Background: The pandemic of COVID-19 has a great impact on all health-care services worldwide. Neurosurgical recommendations are to postpone the endoscopic endonasal pituitary surgeries during the pandemic. We would like to express our experience with urgent pituitary adenomas during the current COVID-19 pandemic. Methods: In our country, COVID-19 has started to become a paramount problem by March 2020. Nine cases of pituitary adenomas have presented with urgent manifestations. The endoscopic endonasal approach was performed in eight patients, while a craniotomy was selected for a recurrent pituitary adenoma. Pre- and postoperative thorough clinical evaluations with chest CT scans were performed. Other strict infection control measures have been applied. Results: In 8 weeks duration starting from the past days of February 2020, we have operated on four females and five males of pituitary adenomas. Visual deterioration was the main presenting symptom. The driving factor for surgery was saving vision in eight patients. Fortunately, the postoperative course was uneventful for all patients. No suspected COVID-19 infection has been reported in any patient or health-care team except one patient. In our city, PCR test was routinely not available. Conclusion: In the era of COVID-19, strict infection control precautions should be employed to limit the possibility of transmission of any possible infection to patient or any of the surgical team. We believe that the risk of getting such infection is not increased by the endonasal approach. Long-term follow-up and large numbers of prospective studies are recommended to delineate the impact of COVID-19 infection on pituitary surgeries.

Background: Transpedicular screws are extensively utilized in lumbar spine surgery. The placement of these screws is typically guided by anatomical landmarks and intraoperative fluoroscopy. Here, we utilized 2-week postoperative computed tomography (CT) studies to confirm the accuracy/inaccuracy of lumbar pedicle screw placement in 145 patients and correlated these findings with clinical outcomes. Methods: Over 6 months, we prospectively evaluated the location of 612 pedicle screws placed in 145 patients undergoing instrumented lumbar fusions addressing diverse pathology with instability. Routine anteroposterior and lateral plain radiographs were obtained 48 h after the surgery, while CT scans were obtained at 2 postoperative weeks (i.e., ideally these should have been performed intraoperatively or within 24–48 h of surgery). Results: Of the 612 screws, minor misplacement of screws (≤2 mm) was seen in 104 patients, moderate misplacement in 34 patients (2–4 mm), and severe misplacement in 7 patients (>4 mm). Notably, all the latter 7 (4.8% of the 145) patients required repeated operative intervention. Conclusion: Transpedicular screw insertion in the lumbar spine carries the risks of pedicle medial/lateral violation that is best confirmed on CT rather than X-rays/fluoroscopy alone. Here, we additional found 7 patients (4.8%) who with severe medial/lateral pedicle breach who warranting repeated operative intervention. In the future, CT studies should be performed intraoperatively or within 24–48 h of surgery to confirm the location of pedicle screws and rule in our out medial or lateral pedicle breaches.

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Background Data: Cranial facet joint violation (FJV) by pedicle screws may increase stress to the level adjacent to the instrumentation and may contribute to adjacent segment disease (ASD). Purpose: This study determines the frequency and risk factors for cranial FJV during pedicle screw instrumentation in various lumbar spine disorders. Study Design: A retrospective study. Patients and Methods: The data and imaging of adult patients with pedicle screw instrumentation for lumbar disorders from June 2018 to June 2021 were retrospectively reviewed for cranial FJV rate and evaluated for the role of the technique of instrumentation (conventional open or percutaneous), the facet angle (FA), the lumbar level, and the type of the disorder as risk factors for this violation. Preoperative Magnetic Resonance Imaging (MRI) was reviewed to measure the FA using T2 axial images. Postoperative Computed Tomography (CT) scans were examined to determine and grade cranial FJV. Results: The study included 360 patients. The overall FJV rate was 17.6%. The FJV rate significantly increased among the percutaneous fixation group compared to that of the open one (29.2% vs. 15.9%, respectively, p = 0.001). Patients with FJV had significantly larger FAs (p < 0.001). Moreover, patients with significantly larger FAs had higher grades of FJV (p value < 0.001). The FJV rate significantly increased with FAs > 40.12° (p < 0.001). L5 level and degenerative disease were more prone to FJV and higher grades of violation. Conclusion:The method of fixation, FA, lumbar level, and the type of lumbar disorder were the independent predictors of cranial FJV. This study reported a higher rate of FJV among patients with percutaneous fixation. The larger the FA, the higher the FJV rate and grade, especially with FAs > 40.12°, L5 level, and degenerative disease. (2021ESJ242)

Background Post discectomy discitis is regarded as the most disabling cause of failed back surgery. Value of local intra-operative application of antibiotics in prevention of such complication has been a matter of debate. We evaluate the role of intraoperative intra-discal vancomycin powder instillation as a prophylaxis in prevention of postoperative discitis in patients undergoing microscopic discectomy. We allocated 100 patients undergoing discectomy equally into two groups. In the first group, a local Vancomycin powder was inserted into the disc space after finishing discectomy, and in the second group, nothing was inserted. Results The postoperative discitis was reported in 6 cases; of them, two patients were in the Vancomycin group (4%), while four patients were in the non-Vancomycin group (8%). Conclusions We concluded that the intra-operative prophylaxis, with intra-discal Vancomycin, decreased the incidence of postoperative discitis but without significant statistical difference. We advocate using local vancomycin especially in high risk patients for prevention of post discectomy discitis.