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Study DesignRetrospective comparative clinical study.PurposeThis study aimed to assess paraspinal muscle atrophy in patients who underwent minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and unilateral pedicle screw fixation using a novel contralateral intact muscle-controlled model.Overview of LiteratureThe increased incidence of paravertebral lumbar muscle injuries after open techniques has raised the importance of implementing minimally invasive spine surgical techniques using tubular retractors and minimally invasive screw placement. The functional cross-sectional area (FCSA) represents the lean muscle mass; furthermore, FCSA is a useful marker of the contractile ability of a muscle following a spine surgery. However, the benefits of unilateral fixation and MI-TLIF on paraspinal muscles have not been defined.MethodsWe performed a retrospective imagenological review on eleven patients who underwent unilateral MI-TLIF and unilateral transpedicular screw lumbar placement. FCSAs of the multifidus and erector spinae were measured 1 year after surgery at adjacent levels and were compared to the contralateral intact muscles. Measurement differences between the surgical and nonsurgical sites were compared. The interobserver reliability was calculated using an intraclass correlation coefficient.ResultsThe mean FCSA at the surgical site was 20.97±5.07 cm2 at the superior level and 8.89±2.87 cm2 at the inferior level. The mean FCSA at the contralateral nonsurgical site was 20.15±5.95 cm2 at the superior level and 9.20±2.66 cm2 at the inferior level was. The superior and inferior FCSA measurements showed no significant difference between the surgical and nonsurgical sites (p=0.5, p=0.922, respectively).ConclusionsUsing a mini-open tubular approach through the sulcus between the longissimus and iliocostalis, MI-TLIF and unilateral pedicle screw instrumentation produced minimal paraspinal muscle damage at the superior and inferior adjacent levels.

Background The COVID-19 pandemic has exerted a significant impact on health-care workers. Recent publications have reported the detrimental effects of the pandemic on neurosurgery residents in North America, Asia and Italy. However, the impact of the pandemic on neurosurgical training in Latin America and Spain has not been yet reported. In the present report we describe effects of COVID-19 on training and working conditions of neurosurgery residents in these countries. Methods An electronic survey with 33 questions was sent to neurosurgery residents between September 7, 2020 to October 7, 2020. Statistical analysis was made in IBM SPSS Statistics 25. Results 293 neurosurgery residents responded. Median age was 29.47 ± 2.6 years, 79% (n = 231) were male. 36.5% (n = 107) were of residents training from Mexico. 42% surveyed reported COVID-symptoms and two (0.7%) received ICU care. 61.4% of residents had been tested for COVID and 21.5% had a positive result. 84% of the respondents mentioned persisted with same workload (≥70 hours per week) during the pandemic. Most of residents from Mexico were assigned to management of COVID patients compared to the rest of the countries (88% vs 68.3%, p <0.001); mainly in the areas of medical care (65.4% vs 40.9%, <0.001), mechanical ventilators (16.8% vs 5.9%, p=0.003) and neurological surgeries (94% vs 83%, p=0.006). Conclusion Our results offer a first glimpse of the changes imposed by the COVID-19 pandemic to neurosurgical work and training in Latin America and Spain, where health systems rely strongly on resident workforce.

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Our study demonstrated a high accuracy (90.2%) for 2-D fluoroscopy-guided pedicle screw using electromonitoring. Only 0.71% of the 470 screws had a major breach. Knowing the radiological spine pedicle anatomy and the correct interpretation of EMG are the key factors for this technique.