan quality in reference to the bone control.

Eckhardt Grabbe - One of the best experts on this subject based on the ideXlab platform.

  • Implant detectibility of intervertebral disc spacers in post Fusion MRI: evaluation of the MRI scan quality by using a scoring system—an in vitro study
    Neuroradiology, 2007
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich, W. Schultz, Eckhardt Grabbe
    Abstract:

    Introduction Intervertebral spacers for Anterior Spine Fusion are made of different materials, such as titanium and cobalt chromium alloys and carbon fiber-reinforced polymers. Implant-related susceptibility artifacts can decrease the quality of MRI scans. The aim of this cadaveric study was to demonstrate the extent that implant-related MRI artifacting affects the postFusion differentiation of determined regions of interest (ROIs). Methods In six cadaveric porcine Spines, we evaluated the postimplantation MRI scans of a titanium, cobalt-chromium and carbon spacer that differed in shape and surface qualities. A spacer made of human cortical bone was used as a control. A defined evaluation unit was divided into ROIs to characterize the spinal canal as well as the intervertebral disc space. Considering 15 different MRI sequences read independently by an interobserver-validated team of specialists the artifact-affected image quality of the median MRI slice was rated on a score of 0–3. A maximum score of 18 points (100%) for the determined ROIs was possible. Results Turbo spin echo sequences produced the best scores for all spacers and the control. Only the control achieved a score of 100%. For the determined ROI maximum scores for the cobalt-chromium, titanium and carbon spacers were 24%, 32% and 84%, respectively. Conclusion By using favored T1 TSE sequences the carbon spacer showed a clear advantage in postFusion spinal imaging. Independent of artifact dimensions, the scoring system used allowed us to create an implant-related ranking of MRI scan quality in reference to the bone control.

  • Implant detectibility of intervertebral disc spacers in post Fusion MRI: evaluation of the MRI scan quality by using a scoring system--an in vitro study.
    Neuroradiology, 2006
    Co-Authors: Thorsten Ernstberger, Gabert Heidrich, W. Schultz, Eckhardt Grabbe
    Abstract:

    Introduction Intervertebral spacers for Anterior Spine Fusion are made of different materials, such as titanium and cobalt chromium alloys and carbon fiber-reinforced polymers. Implant-related susceptibility artifacts can decrease the quality of MRI scans. The aim of this cadaveric study was to demonstrate the extent that implant-related MRI artifacting affects the postFusion differentiation of determined regions of interest (ROIs).

Metin Kaya - One of the best experts on this subject based on the ideXlab platform.

  • Assessment of Anterior Spine Fusion with the use of polyethylene cylindrical tubes in an animal model
    European Journal of Orthopaedic Surgery & Traumatology, 2007
    Co-Authors: Salim Ersozlu, Cagatay Ozturk, Ufuk Aydinli, Sahin Sirmali, Metin Kaya
    Abstract:

    Ten dogs of the same species underwent lumbar 5–6 discectomy and adjacent partial corpectomy filled with polyethylene cylindrical tube filled with autologous bone and stabilized with plate and screws. At the end of 5 months follow-up, the dogs were sacrificed and L5-L6 vertebrae were excised en bloc and CT scans were taken. All specimens underwent routine histological examination with hematoxylin and eosin (H&E) and viewed qualitatively with light microscopy. The plain X-rays and CT scans clearly showed the Fusion in all dogs. Histological examination disclosed many viable cells and normal lamella of trabecular bone formation in the bone inside and outside of both ends of the polyethylene tube. Remodeling of the bone inside the tube was apparent. Combined reconstruction using Anterior polyethylene tube with Anterior instrumentation after partial corpectomy and discectomy makes it possible to achieve biological Fusion of the bone inside the polyethylene tube with adjacent vertebral bodies. However, further animal studies from biomechanical standpoint will be helpful for their future human usage. Dix chiens de la même race ont été opérés par discectomie lombaire L-L et corporectomie adjacente comblée avec un tube cylindrique en polyéthylène rempli avec de l’os autologue et stabilisé par une plaque et des vis. Après un suivi de 5 mois les chiens ont été sacrifiés, les vertèbres L5-L6 excisées en bloc et passées au scanner. Tous les échantillons ont été examinés histologiquement avec la coloration Hématoxyline et Eosine (H & E) et analysés qualitativement au microscope. Les radiographies standard et les coupes scanographiques montraient une consolidation osseuse chez tous les chiens. L’étude histologique a mis en évidence de nombreuses cellules vivantes ainsi que de l’os trabéculaire aux deux extrémités du tube de polyéthylène. Un remodelage osseux à l’intérieur du tube était visible. Une reconstruction combinant un tube de polyéthylène avec une instrumentation antérieure après corporectomie partielle et discectomie permet une Fusion biologique à l’intérieur de ce tube à partir des corps vertébraux adjacents. Cependant d’autres études animales du point de vue biomécanique seront nécessaires avant toute application humaine future.

  • Assessment of Anterior Spine Fusion with the use of polyethylene cylindrical tubes in an animal model
    European Journal of Orthopaedic Surgery & Traumatology, 2006
    Co-Authors: Salim Ersozlu, Cagatay Ozturk, Ufuk Aydinli, Sahin Sirmali, Metin Kaya
    Abstract:

    Ten dogs of the same species underwent lumbar 5–6 discectomy and adjacent partial corpectomy filled with polyethylene cylindrical tube filled with autologous bone and stabilized with plate and screws. At the end of 5 months follow-up, the dogs were sacrificed and L5-L6 vertebrae were excised en bloc and CT scans were taken. All specimens underwent routine histological examination with hematoxylin and eosin (H&E) and viewed qualitatively with light microscopy. The plain X-rays and CT scans clearly showed the Fusion in all dogs. Histological examination disclosed many viable cells and normal lamella of trabecular bone formation in the bone inside and outside of both ends of the polyethylene tube. Remodeling of the bone inside the tube was apparent. Combined reconstruction using Anterior polyethylene tube with Anterior instrumentation after partial corpectomy and discectomy makes it possible to achieve biological Fusion of the bone inside the polyethylene tube with adjacent vertebral bodies. However, further animal studies from biomechanical standpoint will be helpful for their future human usage.

Michael D. Menger - One of the best experts on this subject based on the ideXlab platform.

  • Reliable noninvasive parameters for early detection of cardiopulmonary compromise induced by carbon dioxide thoracoretroperitoneum in minimally invasive thoracolumboendoscopic Spine surgeryrid=""id=""Presented at the annual meeting of the Society of
    Surgical Endoscopy, 2000
    Co-Authors: Brigitte Vollmar, A. Olinger, U. Hildebrandt, Michael D. Menger
    Abstract:

    Background: Using a novel endoscopic retroperitoneal approach for thoracolumbar Anterior Spine Fusion, we examined the cardiopulmonary effects of the inevitably associated carbon dioxide (CO_2) thoracoretroperitoneum and evaluated noninvasive parameters, which may provide early and adequate recognition of cardiopulmonary dysfunction. Methods: Under balanced anesthesia and paralysis, six pigs subjected to endoscopic CO_2 thoracoretroperitoneal Spine Fusion underwent extensive pulmonary and hemodynamic online monitoring throughout the operative procedure. Open thoracophrenolumbotomy in six pigs served as a control procedure. Results: In contrast to unchanged cardiopulmonary parameters during open thoracolumbar Spine surgery, CO_2 thoracoretroperitoneum caused significant hypercapnia, hypoxia, and acidemia with concomitant tachycardia, pulmonary hypertension, and systemic hypotension. Ventilatory adjustment, CO_2 evacuation, or both promptly reversed the cardiopulmonary effects. Noninvasively assessed end-tidal CO_2, peak respiratory pressure, and heart rate were early clues for detecting the tension pneumothorax-like cardiopulmonary dysfunction, as indicated by a significant correlation with the invasively assessed pulmonary hemodynamic parameters and arterial blood gases. Conclusions: During endoscopic thoracolumbar Spine Fusion, CO_2 thoracoretroperitoneum induces cardiopulmonary dysfunction, which, however, can be detected reliably by changes in end-tidal CO_2, peak respiratory pressure, and heart rate, and which can be corrected immediately by appropriate ventilatory adjustments. Therefore, endoscopic CO_2 thoracoretroperitoneal Spine Fusion might not necessarily require extraordinarily extensive and invasive monitoring of systemic and pulmonary hemodynamics, but ventilatory adjustment and intrathoracic pressure evacuation should be readily available to reexpand the lung, and to facilitate rapid normalization of hemodynamic conditions.

  • Reliable noninvasive parameters for early detection of cardiopulmonary compromise induced by carbon dioxide thoracoretroperitoneum in minimally invasive thoracolumboendoscopic Spine surgery.
    Surgical endoscopy, 2000
    Co-Authors: Brigitte Vollmar, A. Olinger, U. Hildebrandt, Michael D. Menger
    Abstract:

    Background: Using a novel endoscopic retroperitoneal approach for thoracolumbar Anterior Spine Fusion, we examined the cardiopulmonary effects of the inevitably associated carbon dioxide (CO2) thoracoretroperitoneum and evaluated noninvasive parameters, which may provide early and adequate recognition of cardiopulmonary dysfunction.

  • Cardiopulmonary dysfunction during minimally invasive thoraco-lumboendoscopic Spine surgery.
    Anesthesia and analgesia, 1999
    Co-Authors: Brigitte Vollmar, U. Hildebrandt, Angela Olinger, Michael D. Menger
    Abstract:

    The endoscopic retroperitoneal approach to thoraco-lumbar Anterior Spine Fusion is associated with CO 2 insufflation into the thoracic space. We studied the cardiopulmonary effects of this CO 2 thoraco-retroperitoneal insufflation compared with the conventional open surgical procedure using thoraco-phreno-lumbotomy in 12 pigs under balanced anesthesia, paralysis, and mechanical ventilation. During open surgery of the thoraco-lumbar Spine, animals exhibited unchanged systemic and pulmonary hemodynamics, as well as ventilation and oxygenation variables. Animals retroperitoneally insufflated with CO 2 (12 mm Hg) exhibited a significant increase of Paco 2 and a moderate decrease of Pao 2 , Sao 2 , and pH, with insignificant changes of central venous filling pressures and systemic hemodynamics. Endoscopic phrenotomy with thoracic CO 2 insufflation instantaneously and drastically affected hemodynamic status and pulmonary gas exchange with marked hypoxia, hypercapnia, systemic hypotension, tachycardia, and pulmonary hypertension within minutes. An increase of minute ventilation, inspiratory oxygen fraction, and positive end-expiratory pressure promptly reversed these cardiopulmonary effects. CO 2 evacuation allowed the animals to completely recover and regain almost baseline cardiopulmonary status, except for a reduced arterial blood pressure. Appropriate monitoring and immediate CO 2 desufflation may be beneficial in cases of therapy-resistent hemodynamic, oxygenation, and ventilation difficulties. Implications: For endoscopic thoraco-lumbar Spine Fusion, CO 2 thoraco-retroperitoneum-induced cardiopulmonary dysfunction must be of concern, especially in patients with cardiopulmonary compromise. Appropriate monitoring and immediate CO 2 desufflation may be beneficial in cases of therapy-resistant hemodynamic, oxygenation, and ventilation difficulties.