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Sample records for corrective spinal surgery

  1. CORRECTIVE SURGERY OF CONGENITAL SCOLIOSIS WITH TYPE Ⅱ SPLIT SPINAL CORD MALFORMATION

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective To investigate the corrective results of congenital scoliosis with type Ⅱ split spinal cord malformation. Methods By reviewing the medical records and roentgenograms of congenital scoliosis patients with type Ⅱ split spinal cord malformation that underwent corrective surgery, septum location and length, curve type, coronal and sagittal Cobb's angles, apical vertebral rotation and translation, and trunk shift were measured and analyzed. Results A total of 23 congenital scoliosis patients with type Ⅱ split spinal cord malformation were studied, 6 cases were due to failure of segmentation, 8 cases due to failure of formation, and the remaining 9 cases due to mixed defects. The fibrous septums were located in the thoracic spine in 8 patients, lumbar spine in 4 patients, thoracic and lumbar spine in 10 patients, and from cervical to lumbar spine in 1 patient. The septum extended an average of 4. 9 segments. Corrective surgeries included anterior correction with instrumentation in 2 patients, posterior correction with instrumentation in 11 patients, anterior release and posterior correction with instrumentation in 6 patients, anterior and posterior resection of the hemivertebra and posterior correction with instrumentation in 4 patients. The pre- and postoperative coronal Cobb's angles, apical vertebral translations, apical vertebral rotations, trunk shifts were 61.9° and 32. 5° ( P < 0. 001 ), 48. 9 mm and 31.5 mm ( P <0. 001 ), 1.2 and 1.1, 12. 7 mm and 8.2 mm, respectively. The average correction rate of coronal Cobb's angle was 47. 5%.The sagittal balance was also well improved. The fibrous septums were all left in situ. There was no neurological complication. Conclusion For congenital scoliosis with type Ⅱ split spinal cord malformation, positive correction results with no neurological complication may be obtained without resection of the fibrous septum.

  2. Pleural Effusion in Spinal Deformity Correction Surgery- A Report of 28 Cases in a Single Center.

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    Weiqiang Liang

    Full Text Available To analyze the occurrence, risk factors, treatment and prognosis of postoperative pleural effusion after spinal deformity correction surgery.The clinical and imaging data of 3325 patients undergoing spinal deformity correction were collected from the database of our hospital. We analyzed the therapeutic process of the 28 patients who had postoperative pleural effusion, and we identified the potential risk factors using logistic regression.Among the 28 patients with postoperative pleural effusion, 24 (85.7% suffered from hemothorax, 2 (7.1% from chylothorax, and 2 (7.1% from subarachnoid-pleural fistula. The pleural effusion occurred on the convex side in 19 patients (67.9%, on the concave side in 4 patients (14.3%, and on both sides in 4 patients (14.3%. One patient with left hemothorax was diagnosed with kyphosis. The treatment included conservative clinical observation for 5 patients and chest tube drainage for 23 patients. One patient also underwent thoracic duct ligation and pleurodesis. All of these treatments were successful. Logistic regression analysis showed that adult patients(≥18 years old, congenital scoliosis, osteotomy and thoracoplasty were risk factors for postoperative pleural effusion in spinal deformity correction surgery.The incidence of postoperative pleural effusion in spinal deformity correction surgery was approximately 0.84% (28/3325, and hemothorax was the most common type. Chest tube drainage treatment was usually successful, and the prognosis was good. Adult patients(≥18 years old, congenital scoliosis, and had undergone osteotomy or surgery with thoracoplasty were more likely to suffer from postoperative pleural effusion.

  3. Does corrective spine surgery improve the standing balance in patients with adult spinal deformity?

    Science.gov (United States)

    Yagi, Mitsuru; Ohne, Hideaki; Kaneko, Shinjiro; Machida, Masafumi; Yato, Yoshiyuki; Asazuma, Takashi

    2017-05-23

    The effect of corrective spine surgery on standing stability in adult spinal deformity (ASD) has not been fully documented. To compare pre- and postoperative standing balance and posture in patients with ASD. This study is a prospective case series. Standing balance before and after corrective spine surgery was compared in 35 consecutive female patients with ASD (65.6±6.9 years, body mass index 22.3±2.7 kg/m(2), Cobb angle 50.2±19.2°, C7 plumb line 9.3±5.6 cm, and pelvic incidence-lumbar lordosis mismatch 40.8±23.3°). The Scoliosis Research Society Patient Questionnaire, the Oswestry Disability Index, and force-plate analysis were used to evaluate the patient outcomes. We reviewed patient charts and X-rays and compared standing balance before and after corrective spine surgery. All subjects were assessed by force-plate analysis using optical markers while standing naturally on a custom-built force platform. The spinal tilt, pelvic obliquity, pelvic tilt, and joint angle were calculated. The lower leg lean volume was obtained by whole-body dual X-ray absorptiometry to assess muscle strength. ASD patients showed significant differences between the left and right sides in ground reaction force (dGRFs), hip (dHip), and knee angle (dKnee) while standing (dGRF 15.1±8.7%, dHip 7.1±6.6°, dKnee 5.9±5.5°). The recorded center-of-gravity (CoG) area was not improved after surgery, whereas the dGRF, dHip, and dKnee all decreased. The spinal tilt, pelvic obliquity, and pelvic tilt were all significantly improved after surgery. We found significant correlations between the radiographic trunk shift and the postoperative coronal CoG distance and recorded CoG area, and between the sagittal CoG distance and the age and the lean volume of the lower extremities (trunk shift R=0.33, 0.45; age R=0.32; lean volume R=0.31). Corrective spinal surgery improved the spinal alignment and joint angles in patients with ASD but did not improve the standing stability. A correlation

  4. Corrective Jaw Surgery

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  5. The prognostic value of pre-operative predicted forced vital capacity in corrective spinal surgery for Duchenne's muscular dystrophy.

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    Harper, C M; Ambler, G; Edge, G

    2004-12-01

    The majority of patients with Duchenne's muscular dystrophy require corrective spinal surgery for scoliosis to maintain seated balance and to slow the progression of respiratory compromise, thereby facilitating nursing and enhancing their quality of life. Traditionally patients with a pre-operative forced vital capacity (PFVC) of 30% or below predicted have been denied this surgery as it was thought that the incidence of postoperative complications was unacceptably high. We present data collected prospectively from 45 consecutive operations undertaken in our unit. These cases indicate that there is no clinically significant difference in operative and postoperative outcomes between patients with PFVC > 30% and vital.

  6. Corrective Jaw Surgery

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  7. Corrective Jaw Surgery

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    ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  8. Mini-Open Anterior Lumbar Interbody Fusion Combined with Lateral Lumbar Interbody Fusion in Corrective Surgery for Adult Spinal Deformity

    Science.gov (United States)

    Lee, Chong-Suh; Chung, Sung-Soo; Lee, Jun-Young; Yum, Tae-Hoon; Shin, Seong-Kee

    2016-01-01

    Study Design Prospective observational study. Purpose To introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformity Overview of Literature Although LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal. Methods Thirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5–S1 or L4–S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded. Results No major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p sagittal balance and reducing the necessity of more extensive surgery. PMID:27994777

  9. Corrective Jaw Surgery

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    Full Text Available ... of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on ...

  10. Corrective Jaw Surgery

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    Full Text Available ... functional problems. Jaw Surgery can have a dramatic effect on many aspects of life. Following are some of the conditions that may indicate the need for corrective jaw surgery: Difficulty chewing, or biting food Difficulty swallowing Chronic jaw or jaw joint (TMJ) ...

  11. A prospective, randomized, double-blinded single-site control study comparing blood loss prevention of tranexamic acid (TXA to epsilon aminocaproic acid (EACA for corrective spinal surgery

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    Vaz Kenneth M

    2010-04-01

    Full Text Available Abstract Background Multilevel spinal fusion surgery has typically been associated with significant blood loss. To limit both the need for transfusions and co-morbidities associated with blood loss, the use of anti-fibrinolytic agents has been proposed. While there is some literature comparing the effectiveness of tranexamic acid (TXA to epsilon aminocaproic acid (EACA in cardiac procedures, there is currently no literature directly comparing TXA to EACA in orthopedic surgery. Methods/Design Here we propose a prospective, randomized, double-blinded control study evaluating the effects of TXA, EACA, and placebo for treatment of adolescent idiopathic scoliosis (AIS, neuromuscular scoliosis (NMS, and adult deformity (AD via corrective spinal surgery. Efficacy will be determined by intraoperative and postoperative blood loss. Other clinical outcomes that will be compared include transfusion rates, preoperative and postoperative hemodynamic values, and length of hospital stay after the procedure. Discussion The primary goal of the study is to determine perioperative blood loss as a measure of the efficacy of TXA, EACA, and placebo. Based on current literature and the mechanism by which the medications act, we hypothesize that TXA will be more effective at reducing blood loss than EACA or placebo and result in improved patient outcomes. Trial Registration ClinicalTrials.gov ID: NCT00958581

  12. Corrective Jaw Surgery

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  13. Corrective Jaw Surgery

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  14. Corrective Jaw Surgery

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  15. Corrective Jaw Surgery

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    Full Text Available ... implant surgery is, of course, surgery, and is best performed by a trained surgeon with specialized education ... implant surgery is, of course, surgery, and is best performed by a trained surgeon with specialized education ...

  16. Corrective Jaw Surgery

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    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  17. Corrective Jaw Surgery

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    ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ...

  18. Corrective Jaw Surgery

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  19. Corrective Jaw Surgery

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  20. Corrective Jaw Surgery

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  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may ...

  2. Corrective Jaw Surgery

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    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  3. Corrective Jaw Surgery

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    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  4. Remote cerebellar hemorrhage after lumbar spinal surgery

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    Cevik, Belma [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: belmac@baskent-ank.edu.tr; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet [Baskent University Faculty of Medicine, Department of Radiology, Fevzi Cakmak Cad. 10. sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)

    2009-04-15

    Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

  5. Timing of Surgery After Spinal Cord Injury.

    Science.gov (United States)

    Piazza, Matthew; Schuster, James

    2017-01-01

    Although timing for surgical intervention after spinal cord injury remains controversial, there is accumulating evidence suggesting that early surgery may improve neurologic outcomes, particularly with incomplete spinal cord injury, and may reduce non-neurologic complications and health care resource utilization. Moreover, even in patients with complete spinal cord injury, minor improvement in neurologic function can lead to significant changes in quality of life. This article reviews the experimental and clinical data examining surgical timing after spinal cord injury.

  6. Corrective Jaw Surgery

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    Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who We Are News Videos Contact Find a Surgeon What We ... may require one or more surgeries depending on the extent of the repair needed. Click here to ...

  7. The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery.

    Science.gov (United States)

    Boissière, Louis; Bourghli, Anouar; Vital, Jean-Marc; Gille, Olivier; Obeid, Ibrahim

    2013-06-01

    Sagittal malalignment is frequently observed in adult scoliosis. C7 plumb line, lumbar lordosis and pelvic tilt are the main factors to evaluate sagittal balance and the need of a vertebral osteotomy to correct it. We described a ratio: the lumbar lordosis index (ratio lumbar lordosis/pelvic incidence) (LLI) and analyzed its relationships with spinal malalignment and vertebral osteotomies. 53 consecutive patients with a surgical adult scoliosis had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters and LLI. The lack of lordosis was calculated after prediction of theoretical lumbar lordosis. Correlation analysis between the different parameters was performed. All parameters were correlated with spinal malalignment but LLI is the most correlated parameter (r = -0.978). It is also the best parameter in this study to predict the need of a spinal osteotomy (r = 1 if LLI <0.5). LLI is a statistically validated parameter for sagittal malalignment analysis. It can be used as a mathematical tool to detect spinal malalignment in adult scoliosis and guides the surgeon decision of realizing a vertebral osteotomy for adult scoliosis sagittal correction. It can be used as well for the interpretation of clinical series in adult scoliosis.

  8. Corrective Jaw Surgery

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    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... It can also invite bacteria that lead to gum disease. Click here to find out more. Corrective Jaw ...

  9. Corrective Jaw Surgery

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    Full Text Available ... which will probably include orthodontics before and after surgery, may take several years to complete. Your OMS and orthodontist understand that this is a long-term commitment for you and your family, and will try to realistically estimate the time ...

  10. Common surgical complications in degenerative spinal surgery.

    Science.gov (United States)

    Papadakis, Michael; Aggeliki, Lianou; Papadopoulos, Elias C; Girardi, Federico P

    2013-04-18

    The rapid growth of spine degenerative surgery has led to unrelenting efforts to define and prevent possible complications, the incidence of which is probably higher than that reported and varies according to the region of the spine involved (cervical and thoracolumbar) and the severity of the surgery. Several issues are becoming progressively clearer, such as complication rates in primary versus revision spinal surgery, complications in the elderly, the contribution of minimally invasive surgery to the reduction of complication rate. In this paper the most common surgical complications in degenerative spinal surgery are outlined and discussed.

  11. [Orthognathic surgery: corrective bone operations].

    Science.gov (United States)

    Reuther, J

    2000-05-01

    The article reviews the history of orthognathic surgery from the middle of the last century up to the present. Initially, mandibular osteotomies were only performed in cases of severe malformations. But during the last century a precise and standardized procedure for correction of the mandible was established. Multiple modifications allowed control of small fragments, functionally stable osteosynthesis, and finally a precise positioning of the condyle. In 1955 Obwegeser and Trauner introduced the sagittal split osteotomy by an intraoral approach. It was the final breakthrough for orthognathic surgery as a standard treatment for corrections of the mandible. Surgery of the maxilla dates back to the nineteenth century. B. von Langenbeck from Berlin is said to have performed the first Le Fort I osteotomy in 1859. After minor changes, Wassmund corrected a posttraumatic malocclusion by a Le Fort I osteotomy in 1927. But it was Axhausen who risked the total mobilization of the maxilla in 1934. By additional modifications and further refinements, Obwegeser paved the way for this approach to become a standard procedure in maxillofacial surgery. Tessier mobilized the whole midface by a Le Fort III osteotomy and showed new perspectives in the correction of severe malformations of the facial bones, creating the basis of modern craniofacial surgery. While the last 150 years were distinguished by the creation and standardization of surgical methods, the present focus lies on precise treatment planning and the consideration of functional aspects of the whole stomatognathic system. To date, 3D visualization by CT scans, stereolithographic models, and computer-aided treatment planning and simulation allow surgery of complex cases and accurate predictions of soft tissue changes.

  12. Neuroimaging for spine and spinal cord surgery

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    Koyanagi, Izumi [Hokkaido Neurosurgical Memorial Hospital (Japan); Iwasaki, Yoshinobu; Hida, Kazutoshi

    2001-01-01

    Recent advances in neuroimaging of the spine and spinal cord are described based upon our clinical experiences with spinal disorders. Preoperative neuroradiological examinations, including magnetic resonance (MR) imaging and computerized tomography (CT) with three-dimensional reconstruction (3D-CT), were retrospectively analyzed in patients with cervical spondylosis or ossification of the posterior longitudinal ligament (130 cases), spinal trauma (43 cases) and intramedullary spinal cord tumors (92 cases). CT scan and 3D-CT were useful in elucidating the spine pathology associated with degenerative and traumatic spine diseases. Visualization of the deformity of the spine or fracture-dislocation of the spinal column with 3D-CT helped to determine the correct surgical treatment. MR imaging was most important in the diagnosis of both spine and spinal cord abnormalities. The axial MR images of the spinal cord were essential in understanding the laterality of the spinal cord compression in spinal column disorders and in determining surgical approaches to the intramedullary lesions. Although non-invasive diagnostic modalities such as MR imaging and CT scans are adequate for deciding which surgical treatment to use in the majority of spine and spinal cord disorders, conventional myelography is still needed in the diagnosis of nerve root compression in some cases of cervical spondylosis. (author)

  13. Role of fetal surgery in spinal dysraphism

    Directory of Open Access Journals (Sweden)

    A Martina Messing-Jünger

    2013-01-01

    Full Text Available Open spinal dysraphism is a common and clinically challenging organo-genetic malformation. Due to the well-known multi-organ affection with significant implication on the lives of patients and their families, abortion after prenatal diagnosis became reality in most parts of the world. After publication of the Management of Myelomeningocele Study (MOMS results fetal surgery seems to be a new option and a broad discussion arose regarding advantages and risks of in utero treatment of spina bifida. This paper tries to evaluate objectively the actual state of knowledge and experience. This review article gives a historical overview as well as the experimental and pathophysiological background of fetal surgery in open spinal dysraphism. Additionally clinical follow-up experience of foetoscopically treated patients are presented and discussed. After carefully outweighing all available information on fetal surgery for spina bifida, one has to conclude, in accordance with the MOMS investigators, that in utero surgery cannot be considered a standard option at present time. But there is clear evidence of the hypothesis that early closure of the spinal canal has a positive influence on spinal cord function and severity of Chiari malformation type II, has been proven. A persisting problem is the fetal risk of prematurity and the maternal risk of uterus damage. There is also evidence that due to technical restrictions, fetal closure of the spinal canal bears unsolved problems leading to a higher postnatal incidence of complication surgery. Finally, missing long-term results make a definite evaluation impossible so far. At the moment, fetal surgery in open spinal dysraphism is not a standard of care despite promising results regarding central nervous system protection due to early spinal canal closure. Many technical problems need to be solved in the future in order to make this option a safe and standard one.

  14. Neurologic Outcomes of Complex Adult Spinal Deformity Surgery

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    Lenke, Lawrence G; Fehlings, Michael G; Shaffrey, Christopher I

    2016-01-01

    STUDY DESIGN: Prospective, multicenter, international observational study. OBJECTIVE: To evaluate motor neurologic outcomes in patients undergoing surgery for complex adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA: The neurologic outcomes after surgical correction for ASD have been...... reported with significant variability and have not been measured as a primary endpoint in any prospective, multicenter, observational study. METHODS: The primary outcome measure was the change in American Spinal Injury Association (ASIA) Lower Extremity Motor Scores (LEMS) obtained preoperatively...... with a preoperative neurologic deficit, a significant portion of patients with ASD experienced postoperative decline in LEMS. Measures that can anticipate and reduce the risk of postoperative neurologic complications are warranted. LEVEL OF EVIDENCE: 3....

  15. SURGICAL CORRECTION OF SPINAL DEFORMITY IN IDIOPATHIC SCOLIOSIS: THE HISTORY AND CURRENT STATE (REVIEW

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    S. V. Vissarionov

    2013-01-01

    Full Text Available The article presents the historical and contemporary aspects of the state of the question correct scoliosis spine with dorsal and ventral spinal systems. The variants of spinal deformity correction method from Harrington to modern surgical techniques using both hook and metal screw. Detailed technological aspects of surgical interventions for the correction of spinal deformity using a variety of spinal structures. A comparative estimate of the correction of spinal deformity, the impact on the result of the initial mobility of the spine, level metallofiksatsii vertebral-motor segment, as well as the degree of true derotation vertebrae at the top of the curvature in a variety of surgical procedures. Describes the advantages and disadvantages of options for surgery.

  16. FACTORS ASSOCIATED WITH INFECTIONS IN SPINAL SURGERY

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    ANA MARÍA MORALES LÓPEZ

    Full Text Available ABSTRACT Objective: To identify the factors associated with postoperative infections in spinal surgery. Methods: Descriptive, retrospective, cross-sectional study conducted in the spine surgery department of the Medical Unit of High Specialty (UMAE at the Hospital of Traumatology and Orthopedics Lomas Verdes, Mexican Institute of Social Security (IMSS between January 01, 2013 and June 30, 2014 through medical records of the service and the records of clinical care. Data were gathered in accordance with the records of patients with infection after spinal surgery. The factors considered were age group, etiologic agent, surgical site, type of treatment, bleeding volume and pharmacotherapy. Frequency and descriptive statistic was conducted. The rank sum test with the Wilcoxon test for a single sample was performed in different measurements; Pearson's correlation was calculated and all p<0.05 values were considered significant. Results: The sample was composed of 14 patients of which 11 were female (78.6% and 3 male (21.4% with predominance of surgical area in the lumbar and dorsolumbar region. There was a significant correlation between the surgical time and the amount of bleeding with p<0.001. Conclusions: It was clear that the infections present in patients after spinal surgery are multifactorial. However, in this study the correlation between time of surgery and bleeding amount had the highest importance and relevance.

  17. Recurrent spinal deformity after scoliosis surgery in children.

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    Gomez, Jaime A; Makhni, Melvin C; Vitale, Michael G

    2014-01-01

    The management of complex spinal deformities in the growing child continues to evolve. The implementation of new techniques and biomaterial constructs has improved outcomes of deformity correction procedures but has also led to unforeseen complications. After spinal alignment through posterior instrumentation and fusion, progressive global decompensation in the coronal and sagittal planes or local decompensation in the vertebral segments adjacent to the fusion have developed in some children. These complications can lead to poor cosmesis, function, and quality of life, and a higher risk for revision surgery. Although postoperative spinal imbalance develops in few children, diligent monitoring of patients with predisposing risk factors for decompensation will allow surgeons to better predict, manage, and potentially prevent these complications.

  18. Navigation, robotics, and intraoperative imaging in spinal surgery.

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    Ringel, Florian; Villard, Jimmy; Ryang, Yu-Mi; Meyer, Bernhard

    2014-01-01

    Spinal navigation is a technique gaining increasing popularity. Different approaches as CT-based or intraoperative imaging-based navigation are available, requiring different methods of patient registration, bearing certain advantages and disadvantages. So far, a large number of studies assessed the accuracy of pedicle screw implantation in the cervical, thoracic, and lumbar spine, elucidating the advantages of image guidance. However, a clear proof of patient benefit is missing, so far. Spinal navigation is closely related to intraoperative 3D imaging providing an imaging dataset for navigational use and the opportunity for immediate intraoperative assessment of final screw position giving the option of immediate screw revision if necessary. Thus, postoperative imaging and a potential revision surgery for screw correction become dispensable.Different concept of spinal robotics as the DaVinci system and SpineAssist are under investigation.

  19. Smartphone apps for spinal surgery: is technology good or evil?

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    Robertson, Greg A J; Wong, Seng Juong; Brady, Richard R; Subramanian, Ashok S

    2016-05-01

    The increased utilization of smartphones together with their downloadable applications (apps) provides opportunity for doctors, including spinal surgeons, to integrate such technology into clinical practice. However, the clinical reliability of the medical app sector remains questionable. We reviewed available apps themed specifically towards spinal surgery and related conditions and assessed the level of medical professional involvement in their design and content. The most popular smartphone app stores (Android, Apple, Blackberry, Windows, Samsung, Nokia) were searched for spinal surgery-themed apps, using the disease terms Spinal Surgery, Back Surgery, Spine, Disc Prolapse, Sciatica, Radiculopathy, Spinal Stenosis, Scoliosis, Spinal Fracture and Spondylolisthesis. A total of 78 individual spinal surgery themed apps were identified, of which there were six duplicates (N = 72). According to app store classifications, there were 57 (79 %) medical themed apps, 11 (15 %) health and fitness themed apps, 1 (1 %) business and 3 (4 %) education themed apps. Forty-five (63 %) apps were available for download free of charge. For those that charged access, the prices ranged from £0.62 to £47.99. Only 44 % of spinal surgery apps had customer satisfaction ratings and 56 % had named medical professional involvement in their development or content. This is the first study to specifically address the characteristics of apps related to spinal surgery. We found that nearly half of spinal surgery apps had no named medical professional involvement, raising concerns over app content and evidence base for their use. We recommend increased regulation of spinal surgical apps to improve the accountability of app content.

  20. Postoperative Surgical Infection After Spinal Surgery in Rheumatoid Arthritis.

    Science.gov (United States)

    Koyama, Kensuke; Ohba, Tetsuro; Ebata, Shigeto; Haro, Hirotaka

    2016-05-01

    Individuals with rheumatoid arthritis are at higher risk for infection than the general population, and surgical site infection after spinal surgery in this population can result in clinically significant complications. The goal of this study was to identify risk factors for acute surgical site infection after spinal surgery in patients with rheumatoid arthritis who were treated with nonbiologic (conventional) disease-modifying antirheumatic drugs (DMARDs) alone or with biologic DMARDs. All patients treated with biologic agents were treated with nonbiologic agents as well. The authors performed a retrospective, single-center review of 47 consecutive patients with rheumatoid arthritis who underwent spinal surgery and had follow-up of 3 months or longer. The incidence of surgical site infection was examined, and multivariate logistic regression analysis was performed to test the association of surgical site infection with putative risk factors, including the use of biologic agents, methotrexate, and prednisolone, as well as the duration of rheumatoid arthritis, the presence of diabetes, patient age, length of surgery, and number of operative levels. After spinal surgery, 14.89% (7 of 47) of patients had surgical site infection. Use of methotrexate and/or prednisolone, patient age, diabetes, duration of rheumatoid arthritis, length of surgery, number of operative levels, and use of biologic DMARDs did not significantly increase the risk of infection associated with spinal surgery. All patients who had surgical site infection had undergone spinal surgery with instrumentation. The findings show that greater attention to preventing surgical site infection may be needed in patients with rheumatoid arthritis who undergo spinal surgery with instrumentation. To the authors' knowledge, this is the first study to show that the use of biologic agents did not increase the incidence of surgical site infection after spinal surgery in patients with rheumatoid arthritis

  1. How to avoid perioperative visual loss following prone spinal surgery

    Science.gov (United States)

    Epstein, Nancy E.

    2016-01-01

    Background: In a prior article, “Perioperative visual loss (POVL) following prone spinal surgery: A review,” Epstein documented that postoperative visual loss (POVL) occurs in from 0.013% to 0.2% of spine procedures performed in the prone position. POVL is largely attributed to ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO), cortical blindness (CB), direct compression (prone pillows/horseshoe, eye protectors), and rarely, acute angle closure glaucoma. Methods: Risk factors for ION include prolonged surgery, extensive fusions, anemia, hypotension, hypovolemia, diabetes, obesity, use of the Wilson frame, male sex, and microvascular pathology. CRAO may result from improper prone positioning (e.g., eye compression or rotation contributing to jugular/venous or carotid compression), while CB more typically results from both direct compression and obesity. Results: Several preventive/prophylactic measures should limit the risk of POVL. The routine use of an arterial line and continuous intraoperative monitoring document intraoperative hypotension/hypovolemia/anemia that can be immediately corrected with appropriate resuscitative measures. Application of a 3-pin head holder completely eliminates direct eye compression and maintains the neck in a neutral posture, thus avoiding rotation that can contribute to jugular/venous obstruction and/or inadvertent carotid compression. In addition, elevating the head 10° from the horizontal directly reduces intraocular pressure. Conclusions: The best way to avoid POVL following prone spine surgery is to prevent it. Routine use of an arterial line, intraoperative monitoring, a 3-pin head holder, and elevation of the head 10° from the horizontal should limit the risk of encountering POVL after spinal procedures performed in the prone position. PMID:27274406

  2. "The effect of halo traction between anterior and posterior spinal fusion on the correction of scoliosis "

    Directory of Open Access Journals (Sweden)

    Behtash H

    2007-04-01

    Full Text Available Background: The currently accepted treatment of scoliosis are bracing and surgery. Two-stage anterior and posterior spinal fusion is used to correct scoliosis. It seems that the application of a longitudinal force to the axis of the spinal column as a means of stabilizing by halo traction, may increase the correction of the curve. The aim of this study was to evaluate the effect of halo traction used between the two stages of corrective surgery, anterior and posterior spinal fusion, on the correction of scoliosis curvature. Methods: In this randomized clinical trial twelve scoliotic patients, aged from 12-19 years old, were treated by two-stage anterior spinal release and fusion (ASF and posterior spinal fusion (PSF. The patients were divided in two groups: 6 scoliotic patients without any traction between ASF and PSF surgeries (group A, and 6 scoliotic patients were undergone halo traction for one week between ASF and PSF surgeries (group B. Major curve angle was measured before surgery, one week after ASF and one year after PSF surgeries. Data were collected and analyzed using SPSS v.13.5. Results: The mean baseline curve angles were 90° (SD=18.70 and 94.17°(SD=28.18 in groups A and B, respectively. Whereas, the mean final curve angles (one year after PSF were 51.17°(SD=29.59 and 39.17°(23.11 in groups A and B, respectively. Final angle improvement was 46.58% (SD=20.31 in patients without traction and 61.32% (SD=14.02 in patients with halo traction. The major curve angles showed significantly better correction in patients with traction one week after ASF [38.67°(SD=7.86 vs. 25°(SD=6.28, P=0.012]. This difference persisted at the end of the first year after operation. [55°(SD=8.94 vs. 38.83°(SD=11.65, P=0.022]. Conclusion: Application of halo traction between ASF and PSF surgeries may lead to better improvement of the scoliotic curvature and short time application of halo traction decreases possible complications.

  3. Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

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    Michael Y. Wang

    2012-01-01

    Full Text Available Introduction. Adult spinal deformity (ASD surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws. Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females. Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body. Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation. Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs.

  4. Spinal Surgery Complications and Failures in Patients with Parkinsons Disease.

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    Sapkas, George S; Mavrogenis, Andreas F; Papastathis, Elias; Tsiavos, Kostas; Igoumenou, Vasilios; Megaloikonomos, Panayiotis D; Galanopoulos, Ioannis; Soultanis, Konstantinos; Papadopoulos, Elias C; Papagelopoulos, Panayiotis J

    2016-01-01

    Parkinson's disease is a degenerative disorder of the central nervous system affecting the substantia nigra in the midbrain. It accounts for 1.5% of the population in Europe over 60 years of age. Recent advances in the medical treatment of Parkinson's disease have improved the quality of life and life expectancy of the patients. However, it remains a debilitating disease. Spinal disorders are frequent in these patients, and as the population ages, more patients with Parkinson's disease are expected to require spinal surgery. Spinal surgery in patients with Parkinson's disease has been associated with an exceptionally high rate of complications; failures and reoperations are common, and patient outcomes are dismal.

  5. Pain prevalence and trajectories following pediatric spinal fusion surgery

    OpenAIRE

    Sieberg, Christine B; Simons, Laura E.; Edelstein, Mark R.; DeAngelis, Maria R.; Pielech, Melissa; Sethna, Navil; Hresko, M. Timothy

    2013-01-01

    Factors contributing to pain following surgery are poorly understood with previous research largely focused on adults. With approximately 6 million children undergoing surgery each year8, there is a need to study pediatric persistent postsurgical pain. The present study includes patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery enrolled in a prospective, multi-centered registry examining post-surgical outcomes. The Scoliosis Research Society Questionnaire- Version...

  6. Evaluating perfusion of thoracic spinal cord blood using CEUS during thoracic spinal stenosis decompression surgery.

    Science.gov (United States)

    Ling, J; Jinrui, W; Ligang, C; Wen, C; Xiaoguang, L; Liang, J

    2015-01-13

    Study design:A clinical study in human spinal cord.Objectives:To evaluate changes in spinal cord blood perfusion in patients with thoracic spinal stenosis using contrast-enhanced ultrasonography and to semiquantitatively analyze blood perfusion changes in compressed spinal cord before and after ventral decompression.Setting:Ultrasound department of a university hospital.Methods:Twelve patients with confirmed thoracic spinal stenosis who needed decompression surgery participated. They underwent an intravenous injection of a contrast agent before and after ventral decompression. Quantitative analysis software (Philips Healthcare, Bothell, WA, USA) was used to perform time-intensity curve (TIC) analysis. The enhanced intensity (ΔI), rise time (ΔT) and slope of the TIC (β) were separately calculated; t-tests of the independent samples were performed on the indicators.Results:The TICs showed no significant differences between compressed spinal cord and normal spinal cord in ΔT, enhanced ΔI and β (P= 0.46, P=0.23 and P=0.16, respectively). After ventral decompression, ΔI of the originally compressed spinal cord increased substantially (P= 0.04) compared with ΔI of the normal spinal cord; however, the ΔT and β showed no significant differences (P= 0.18 and P=0.09, respectively). Comparison of the blood perfusion parameters (that is, ΔT and ΔI) of the compressed spinal cords before and after ventral decompression showed no significant differences (P=0.14 and P=0.12, respectively), but β showed significant difference (P=0.02).Conclusion:Contrast-enhanced ultrasonography can dynamically display spinal cord blood perfusion. The characteristics of blood perfusion can be semiquantitatively analyzed using a software technique.Spinal Cord advance online publication, 13 January 2015; doi:10.1038/sc.2014.213.

  7. Decompression surgery for spinal metastases: a systematic review.

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    Bakar, Dara; Tanenbaum, Joseph E; Phan, Kevin; Alentado, Vincent J; Steinmetz, Michael P; Benzel, Edward C; Mroz, Thomas E

    2016-08-01

    OBJECTIVE The aim of this study was to systematically review the literature on reported outcomes following decompression surgery for spinal metastases. METHODS The authors conducted MEDLINE, Scopus, and Web of Science database searches for studies reporting clinical outcomes and complications associated with decompression surgery for metastatic spinal tumors. Both retrospective and prospective studies were included. After meeting inclusion criteria, articles were categorized based on the following reported outcomes: survival, ambulation, surgical technique, neurological function, primary tumor histology, and miscellaneous outcomes. RESULTS Of the 4148 articles retrieved from databases, 36 met inclusion criteria. Of those included, 8 were prospective studies and 28 were retrospective studies. The year of publication ranged from 1992 to 2015. Study size ranged from 21 to 711 patients. Three studies found that good preoperative Karnofsky Performance Status (KPS ≥ 80%) was a significant predictor of survival. No study reported a significant effect of time-to-surgery following the onset of spinal cord compression symptoms on survival. Three studies reported improvement in neurological function following surgery. The most commonly cited complication was wound infection or dehiscence (22 studies). Eight studies reported that preoperative ambulatory or preoperative motor status was a significant predictor of postoperative ambulatory status. A wide variety of surgical techniques were reported: posterior decompression and stabilization, posterior decompression without stabilization, and posterior decompression with total or subtotal tumor resection. Although a wide range of functional scales were used to assess neurological outcomes, four studies used the American Spinal Injury Association (ASIA) Impairment Scale to assess neurological function. Four studies reported the effects of radiation therapy and local disease control for spinal metastases. Two studies reported that

  8. Bone cement implantation syndrome during spinal surgery requiring cardiac surgery.

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    Sastre, José A; López, Teresa; Dalmau, María J; Cuello, Rafael E

    2013-12-15

    During a posterior segmental spinal fusion procedure, a 71-year-old woman developed cardiac and pulmonary embolism characterized by nonsustained ventricular tachycardia during cement injection, rapid and severe hypoxemia, and hemodynamic instability. Management included exploratory cardiotomy under cardiopulmonary bypass and removal of the emboli from the pulmonary vessels. Postoperative recovery was successful, and the patient was discharged without sequelae. We discuss the pathophysiology of bone cement implantation syndrome during spinal fusion, possible causative factors, and treatment alternatives.

  9. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than ty

  10. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than

  11. How to avoid perioperative visual loss following prone spinal surgery

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2016-01-01

    Conclusions: The best way to avoid POVL following prone spine surgery is to prevent it. Routine use of an arterial line, intraoperative monitoring, a 3-pin head holder, and elevation of the head 10° from the horizontal should limit the risk of encountering POVL after spinal procedures performed in the prone position.

  12. Sexual and reproductive function in spinal cord injury and spinal surgery patients

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    Theodore H. Albright

    2015-09-01

    Full Text Available Sexual and reproductive health is important quality of life outcomes, which can have a major impact on patient satisfaction. Spinal pathology arising from trauma, deformity, and degenerative disease processes may be detrimental to sexual and reproductive function. Furthermore, spine surgery may impact sexual and reproductive function due to post-surgical mechanical, neurologic, and psychological factors. The aim of this paper is to provide a concise evidence-based review on the impact that spine surgery and pathology can have on sexual and reproductive function. A review of published literature regarding sexual and reproductive function in spinal injury and spinal surgery patients was performed. We have found that sexual and reproductive dysfunction can occur due to numerous etiological factors associated with spinal pathology. Numerous treatment options are available for those patients, depending on the degree of dysfunction. Spine surgeons and non-operative healthcare providers should be aware of the issues surrounding sexual and reproductive function as related to spine pathology and spine surgery. It is important for spine surgeons to educate their patients on the operative risks that spine surgery encompasses with regard to sexual dysfunction, although current data examining these topics largely consists of level IV data.

  13. [Spinal meningioma surgery after 75 years of age].

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    Sacko, O; Rabarijaona, M; Loiseau, H

    2008-08-01

    Spinal meningioma surgery is usually not difficult and is commonly associated with good outcome. However, advanced age and severe neurological deficit have been considered to be predictors of poor surgical outcome. Therefore, we attempted to assess the surgical outcome of spinal meningiomas in the elderly and to analyze the role of outcome predictors. From 1990 to 2006, 32 patients 76 years or older with spinal meningiomas were operated on in our Neurosurgery Departments. All patients had MRI. Neurological status was assessed using the Solero score. Neurological evaluations were conducted three months and one year after surgery. The mean follow-up was 36 months. A multiple logistic regression was applied to establish the relationship between the risk factors and outcome. The median age was 79.3 years. The mean duration of symptoms until surgery was 12.7 months. One patient was rated Solero grade I, 11 grade II, 17 grade III and three patients were rated grade IV. Radical tumor removal was performed in 30 patients (94%). All meningiomas were benign. There was no recurrence, morbidity was 9%, and 1-year mortality was 0%. One year after surgery, all patients had improved, 56 % had recovered completely. Among 20 patients with severe paraparesis or paraplegia, 30 % had recovered completely. There was no statistical correlation between outcome and various risk factors: age, gender, ASA, tumor size, quality of tumor removal, and location. Only preoperative Solero score and duration of symptoms before surgery were statistically significant. Surgery is the only treatment of symptomatic spinal meningioma. Advanced age did not seem to contraindicate surgery, even in those with severe preoperative neurological deficits, because quality of life can be improved in the vast majority of cases. There was a correlation between duration and severity of deficit and outcome.

  14. 5-Aminolevulinic acid fluorescence-guided surgery for spinal meningioma.

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    Muroi, Carl; Fandino, Javier; Coluccia, Daniel; Berkmann, Sven; Fathi, Ali-Reza; Landolt, Hans

    2013-01-01

    Fluorescence-guided surgery for cranial meningioma has been reported to be useful. There are no reports about spinal cases using this technique. We report on a meningioma of the cervical spine for which fluorescence-guided surgery was used. A 78-year-old female patient with a meningioma located in the cervical spine underwent surgery using fluorescence guidance. After complete removal of the meningioma and removal and coagulation of the dural attachment (equal to Simpson grade II resection), a fluorescence-positive remnant could be identified and successfully removed. The remnant was found to harbor meningioma tissue on histological examination. Fluorescence-guided microsurgery is helpful in achieving a total resection of spinal meningiomas, and might therefore reduce the risk of recurrence. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Preliminary development of augmented reality systems for spinal surgery

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    Nguyen, Nhu Q.; Ramjist, Joel M.; Jivraj, Jamil; Jakubovic, Raphael; Deorajh, Ryan; Yang, Victor X. D.

    2017-02-01

    Surgical navigation has been more actively deployed in open spinal surgeries due to the need for improved precision during procedures. This is increasingly difficult in minimally invasive surgeries due to the lack of visual cues caused by smaller exposure sites, and increases a surgeon's dependence on their knowledge of anatomical landmarks as well as the CT or MRI images. The use of augmented reality (AR) systems and registration technologies in spinal surgeries could allow for improvements to techniques by overlaying a 3D reconstruction of patient anatomy in the surgeon's field of view, creating a mixed reality visualization. The AR system will be capable of projecting the 3D reconstruction onto a field and preliminary object tracking on a phantom. Dimensional accuracy of the mixed media will also be quantified to account for distortions in tracking.

  16. The impact of fluorescence guidance on spinal intradural tumour surgery.

    Science.gov (United States)

    Eicker, Sven O; Floeth, Frank W; Kamp, Marcel; Steiger, Hans-Jakob; Hänggi, Daniel

    2013-06-01

    5-Aminolevulinic acid (5-ALA)-based fluorescence-guided surgery was shown to be beneficial for cerebral malignant gliomas. Extension of this technique for resection of meningiomas and cerebral metastasis has been recently evaluated. Aim of the present study is to evaluate the impact of fluorescence-guided surgery in spinal tumor surgery. Twenty-six patients with intradural spinal tumors were included in the study. 5-ALA was administered orally prior to the induction of anesthesia. Intraoperative, 440 nm fluorescence was applied after exploration of the tumor and, if positive, periodically during and at the end of resection to detect tumor-infiltrated sites. Tumors of WHO grade III and IV were found in five patients. In detail intra- or perimedullary metastasis of malignant cerebral gliomas was found including glioblastoma WHO grade IV (n = 2), anaplastic astrocytoma WHO grade III (n = 1), anaplastic oligoastrocytoma WHO grade III (n = 1). In addition, one patient suffered from a spinal drop metastasis of a cerebellar medulloblastoma WHO grade IV. Tumors of WHO grade I were diagnosed in 18 patients: Eight cases of meningioma (two recurrences), six cases of neurinoma, one neurofibroma, two ependymoma and one plexus papilloma. At least, benign pathologies were histologically proven in three patients. All four spinal metastasis of malignant glioma (100 %), seven of eight meningiomas (87.5 %) and one of two ependymoma (50 %) were found to be ALA-positive. The present study demonstrates that spinal intramedullary gliomas and the majority of spinal intradural meningiomas are 5-ALA positive. As a surgical consequence, especially in intramedullary gliomas, the use of 5-ALA fluorescence seems to be beneficial.

  17. Spinal stenosis surgery in pediatric patients with achondroplasia.

    Science.gov (United States)

    Sciubba, Daniel M; Noggle, Joseph C; Marupudi, Neena I; Bagley, Carlos A; Bookland, Markus J; Carson, Benjamin S; Ain, Michael C; Jallo, George I

    2007-05-01

    Achondroplasia is a hereditary form of dwarfism caused by a defect in endochondral bone formation, resulting in skeletal abnormalities including short stature, shortened limb bones, macrocephaly, and small vertebral bodies. In the pediatric population, symptomatic spinal stenosis occurs at all spinal levels due to the abnormally narrow bone canal. In this study, clinical outcomes were assessed in children with achondroplasia after spinal canal decompression. A retrospective review was conducted involving pediatric patients with heterozygous achondroplasia and symptomatic stenosis after decompressive procedures at the authors' institution within a 9-year period. Measured outcomes included resolution of symptoms, need for repeated surgery, presence of fusion, development of deformity, and complications. Forty-four pediatric patients underwent a total of 60 decompressive procedures. The average patient age at surgery was 12.7 years (range 5-21 years). Forty-nine operations were performed for initial treatment of stenosis, and 11 were performed as revision surgeries on previously operated levels. A large proportion of patients (> 60%) required additional cervicomedullary decompressions, most often preceding the symptoms of spinal stenosis. Of the initial procedures, decompression locations included 32 thoracolumbar (65%), 10 lumbar (20%), four cervical (8%), two cervicothoracic (4%), and one thoracic (2%). Forty-three of the decompressive procedures (72%) included spinal fusion procedures. Of the 11 revisions, five were fusion procedures for progressive deformity at levels previously decompressed but not fused (all thoracolumbar), five were for decompressions of symptomatic junctional stenosis with extension of fusion, and one was for repeated decompression at the same level due to recurrence of symptomatic stenosis. Decompression of the spinal canal in pediatric patients with achondroplasia can be accomplished safely with significant clinical benefit. Patients with a

  18. Risk Factors and Prognosis of Surgery for Spinal Metastasis

    Institute of Scientific and Technical Information of China (English)

    HuiminTao; ZhengmingYang; ZhaomingYe; DishengYang; WeixuLi

    2004-01-01

    OBJECTIVE To evaluate the risk factors and prognosis of surgery for spinal metastasis.METHODS A retrospective analysis was performed for 63 patients with spinal metastasis who underwent surgical treatment between June 1992 and June 2002. Forty-one patients underwent anterior en-bloc or partial resection, decompression and reconstruction with internal fixation of the spine.Laminectomy and decompression with internal fixation were done in patients. One-stage anterior-posterior en-bloc resection and decompression followed by reconstructive stabilization were conducted in 14 patients.RESULTS After follow-up for more than 6 months, postoperative radiological evaluation revealed that spinal stabilization was evident in all patients. Fiftyseven (91.9%) patients benefited with quality of life significantly improved through pain alleviation, and 41 (66.1%) patients improved in theirneurological status. No serious complications were observed in surgery. The mean survival time after surgery was 6 months in patients with lung and liver carcinoma, 15 months with breast, prostate, and stomach carcinoma as well as the other miscellaneous malignancies, and 28 months with thyroid and kidney carcinoma. Differences were significant among the 3 groups (P<0.01).CONCLUSION Surgical treatment for spinal metastasis is able to relieve neurological symptoms and improve the quality of life. The survival time is related to the site of the primary tumor; shorter survival in lung and liver carcinoma, longer in breast, prostate, stomach carcinoma and longest In thyroid and kidney carcinoma.

  19. A Surgery Protocol for Adult Zebrafish Spinal Cord Injury

    Institute of Scientific and Technical Information of China (English)

    Ping Fang; Jin-Fei Lin; Hong-Chao Pan; Yan-Qin Shen; Melitta Schachner

    2012-01-01

    Adult zebrafish has a remarkable capability to recover from spinal cord injury,providing an excellent model for studying neuroregeneration.Here we list equipment and reagents,and give a detailed protocol for complete transection of the adult zebrafish spinal cord.In this protocol,potential problems and their solutions are described so that the zebrafish spinal cord injury model can be more easily and reproducibly performed.In addition,two assessments are introduced to monitor the success of the surgery and functional recovery:one test to assess free swimming capability and the other test to assess extent of neuroregeneration by in vivo anterograde axonal tracing.In the swimming behavior test,successful complete spinal cord transection is monitored by the inability of zebrafish to swim freely for 1 week after spinal cord injury,followed by the gradual reacquisition of full locomotor ability within 6 weeks after injury.As a morphometric correlate,anterograde axonal tracing allows the investigator to monitor the ability of regenerated axons to cross the lesion site and increasingly extend into the gray and white matter with time after injury,confirming functional recovery.This zebrafish model provides a paradigm for recovery from spinal cord injury,enabling the identification of pathways and components of neuroregeneration.

  20. Optimization of Spinal Anesthesia in Surgery of Intervertebral Disks

    Directory of Open Access Journals (Sweden)

    V. I. Gorbachev

    2006-01-01

    Full Text Available The paper gives the data of preoperative evaluation of autonomous nervous system tone and its correction, pharmacokinetics of local anesthetics in the subarachnoidal space, as well as the optimization of a procedure for spinal anesthesia in patients operated on for lumbosacral radiculitis. 

  1. CORRECTION OF THE SPINAL DEVIATIONS USING THE CYRIAX METHOD

    Directory of Open Access Journals (Sweden)

    Gabriela OCHIANĂ

    2011-07-01

    Full Text Available musculoskeletal and other functions (respiration,circulation, digestion, metabolic exchanges, etc.. Inthis study, I have decided to check two aspects, checkto what extend Cyriax method specific techniques arean effective treatment means of problems caused bylesions of intervertebral disc (correcting suchdeficiencies column and whether prophylacticcompliance measures within this method can preventthe disc lesions.Research was conducted on 6 subjects with deviationsof the spine in the sagittal plane (cifoza and lordosisfor a period of 4 months. To assess and compare theresults obtained we use the evaluation form Cyriax,mobility tests and pain scale. From Cyriax method weused deep transverse massage and manipulationtechniques at the spine level and the extremities.- The results, materialized by the disappearance ofpain and correction of bias, confirm that thetechniques of the Cyriax method are an appropriatestrategy for treatment and prophylaxis in spinedisorders. Even if some people have incorrectpositions of the spinal column, (after the age of 25,the sign which forces the patient to correct his/herposition is the pain. The use of the manipulationtechniques within this method must be known andapplied only by people who have attended specializedcourses, in order to prevent any other subsequentcomplications. For the amelioration of the discprotrusions, the disappearance of the pain and thecorrection of the spinal position, maximum 10sessions (1 session every 2-3 days are used, and theperson treated must follow the prophylaxis measuresmentioned above all his/her life.

  2. Spontaneous spinal epidural hematoma presenting as paraplegia after cardiac surgery.

    Science.gov (United States)

    Kin, Hajime; Mukaida, Masayuki; Koizumi, Junichi; Kamada, Takeshi; Mitsunaga, Yoshino; Iwase, Tomoyuki; Ikai, Akio; Okabayashi, Hitoshi

    2016-03-01

    An 86-year-old woman was scheduled to undergo aortic valve replacement and coronary artery bypass graft. On postoperative day 3, she developed sudden-onset neck pain followed by weakness in the right arm. Her symptoms worsened with time, and she developed paraplegia. At 60 h after the first complaint, spontaneous spinal epidural hematoma (SSEH) from C2 to C6 with spinal cord compression was diagnosed from a magnetic resonance image of the cervical region. We decided on conservative therapy because operative recovery was impossible. Delayed diagnosis led to grievous results in the present case. When neurological abnormalities follow neck or back pain after open heart surgery, SSEH must be considered in the differential diagnosis. Further, if it is suspected, early cervical computed tomography/magnetic resonance imaging and surgery should be considered.

  3. Perioperative visual loss following prone spinal surgery: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2016-01-01

    Conclusions: The best way to avoid POVL is to recognize its multiple etiologies and limit the various risk factors that contribute to this devastating complication of prone spinal surgery. Furthermore, routinely utilizing a 3-pin head holder will completely avoid ophthalmic compression, while maintaining the neck in a neutral posture, largely avoiding the risk of jugular vein and/or carotid artery compromise and thus avoiding increasing IOP.

  4. Acute kidney injury following spinal instrumentation surgery in children

    Science.gov (United States)

    Jöbsis, Jasper J; Alabbas, Abdullah; Milner, Ruth; Reilly, Christopher; Mulpuri, Kishore; Mammen, Cherry

    2017-01-01

    AIM To determine acute kidney in jury (AKI) incidence and potential risk factors of AKI in children undergoing spinal instrumentation surgery. METHODS AKI incidence in children undergoing spinal instrumentation surgery at British Columbia Children’s Hospital between January 2006 and December 2008 was determined by the Acute Kidney Injury Networ classification using serum creatinine and urine output criteria. During this specific time period, all patients following spinal surgery were monitored in the pediatric intensive care unit and had an indwelling Foley catheter permitting hourly urine output recording. Cases of AKI were identified from our database. From the remaining cohort, we selected group-matched controls that did not satisfy criteria for AKI. The controls were matched for sex, age and underlying diagnosis (idiopathic vs non-idiopathic scoliosis). RESULTS Thirty five of 208 patients met criteria for AKI with an incidence of 17% (95%CI: 12%-23%). Of all children who developed AKI, 17 (49%) developed mild AKI (AKI Stage 1), 17 (49%) developed moderate AKI (Stage 2) and 1 patient (3%) met criteria for severe AKI (Stage 3). An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively. An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively classified by fluid tertiles: 70% incidence in those that received the least amount of fluids vs 29% that received the most fluids (> 7.9, P = 0.02). Patients who developed AKI were more frequently exposed to nephrotoxins (non steroidal anti inflammatory drugs or aminoglycosides) than control patients during their peri-operative course (60% vs 22%, P < 0.001). CONCLUSION We observed a high incidence of AKI following spinal instrumentation surgery in children that is potentially related to the frequent use of nephrotoxins and the amount of fluid administered peri-operatively. PMID:28316941

  5. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  6. Pain prevalence and trajectories following pediatric spinal fusion surgery.

    Science.gov (United States)

    Sieberg, Christine B; Simons, Laura E; Edelstein, Mark R; DeAngelis, Maria R; Pielech, Melissa; Sethna, Navil; Hresko, M Timothy

    2013-12-01

    Factors contributing to pain following surgery are poorly understood, with previous research largely focused on adults. With approximately 6 million children undergoing surgery each year, there is a need to study pediatric persistent postsurgical pain. The present study includes patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery enrolled in a prospective, multicentered registry examining postsurgical outcomes. The Scoliosis Research Society Questionnaire-Version 30, which includes pain, activity, mental health, and self-image subscales, was administered to 190 patients prior to surgery and at 1 and 2 years postsurgery. A subset (n = 77) completed 5-year postsurgery data. Pain prevalence at each time point and longitudinal trajectories of pain outcomes derived from SAS PROC TRAJ were examined using analyses of variance and post hoc pairwise analyses across groups. Thirty-five percent of patients reported pain in the moderate to severe range presurgery. One year postoperation, 11% reported pain in this range, whereas 15% reported pain at 2 years postsurgery. At 5 years postsurgery, 15% of patients reported pain in the moderate to severe range. Among the 5 empirically derived pain trajectories, there were significant differences on self-image, mental health, and age. Identifying predictors of poor long-term outcomes in children with postsurgical pain may prevent the development of chronic pain into adulthood. This investigation explores the prevalence of pediatric pain following surgery, up to 5 years after spinal fusion surgery. Five pain trajectories were identified and were distinguishable on presurgical characteristics of age, mental health, and self-image. This is the largest study to examine longitudinal pediatric pain trajectories after surgery. Copyright © 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.

  7. Static and Dynamic Parameters in Patients With Degenerative Flat Back and Change After Corrective Fusion Surgery.

    Science.gov (United States)

    Lee, Jung Hwan; Lee, Sang-Ho

    2016-08-01

    To evaluate characteristics of static and dynamic parameters in patients with degenerative flat back (DFB) and to compare degree of their improvement between successful and unsuccessful surgical outcome groups. Forty-seven patients with DFB were included who took whole spine X-ray and three-dimensional motion analysis before and 6 months after corrective surgery. Forty-four subjects were selected as a control group. As static parameters, thoracic kyphosis (TK), thoracolumbar junction (TLJ), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured. As dynamic parameters, maximal and minimal angle of pelvic tilt, lower limb joints, and thoracic and lumbar vertebrae column (dynamic TK and LL) in sagittal plane were obtained. The DFB group showed smaller TK and larger LL, pelvic posterior tilt, hip flexion, knee flexion, and ankle dorsiflexion than the control group. Most of these parameters were significantly corrected by fusion surgery. Dynamic spinal parameters correlated with static spinal parameters. The successful group obtained significant improvement in maximal and minimal dynamic LL than the unsuccessful group. The DFB group showed characteristic lower limb and spinal angles in dynamic and static parameters. Correlation between static and dynamic parameters was found in spinal segment. Dynamic LL was good predictor of successful surgical outcomes.

  8. Perioperative visual loss following prone spinal surgery: A review

    Science.gov (United States)

    Epstein, Nancy E.

    2016-01-01

    Background: Postoperative visual loss (POVL) following prone spine surgery occurs in from 0.013% to 1% of cases and is variously attributed to ischemic optic neuropathy (ION: anterior ION or posterior ION [reported in 1.9/10,000 cases: constitutes 89% of all POVL cases], central retinal artery occlusion [CRAO], central retinal vein occlusion [CRVO], cortical blindness [CB], direct compression [horseshoe, prone pillows, and eye protectors Dupaco Opti-Gard]), and acute angle closure glaucoma (AACG). Methods: Risk factors for ION include prolonged operative times, long-segment spinal instrumentation, anemia, intraoperative hypotension, diabetes, obesity, male sex, using the Wilson frame, microvascular pathology, decreased the percent of colloid administration, and extensive intraoperative blood loss. Risk factors for CRAO more typically include improper positioning during the surgery (e.g., cervical rotation), while those for CB included prone positioning and obesity. Results: POVL may be avoided by greater utilization of crystalloids versus colloids, administration of α-2 agonists (e.g., decreases intraocular pressure), avoidance of catecholamines (e.g., avoid vasoconstrictors), avoiding intraoperative hypotension, and averting anemia. Patients with glaucoma or glaucoma suspects may undergo preoperative evaluation by ophthalmologists to determine whether they require prophylactic treatment prior to prone spinal surgery and whether and if prophylactic treatment is warranted. Conclusions: The best way to avoid POVL is to recognize its multiple etiologies and limit the various risk factors that contribute to this devastating complication of prone spinal surgery. Furthermore, routinely utilizing a 3-pin head holder will completely avoid ophthalmic compression, while maintaining the neck in a neutral posture, largely avoiding the risk of jugular vein and/or carotid artery compromise and thus avoiding increasing IOP. PMID:27274409

  9. Multimodal intraoperative neuromonitoring in corrective surgery for adolescent idiopathic scoliosis: Evaluation of 354 consecutive cases

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    Kundnani Vishal

    2010-01-01

    Full Text Available Background : Multimodal intraoperative neuromonitoring is recommended during corrective spinal surgery, and has been widely used in surgery for spinal deformity with successful outcomes. Despite successful outcomes of corrective surgery due to increased safety of the patients with the usage of spinal cord monitoring in many large spine centers, this modality has not yet achieved widespread popularity. We report the analysis of prospectively collected intraoperative neurophysiological monitoring data of 354 consecutive patients undergoing corrective surgery for adolescent idiopathic scoliosis (AIS to establish the efficacy of multimodal neuromonitoring and to evaluate comparative sensitivity and specificity. Materials and Methods : The study group consisted of 354 (female = 309; male = 45 patients undergoing spinal deformity corrective surgery between 2004 and 2008. Patients were monitored using electrophysiological methods including somatosensory-evoked potentials and motor-evoked potentials simultaneously. Results : Mean age of patients was 13.6 years (±2.3 years. The operative procedures involved were instrumented fusion of the thoracic/lumbar/both curves, Baseline somatosensory-evoked potentials (SSEP and neurogenic motor-evoked potentials (NMEP were recorded successfully in all cases. Thirteen cases expressed significant alert to prompt reversal of intervention. All these 13 cases with significant alert had detectable NMEP alerts, whereas significant SSEP alert was detected in 8 cases. Two patients awoke with new neurological deficit (0.56% and had significant intraoperative SSEP + NMEP alerts. There were no false positives with SSEP (high specificity but 5 patients with false negatives with SSEP (38% reduced its sensitivity. There was no false negative with NMEP but 2 of 13 cases were false positive with NMEP (15%. The specificity of SSEP (100% is higher than NMEP (96%; however, the sensitivity of NMEP (100% is far better than SSEP (51

  10. National audit of post-operative management in spinal surgery

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    Dicken Ben

    2006-05-01

    Full Text Available Abstract Background There is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial. Methods We conducted a survey of current post-operative practice amongst spinal surgeons in the United Kingdom in 2002 to determine whether such interventions are being included routinely in the post-operative management of spinal patients. The survey included all surgeons who were members of either the British Association of Spinal Surgeons (BASS or the Society for Back Pain Research. Data on the characteristics of each surgeon and his or her current pattern of practice and post-operative care were collected via a reply-paid postal questionnaire. Results Usable responses were provided by 57% of the 89 surgeons included in the survey. Most surgeons (79% had a routine post-operative management regime, but only 35% had a written set of instructions that they gave to their patients concerning this. Over half (55% of surgeons do not send their patients for any physiotherapy after discharge, with an average of less than two sessions of treatment organised by those that refer for physiotherapy at all. Restrictions on lifting, sitting and driving showed considerable inconsistency both between surgeons and also within the recommendations given by individual surgeons. Conclusion Demonstrable inconsistencies within and between spinal surgeons in their approaches to post-operative management can be interpreted as evidence of continuing and significant uncertainty across the sub-speciality as to what does constitute best care in these areas of practice. Conducting further large, rigorous, randomised controlled trials would be the best method for obtaining definitive answers to these questions.

  11. Using Intraoperative Ultrasonography for Spinal Cord Tumor Surgery.

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    Ivanov, Marcel; Budu, Alexandru; Sims-Williams, Hugh; Poeata, Ion

    2017-01-01

    Our aim was to evaluate the usefulness of modern intraoperative ultrasonography (iUS) in the resection of a wide variety of spinal intradural pathologic entities. We evaluated patients with spinal cord disease treated between January 2006 and September 2015. Intraoperative standard B-mode images were acquired using a 3.5-MHz to 12-MHz ultrasonographic probes (linear and curvilinear) on various ultrasound machines. The benefits and disadvantages of iUS were assessed for each case. A total number of 158 intradural spinal lesions were operated on using iUS. Of these, 107 lesions (68%) were intradural extramedullary and 51 (32%) were intramedullary. All lesions were clearly visible using the ultrasound probe. The high-frequency linear probes (10-12 MHz) provided a better image quality compared with lower-frequency probes. Color and power-angiography modes were helpful in assessing the vascularization of the tumors and location of the major vessels in the vascular lesions. We document how iUS was used to facilitate safe and efficient spinal tumor resection at each stage of the operation. iUS was beneficial in confirmation of tumor location and extension, planning myelotomy, and estimation of degree of resection of the intramedullary tumors. It was particularly helpful in guiding the approach in redo surgeries for recurrent spinal cord tumors. iUS has a fast learning curve and offers additional intraoperative information that can help improve surgical accuracy and therefore may reduce procedure-related morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

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    Terrence T. Kim

    2016-01-01

    Full Text Available We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy.

  13. The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Mohamed, A.S.; Skolasky, R.L.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    STUDY DESIGN: Descriptive, retrospective cohort analysis. OBJECTIVE: To evaluate the presentation, etiology, and treatment of surgical site infections (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA: SSI after spine surgery is frequently seen. Small case control studies have been published

  14. Refractive surgery for the correction of myopia.

    Science.gov (United States)

    Swinger, C A

    1981-01-01

    Interest in the surgical correction of myopia is increasing. At the present time, two procedures are clinically employed: radial keratotomy and myopic keratomileusis. The two techniques are described, and a detailed clinical comparison is presented.

  15. Effectiveness of intraoperative neurophysiological monitoring during spinal surgery

    Directory of Open Access Journals (Sweden)

    Valentina А. Kuzmina

    2016-12-01

    Conclusions. The application of IONM minimized the need for the wake-up test and significantly decreased the incidence of neurological complications caused by injury to the spinal cord and spinal roots during execution of spinal manipulations.

  16. The prevalence of abnormal preoperative coagulation tests in pediatric patients undergoing spinal surgery for scoliosis.

    Science.gov (United States)

    Ryan, Katie M; O'Brien, Kirsty; Regan, Irene; O'Byrne, John M; Moore, David; Kelly, Paula M; Noel, Jacques; Butler, Joseph; Nolan, Beatrice; Kiely, Patrick J

    2015-06-01

    Multilevel spinal fusion surgery for deformity correcting spinal surgery in pediatric patients with scoliosis has typically been associated with significant blood loss. The mechanism of bleeding in such patients is not fully understood. Coagulation abnormalities, which may be associated with scoliosis, are thought to play a role. To document and compare the prevalence of preoperative coagulation abnormalities among patients with scoliosis attending a pediatric orthopedic department for spinal fusion surgery with patients attending for minor surgery. An observational study. All patients were recruited from a pediatric tertiary referral center in Dublin, Ireland. Coagulation profile results were prospectively collected over a 2-year period from 165 spinal surgery patients. In total, 175 patients were included in the non-scoliosis group. These patients attended the day ward for minor procedures and were recruited over a 4-month period. The primary outcome measure was the coagulation profiles, which included prothrombin time, activated partial thromboplastin time (APTT), and thrombin time (TT). Levels of Coagulation Factors II, V, VII, and X were also recorded. All blood samples were sent to the haematology laboratory to establish the coagulation profile. The primary outcome was the presence of an abnormal coagulation screening test (if any of PT, APTT, or TT were abnormal). Prothrombin time, APTT, and TT were also analyzed as individual continuous variables, as well as Coagulation Factors II, V, VII, and X. Regression analysis was used to compare the coagulation profile of scoliosis patients with that of non-scoliosis patients. There were no outside funding sources or any potential conflict of interest associated with this study. The scoliosis patients were more likely to have an abnormal preoperative screening test compared with non-scoliosis patients, with an odds ratio of 2.6. Further analysis showed statistically significant longer clotting times for patients with

  17. Surgical correction of spinal deformity with the use of transpedicular screw spinal systems in children with idiopathic thoracic scoliosis

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    Nurbek N Nadirov

    2016-06-01

    Full Text Available Aim. To compare the results of surgical correction of spinal deformity in children with idiopathic thoracic scoliosis with the use of transpedicular screw spinal systems with different pedicle screw placement. Material and methods. Thirty-one patients (14–17 years with spinal curvature with a Cobb angle from 40° to 79° were operated on. Surgical correction of the deformity was performed using two methods, depending on the possible placement of a pedicle screw. The first group included 16 patients for whom the transpedicular support elements were placed on both sides, throughout the completely deformed spine. The second group included 15 patients for whom the pedicle screws were not placed for two or more vertebrae on the concave side of the curve, at the top of the main curve. Results. The mean percent correction of the spinal deformity for the first and second groups was 92.5% and 82.6%, respectively. The mean percentage of derotation of the apical vertebra for the first and second groups was 73.9% and 23%, respectively. Conclusion. The use of data based on the anatomical and anthropometric features of the vertebral body with scoliosis facilitates selection of the best option for correction of thoracic curve in children with idiopathic scoliosis using pedicle multi-support metal construction. The use of the spinal pedicle system for correction of spinal deformity in children with idiopathic scoliosis enabled a uniform load distribution along the support elements of the metal construction and maintained the correction in the late postoperative follow-up period.

  18. Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hong-qi; YIN Xin-hua; LI Feng; GAO Qi-le; GE Lei; WU Jian-huang; LIU Jin-yang; GUO Chao-feng; LIU Shao-hua; LU Shi-jin; LI Jin-song

    2012-01-01

    Background Many investigators advocate anterior release combined with halo-femoral traction and posterior fusion when treating stiff thoracic curves in patient with adolescent idiopathic scoliosis (AIS).But the anterior operations often induce severe complications.Some surgeons choose posterior-only surgery with halo-femoral traction,posterior wide release and correction.But to the best of our knowledge,there are only rare prospective studies on these posterior-only surgeries for AIS patients who have a rigid curve more than 80° and flexibility less than 35%.@@Methods Sixty-four AIS patients were recruited from September 2006 to June 2009.All patients had rigid curves and underwent spinal correction.They were randomly divided into group A (combined anteroposterior surgery) and group B (posterior-only surgery).Images and scoliosis research society-22 questionnaire (SRS-22) scores were performed praand post-operation and during follow-up visits.The operation time,blood loss,hospital days,and hospital charges were compared between the two groups.@@Results These patients were followed for an average of 37.5 months (range,24-65 months).No serious complications were observed.There were no significant differences between the two groups in gender,age,preoperative radiographic data,or preoperative SRS-22 score.The average operation time,blood loss,hospital days and hospital charges in group B were less than those in group A.The SRS-22 score in group B was better than in group A at post-operation and at final follow-up.@@Conclusions In AIS with a rigid curve more than 80° and flexibility less than 35%,strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction can provide better SRS-22 scores,comparable curve correction,shorter operation time,less blood loss,shorter hospital stays and lower charges when compared to combined anterior and posterior surgery.

  19. Poetry and narrative therapy for anxiety about spinal surgery.

    Science.gov (United States)

    Naidu, Thirusha; Shabangu, Sifiso

    2015-01-01

    This case study presents the use of poetry in psychotherapy with an adolescent girl, Buhle (a pseudonym), who needed surgery to correct a curvature of her spine due to adolescent idiopathic scoliosis. She experienced anxiety which prevented surgeons from doing the procedure. Psychotherapists used narrative therapy to explore issues associated with and contributing to her anxiety and encouraged her to document her experiences through poetry, after learning that she was a keen poet. During psychotherapy Buhle's poems were used to track and narrate her experiences and as an empowering method allowing her to make personal sense of challenging experiences. Buhle's poems are presented within an account of the psychotherapy leading up to the surgery. Her poetry reveals a juxtaposition of regular adolescent identity issues in the face of coping with a demanding medical condition and the prospect of invasive surgery.

  20. Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

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    Luiz Eduardo Imbelloni

    Full Text Available CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA and combined spinal epidural anesthesia (CSE are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE. There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

  1. Sagittal balance and pelvic parameters--a paradigm shift in spinal surgery.

    Science.gov (United States)

    Johnson, R D; Valore, A; Villaminar, A; Comisso, M; Balsano, M

    2013-02-01

    It has become evident in recent years that global assessment of spinal sagittal balance is necessary for optimal management of the degenerate spine. Pelvic parameters have been developed which appear to correlate well with the natural history of degenerative spine disorders and outcomes from surgery. Although these parameters have a limited evidence base, they are now in widespread use by spinal surgeons and, in particular, spinal deformity surgeons. It is necessary for all surgeons treating spinal pathology to have a working knowledge of the principles of spinal sagittal balance, to be able to recognise sagittal imbalance and its compensatory mechanisms. In this article we outline the main concepts of spinal sagittal balance and pelvic parameters and how these concepts are leading to a paradigm shift in the surgical management of spinal disorders. We propose that analysis of pelvic parameters of sagittal balance will form an essential part of the evaluation of new surgical techniques for spinal conditions.

  2. A Case Report of Intraoperative Monitoring During the Spinal Surgery by Means of Somatosensory Evoked Potentials

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    S.K. Shakoori

    2006-01-01

    Full Text Available Introduction : To prevent spinal lesions during surgery we can use somatosensory evoked potentials (SSEP to monitor the patients who are under surgery particularly the ones under the spinal cord surgery. Case Report: The following case refers to the monitoring of a 23 year – old youth with the use of Intraoperative SSEP who has been under the operation of tumor removal with the diagnosis of space occupying mass in the conous region of spine in Tabriz Shohada Hospital. Conclusion: SSEP study for left tibial nerve after surgery was the same as before surgery. Pathology diagnosis was epandymom. Patient gave recovery process in few days.

  3. Posterior Correction Without Rib-head Resection for Patients With Neurofibromatosis Type 1, Dystrophic Scoliosis, and Rib-head Protrusion Into the Spinal Canal.

    Science.gov (United States)

    Cai, Siyi; Zhang, Jianguo; Shen, Jianxiong; Zhao, Hong; Weng, Xisheng; Qiu, Guixing

    2017-02-01

    A retrospective study. The objective of this study is to report the result of patients with neurofibromatosis type 1(NF-1), dystrophic scoliosis, and rib-head protrusion into the spinal canal who received posterior scoliosis correction surgery without rib-head resection. A total of 124 patients with NF-1 and dystrophic scoliosis were treated at our institution during the study period. Eight patients with a median age of 12 years had rib-head protrusion into the spinal canal and received surgery and were included in the analysis. All 8 patients (6 male, 2 female) were treated from 2003 to 2013 and received posterior correction with a pedicle screw-rod 3-dimensional correction system or screw-hook hybrid system. Scoliosis correction rate and percentage of spinal canal occupied by the rib head were analyzed. The median patient age, number of segments fused, and follow-up duration were 12 years, 10.5, and 22.5 months, respectively. There were no surgery-related complications, and symptoms in all patients improved after surgery. The median postoperative and 1-year follow-up sagittal kyphotic angles were significantly smaller as compared with the preoperative value (28.5 and 31 vs. 62.5 degrees, P=0.012). The median postoperative coronal Cobb angle of the main thoracic curve was significantly smaller compared with the preoperative value (29 vs. 64.5 degrees, P=0.012). The median percentage of the spinal canal occupied by the intraspinal rib was significantly lower at 1-year follow-up compared with the preoperative value (23.1% vs. 28.6%, P=0.018). Posterior correction without rib-head excision can provide good outcomes for patients with NF-1 and dystrophic scoliosis and rib-head protrusion into the spinal canal.

  4. Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients

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    Pawel Zwolak

    2013-11-01

    Full Text Available We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland nine patients (three women and six men; mean age 68.6, range 43- 87 years were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30. The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy.

  5. Effect of Regular Corrective Exercises on the Spinal Column of Dyspraxic Patients

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    Saeid Teimori

    2014-06-01

    Full Text Available Background: Spinal column abnormalities can highly restrict motor movement in students with dyspraxia. The present study investigated the effect of regular corrective exercises on the spinal column of students with dyspraxia. Materials and Methods: The present study is a quasi-experimental research. For the purposes of the study, spinal column abnormalities of a total of 150 girls and 220 boys were analyzed. The subjects then went through a 12-week period of corrective exercises. The students' spinal column abnormalities were re-examined to determine the effects of the exercise. The study employed SPSS-16 to analyze the data. Also, for the purposes of the study, statistical-descriptive methods, samples t-test and Pearson’s correlation coefficient were used to further analyze the data in detail. Results: The results of the study indicated that students with dyspraxia constituted 6.16 % of the total sample. That is to say, dyspraxic girls and boys made up 5% and 7.3% of the sample, respectively. Moreover, 60% of the boys and 63.3% of the girls suffered from spinal column abnormalities. The results of the experiment indicated that corrective exercises can reduce spinal column abnormalities in school students. Conclusion: The results of the experiment indicated that corrective exercises can reduce spinal column abnormalities in school students.

  6. Application of A-line autoregressive model with exogenous input index during the wake-up test in spinal surgery under propofol-remifentanil anaesthesia

    Institute of Scientific and Technical Information of China (English)

    YAO Wen-long; WANG Xue-ren; LI Bai-li; GUI Ling-li; ZHU Chang; ZHANG Chuan-han

    2007-01-01

    @@ Paraplegia is a rare but terrible complication following major spinal operation. Intraoperative monitoring should be used to detect the neurological complications early so that they can be surgically revised.1 The common procedures for spinal cord monitoring are intraoperative wake-up test and neurophysiological methods. The latter includes somatosensory evoked potentials (SSEP) and motor evoked potentials (MEP). The wake-up test has been routinely used to monitor voluntary motor function of the lower limbs during corrective spinal surgery.During the wake-up procedure, the depth of anaesthesia should be lightened gradually to make patients respond to verbal commands.

  7. Comparison on wake-up time of sufentanil and fentanyl on intraoperative wake-up test in general anesthesia patients undergoing spinal correction surgery%舒芬太尼与芬太尼用于全麻下脊柱矫形术中唤醒效果的比较

    Institute of Scientific and Technical Information of China (English)

    吴礼平; 王文军; 彭建明; 高利臣

    2011-01-01

    AIM: To research the effect of sufentanil and fentanyl on intraoperative wakeup time and quality in patients undergoing spinal correction surgery, and to study the operation method of intraoperatie wake-up test of spinal correction surgery, and further evaluate the effect of wake-up test. METHODS: Thirty eight cases of patients with spinal deformity were treated by spinal correction surgery. They were randomly divided into sufentanil group and fentanyl group with 19 patients in each group. The anesthesia induction was begun with intravenous infusion 0.1 mg/kg midazolam, 1.5-2.0 mg/kg propofol, 0. 15-0.20 mg/kg atracurium and 0.2 μg/kg sufentanil or 4.0μg/kg fentanyl. The anesthesia was maintained with continuous pump injection sufentanil 0.1 μg/(kg · h) or fentanyl 1 μg/(kg · h). Atracurium, sufentanil or fentanyl were stopped pump injection in the time of 30 min before needing awakening. The pump injection of propofol in the time of need awakening was stopped, and the process of waking up was begun. The wake-up time and quality were studied. RESULTS: The gender, age, weight and operation time were no statistically significant differences between sufentanil group and fentanyl group during the research. The recovery time of spontaneous breathing, open eyes, instruction moves of sufentanil group were shorter than fentanyl group (P< 0.05). The wake-up quality of sufentanil group was better than fentanyl group (P<0.05). There was 1 case of patients with intraoperative pain and awareness in fentanyl group. Both groups had no other complications. CONCLUSION: This method of intraoperative wake-up test is fast and effective. The wake-up time of the anesthesia which used sufentanil is shorter than those of fentanyl group, and the wake-up quality is higher than the later.%目的:对比研究舒芬太尼与芬太尼对脊柱畸形矫形术中唤醒时间及质量的影响,探讨在脊柱畸形矫形术中唤醒试验的操作方法,评估唤醒效果.

  8. Surgical options for correction of refractive error following cataract surgery.

    Science.gov (United States)

    Abdelghany, Ahmed A; Alio, Jorge L

    2014-01-01

    Refractive errors are frequently found following cataract surgery and refractive lens exchange. Accurate biometric analysis, selection and calculation of the adequate intraocular lens (IOL) and modern techniques for cataract surgery all contribute to achieving the goal of cataract surgery as a refractive procedure with no refractive error. However, in spite of all these advances, residual refractive error still occasionally occurs after cataract surgery and laser in situ keratomileusis (LASIK) can be considered the most accurate method for its correction. Lens-based procedures, such as IOL exchange or piggyback lens implantation are also possible alternatives especially in cases with extreme ametropia, corneal abnormalities, or in situations where excimer laser is unavailable. In our review, we have found that piggyback IOL is safer and more accurate than IOL exchange. Our aim is to provide a review of the recent literature regarding target refraction and residual refractive error in cataract surgery.

  9. Surface Coil Intensity Correction in Magnetic Resonance Imaging in Spinal Metastases.

    Science.gov (United States)

    Ren, Hong; Lin, Wei; Ding, Xianjun

    2017-01-01

    To evaluate the clinical application of phased-array surface coil intensity correction in magnetic resonance imaging (MRI) in spinal metastases. 3 phantoms and 50 patients with a corresponding total number of 80 spinal metastases were included in this study. Fast spin echo T1- and T2- weighted MRI with and without surface coil intensity correction was routinely performed for all phantoms and patients. Phantoms were evaluated by means of variance to mean ratio of signal intensity on both T1- and T2- weighted MRI obtained with and without surface coil intensity correction. Spinal metastases were evaluated by image quality scores; reading time per case on both T1- and T2- weighted MRI obtained with and without surface coil intensity correction. Spinal metastases were diagnosed more successfully on MRI with surface coil intensity correction than on MRI with conventional surface coil technique. The variance to mean ratio of signal intensity was 53.36% for original T1-weighted MRI and 53.58% for original T2-weighted MRI. The variance to mean ratio of signal intensity was reduced to 18.99% for T1-weighted MRI with surface coil intensity correction and 22.77% for T2-weighted MRI with surface coil intensity correction. The overall image quality scores (interface conspicuity of lesion and details of lesion) were significantly higher than those of the original MRI. The reading time per case was shorter for MRI with surface coil intensity correction than for MRI without surface coil intensity correction. Phased-array surface coil intensity correction in MRIs of spinal metastases provides improvements in image quality that leads to more successfully detection and assessment of spinal metastases than original MRI.

  10. Cognitive outcome after spinal anesthesia and surgery during infancy.

    Science.gov (United States)

    Williams, Robert K; Black, Ian H; Howard, Diantha B; Adams, David C; Mathews, Donald M; Friend, Alexander F; Meyers, H W Bud

    2014-09-01

    Observational studies on pediatric anesthesia neurotoxicity have been unable to distinguish long-term effects of general anesthesia (GA) from factors associated with the need for surgery. A recent study on elementary school children who had received a single GA during the first year of life demonstrated an association in otherwise healthy children between the duration of anesthesia and diminished test scores and also revealed a subgroup of children with "very poor academic achievement" (VPAA), scoring below the fifth percentile on standardized testing. Analysis of postoperative cognitive function in a similar cohort of children anesthetized with an alternative to GA may help to begin to separate the effects of anesthesia from other confounders. We used a novel methodology to construct a combined medical and educational database to search for these effects in a similar cohort of children receiving spinal anesthesia (SA) for the same procedures. We compared former patients with a control population of students matched by grade, gender, year of testing, and socioeconomic status. Vermont Department of Education records were analyzed for 265 students who had a single exposure to SA during infancy for circumcision, pyloromyotomy, or inguinal hernia repair. Exposure to SA and surgery had no significant effect on the odds of children having VPAA. (mathematics: P = 0.18; odds ratio 1.50, confidence interval (CI), 0.83-2.68; reading: P = 0.55; odds ratio = 1.19, CI, 0.67-2.1). There was no relationship between duration of exposure to SA and surgery and performance on mathematics (P = 0.73) or reading (P = 0.57) standardized testing. There was a small but statistically significant decrease in reading and math scores in the exposed group (mathematics: P = 0.03; reading: P = 0.02). We found no link between duration of surgery with infant SA and scores on academic achievement testing in elementary school. We also found no relationship between infant SA and surgery with VPAA on

  11. Effects of Strontium Ranelate on Spinal Interbody Fusion Surgery in an Osteoporotic Rat Model

    OpenAIRE

    Tsai, Tsung-Ting; Tai, Ching-Lung; Ho, Natalie Yi-Ju; Lai, Po-Liang; Fu, Tsai-Sheng; Niu, Chi-Chien; Chen, Lih-Huei; Chen, Wen-Jer

    2017-01-01

    Osteoporosis is a bone disease that afflicts millions of people around the world, and a variety of spinal integrity issues, such as degenerative spinal stenosis and spondylolisthesis, are frequently concomitant with osteoporosis and are sometimes treated with spinal interbody fusion surgery. Previous studies have demonstrated the efficacy of strontium ranelate (SrR) treatment of osteoporosis in improving bone strength, promoting bone remodeling, and reducing the risk of fractures, but its eff...

  12. Low-dose spinal neostigmine further enhances the analgesic effect of spinal bupivacaine combined with epidural dexamethasone, following orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Gabriela Rocha Lauretti

    2014-01-01

    Full Text Available Background: Opioids are considered mainstream for combined spinal-epidural anesthesia, but frequently limited by adverse effects. The aim of this study was to examine whether low-dose spinal neostigmine, epidural dexamethasone or their combination enhances analgesia from spinal bupivacaine without adverse effects. Materials and Methods : A total of 60 patients undergoing orthopedic surgery were randomized to one of four groups and evaluated for 24-h after surgery for analgesia (time to first rescue analgesic and rescue analgesic consumption. Patients received 15 mg bupivacaine plus the test drug intrathecally (saline or 1 microgram (μg neostigmine. The epidural test drug was either saline or 10 mg dexamethasone. The Control group (CG received spinal and epidural saline. The Neostigmine group (NG, spinal neostigmine and epidural saline; the Dexamethasone group (DG, spinal saline and epidural dexamethasone; and the Neostigmine-dexamethasone group (NDG, spinal neostigmine and epidural dexamethasone. Results: The CG (282 ± 163 min and NG (524 ± 142 min were similar in their times to first rescue analgesic and analgesic consumption. The time to first rescue analgesic was longer for the DG (966 ± 397 min compared with CG and NG (P < 0.0002, and the DG had less ketoprofen consumption and lower overall visual analogue scale-pain sores compared with CG and NG (P < 0.0005. Addition of 1 mg-neostigmine (NDG resulted in longer time to rescue analgesic (1205 ± 303 min; P < 0.02 and lower ketoprofen consumption (P < 0.05 compared to DG. Sporadic cases of vesical catheterization and emesis were observed, however adverse effects were similar among groups. Conclusion: Spinal 1 microgram (μg neostigmine further enhanced analgesia from spinal bupivacaine combined with epidural dexamethasone, without increasing the incidence of adverse effects.

  13. Comparing prophylactic effect of phenylephrine and ephedrine on hypotension during spinal anesthesia for hip fracture surgery

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    Rahman Abbasivash

    2016-01-01

    Conclusion: At the doses of ephedrine and phenylephrine administered in this trial, phenylephrine was better to prevent hypotension during hip fracture surgery with spinal anesthesia. Higher frequency of hypotension was observed in the ephedrine group.

  14. A Methodological Systematic Review on Surgical Site Infections Following Spinal Surgery: Part 1: Risk Factors

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Hosman, A.J.F.; Cohen, D.B.; Schuetz, M.; Habil, D.; Laarhoven, C.J. van; Middendorp, J.J. van

    2012-01-01

    STUDY DESIGN.: A methodological systematic review. OBJECTIVE.: To critically appraise the validity of risk factors for surgical site infection (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA.: SSIs lead to higher morbidity, mortality, and increased health care costs. Understanding which

  15. Paraplegia Due to Spinal Cord Infarction After Coronary Artery Bypass Graft Surgery.

    Science.gov (United States)

    Sevuk, Utkan; Kaya, Sedat; Ayaz, Firat; Aktas, Ulas

    2016-01-01

    Paraplegia is an extremely rare complication after coronary artery bypass grafting (CABG) and the underlying mechanisms remain poorly understood. We report a patient who developed paraplegia after CABG and review the literature on spinal cord ischemia following CABG surgery.

  16. Sudden Sensorineural Hearing Loss after Orthopedic Surgery under Combined Spinal and Epidural Anesthesia

    OpenAIRE

    Ditza de Vilhena; Luís Pereira; Delfim Duarte; Nuno Oliveira

    2016-01-01

    Postoperative hearing loss following nonotologic surgery is rare. For patients undergoing subarachnoid anesthesia, the loss of cerebral spinal fluid and hence the drop in intracranial pressure can result in hearing loss and cranial nerve palsy. We report a case in which a patient sustained orthopedic surgery under combined spinal and epidural anesthesia complicated by severe and persistent sensorineural hearing loss. This report is a reminder that postoperative sudden sensorineural hearing lo...

  17. Subarachnoid Hemorrhage Presenting with Seizure due to Cerebrospinal Fluid Leakage after Spinal Surgery.

    Science.gov (United States)

    Bozkurt, Gokhan; Yaman, Mesut Emre

    2016-01-01

    Cerebrospinal fluid leakage may commonly occur during spinal surgeries and it may cause dural tears. These tears may result in hemorrhage in the entire compartments of the brain. Most common site of such hemorrhages are the veins in the cerebellar region. We report a case of hemorrhage, mimicking aneurysmal subarachnoid hemorrhage due to a cerebrospinal fluid leakage following lumbar spinal surgery and discuss the possible mechanisms of action.

  18. Up-to-date thromboprophylaxis in elective spinal surgery. A systematic review

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    Leonardo Oliveira

    2014-01-01

    Full Text Available Deep vein thrombosis (DVT and pulmonary embolism (PE present a high incidence after surgery, posing a high risk in surgical practice. Although a consensus does exist on thromboprophylaxis in orthopedic surgery, this topic remains controversial in regard to spinal surgery. In this current paper, we review and discuss the different forms of prophyilaxis presented in literature, in order to develop guidelines on prophylactic measures in spinal surgery, improving patient´s outcomes and reducing any medical/legal problems that could arise from a thrombotic complication.

  19. Mechanisms Underlying the Neuromodulation of Spinal Circuits for Correcting Gait and Balance Deficits after Spinal Cord Injury.

    Science.gov (United States)

    Moraud, Eduardo Martin; Capogrosso, Marco; Formento, Emanuele; Wenger, Nikolaus; DiGiovanna, Jack; Courtine, Grégoire; Micera, Silvestro

    2016-02-17

    Epidural electrical stimulation of lumbar segments facilitates standing and walking in animal models and humans with spinal cord injury. However, the mechanisms through which this neuromodulation therapy engages spinal circuits remain enigmatic. Using computer simulations and behavioral experiments, we provide evidence that epidural electrical stimulation interacts with muscle spindle feedback circuits to modulate muscle activity during locomotion. Hypothesis-driven strategies emerging from simulations steered the design of stimulation protocols that adjust bilateral hindlimb kinematics throughout gait execution. These stimulation strategies corrected subject-specific gait and balance deficits in rats with incomplete and complete spinal cord injury. The conservation of muscle spindle feedback circuits across mammals suggests that the same mechanisms may facilitate motor control in humans. These results provide a conceptual framework to improve stimulation protocols for clinical applications.

  20. Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

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    Murphy Donald R

    2009-08-01

    Full Text Available Abstract Background It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with information upon which to base advice to patients. The evidence behind claims of increased risk is investigated as well as the evidence regarding the risk of decompression surgery. Methods A literature search was conducted on the risk of spinal cord injury in individuals with asymptomatic cord encroachment and the risk and benefit of preventive decompression surgery. Results Three studies on the risk of spinal cord injury in this population met the inclusion criteria. All reported increased risk. However, none were prospective cohort studies or case-control studies, so the designs did not allow firm conclusions to be drawn. A number of studies and reviews of the risks and benefits of decompression surgery in patients with cervical myelopathy were found, but no studies were found that addressed surgery in asymptomatic individuals thought to be at risk. The complications of decompression surgery range from transient hoarseness to spinal cord injury, with rates ranging from 0.3% to 60%. Conclusion There is insufficient evidence that individuals with spondylotic spinal cord encroachment are at increased risk of spinal cord injury from minor trauma. Prospective cohort or case-control studies are needed to assess this risk. There is no evidence that prophylactic decompression surgery is helpful in this patient population. Decompression surgery appears to be helpful in patients with cervical myelopathy, but the significant risks may outweigh the unknown benefit in asymptomatic individuals. Thus, broad recommendations for decompression surgery in suspected at-risk individuals cannot be made

  1. The evolution of spinal surgery in the west of Ireland, 2005-2013.

    LENUS (Irish Health Repository)

    O’Sullivan, M D

    2016-04-01

    The aim of this study was to determine the changes in both the short and long term, in the trends within the practice of spinal surgery in Galway University Hospitals (GUH) over a seven year period, January 2005 – January 2013. The absolute number of spinal surgery cases has increased from 147 in 2005, to 257 cases by 2013. Multiple level spine surgery accounts for 51% (131) of all cases by 2013, which is an increase from 31% (45) in 2005. On analysis of the trends within spinal surgery during the study period, a statistically significant (p<0.05) increase in all aspects of spinal surgery was noted, with the exception of surgeries for single level, lumbar and infection pathology respectively. The average waiting time for lumbar decompression and instrumentation climbed for an average of 1.3 months in 2008 to 12.1 months by 2012.The volume and complexity of spinal surgery has increased during the study period, in the West of Ireland.

  2. Paraplegia due to missed thoracic meningioma after lumbar spinal decompression surgery: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Mehtap Bozkurt

    2014-03-01

    Full Text Available Spinal meningiomas are often localized to the thoracic level and symptoms from a spinal meningioma are determined by the location of the mass. We present a case of thoracic paraplegia due to a thoracic spinal cord tumor (meningioma that was not detected during lumbar spinal decompressive surgery. Thoracic mass was detected in level of T2-3 on magnetic resonance imaging (MRI. The patient was re-operated and the patient's neurologic symptoms were partially relieved. Surgeons should know that a thoracic silent meningioma can aggrevate neurological symptoms after lumbar spinal decompression surgery and should inform their patient before surgery.

  3. Lateral interbody fusion combined with open posterior surgery for adult spinal deformity.

    Science.gov (United States)

    Strom, Russell G; Bae, Junseok; Mizutani, Jun; Valone, Frank; Ames, Christopher P; Deviren, Vedat

    2016-12-01

    OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and pedicle subtraction osteotomy

  4. What are we waiting for? An argument for early surgery for spinal epidural abscesses

    Science.gov (United States)

    Epstein, Nancy E.

    2015-01-01

    Background: In the article: Timing and prognosis of surgery for spinal epidural abscess (SEA): A review, Epstein raises one major point; it is imperative that spinal surgeons “take back decision-making” from our medical cohorts and reinstitute early surgery (12.5), high C-reactive protein (>115), positive blood cultures, radiographic cord compression, and significant neurological deficits (e.g., 19–45%). Results: Recognizing these risk factors should prompt early open surgery (41-42.5 to up to the 75% failure rate that accompanies the nonsurgical treatment of SEA, much less the >25% mortality rate? PMID:26605113

  5. What are we waiting for? An argument for early surgery for spinal epidural abscesses

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: In the article: Timing and prognosis of surgery for spinal epidural abscess (SEA: A review, Epstein raises one major point; it is imperative that spinal surgeons "take back decision-making" from our medical cohorts and reinstitute early surgery (12.5, high C-reactive protein (>115, positive blood cultures, radiographic cord compression, and significant neurological deficits (e.g., 19-45%. Results: Recognizing these risk factors should prompt early open surgery (41-42.5 to up to the 75% failure rate that accompanies the nonsurgical treatment of SEA, much less the >25% mortality rate?

  6. Delayed spinal extradural hematoma following thoracic spine surgery and resulting in paraplegia: a case report

    Directory of Open Access Journals (Sweden)

    Parthiban Chandra JKB

    2008-05-01

    Full Text Available Abstract Introduction Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spinal extradural hematomas. Case presentation We report a case of acute onset dorsal spinal extradural hematoma from a paraspinal muscular arterial bleed, producing paraplegia 72 hours following surgery for excision of a spinal cord tumor at T8 level. The triggering mechanism was an episode of violent twisting movement by the patient. Fresh blood in the postoperative drain tube provided suspicion of this complication. Emergency evacuation of the clot helped in regaining normal motor and sensory function. The need to avoid straining of the paraspinal muscles in the postoperative period is emphasized. Conclusion Most cases of postoperative spinal extradural hematomas occur as a result of venous bleeding. However, an arterial source of bleeding from paraspinal muscular branches causing extradural hematoma and subsequent neurological deficit is underreported. Undue straining of paraspinal muscles in the postoperative period after major spinal surgery should be avoided for at least a few days.

  7. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study

    OpenAIRE

    KIMURA, Atsushi; Ohmori, Tsukasa; Sakata, Asuka; Endo, Teruaki; Inoue, Hirokazu; Nishimura, Satoshi; Takeshita, Katsushi

    2017-01-01

    Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was perfo...

  8. Surgical management for thoracic spinal tuberculosis posterior only versus anterior video-assisted thoracoscopic surgery.

    Directory of Open Access Journals (Sweden)

    Weiye Zhong

    Full Text Available A comparable retrospective study.To compare the clinical outcomes of surgical treatment by posterior only and anterior video-assisted thoracoscopic surgery for thoracic spinal tuberculosis (TSTB.145 patients with TSTB treated by two different surgical procedures in our institution from June 2001 to June 2014 were studied. All cases were retrospectively analyzed and divided into two groups according to the given treatments: 75 cases (32F/43M in group A performed single-stage posterior debridement, transforaminal thoracic interbody fusion and instrumentation, and 70 cases (30F/40M in group B underwent anterior video-assisted thoracoscopic surgery (VATS. Clinical and radiographic results in the two groups were analyzed and compared.Patients in group A and B were followed up for an average of 4.6±1.8, 4.4±1.2 years, respectively. There was no statistically significant difference between groups in terms of the operation time, blood loss, bony fusion, neurological recovery and the correction angle of kyphotic deformity (P>0.05. Fewer pulmonary complications were observed in group A. Good clinical outcomes were achieved in both groups.Both the anterior VATS and posterior approaches can effectively treat thoracic tuberculosis. Nevertheless, the posterior approach procedure obtained less morbidity and complications than the other.

  9. Comparison of the effects and complications of unilateral spinal anesthesia versus standard spinal anesthesia in lower-limb orthopedic surgery

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    Seyyed Mostafa Moosavi Tekye

    2014-06-01

    Full Text Available Introduction: A restricted sympathetic block during spinal anesthesia may minimize hemodynamic changes. This prospective randomized study compared unilateral and bilateral spinal anesthesia with respect to the intra- and postoperative advantages and complications of each technique. Material and methods: Spinal anesthesia was induced with 0.5% hyperbaric bupivacaine and a 25-G Quincke needle (Dr. J in two groups of patients with physical status ASA I-II who had been admitted for orthopedic surgeries. In group A, dural puncture was performed with the patient in a seated position using 2.5 cm3 of hyperbaric bupivacaine. Each patient was then placed in the supine position. In group B, dural puncture was performed with the patient in the lateral decubitus position with 1.5 cm3 of hyperbaric bupivacaine. The lower limb was the target limb. The speed of injection was 1 mL/30 s, and the duration of time spent in the lateral decubitus position was 20 min. Results: The demographic data were similar in both groups. The time to the onset of the sensory and motor block was significantly shorter in group A (p = 0.00. The duration of motor and sensory block was shorter in group B (p < 0.05. The success rate for unilateral spinal anesthesia in group B was 94.45%. In two patients, the spinal block spread to the non-dependent side. The incidence of complications (nausea, headache, and hypotension was lower in group B (p = 0.02. Conclusion: When unilateral spinal anesthesia was performed using a low-dose, low-volume and low-flow injection technique, it provides adequate sensory-motor block and helps to achieve stable hemodynamic parameters during orthopedic surgery on a lower limb. Patients were more satisfied with this technique as opposed to the conventional approach. Furthermore, this technique avoids unnecessary paralysis on the non-operated side.

  10. CORRECTIVE SURGERY IN CONGENITAL TALIPES EQUINOVARUS DEFORMITY: A CAMP APPROACH

    Directory of Open Access Journals (Sweden)

    Antony R.

    2015-09-01

    Full Text Available The study was intended to assess the results of soft tissue release and bony corrective surgery in patients of moderate to severe deformed rigid club foot (CTEV and neglected clubfoot (CTEV at free disabled surgical camps at Chhattisgarh state . MATERIAL AND METHODS : In our study 50 patients were included with 70% male and 30% female with 4 - 16 years of age grou p and 70% unilateral and 30% bilateral foot involvement. Patients were admitted and operated in different free disabled surgical camps at Chhattisgarh state over the period of 36 months (1 may 2004 to 30 th April 2007. Improvement in functional ability and locomotion of all operated patients were assessed by physical and clinical examination. RESULTS : All patients who were operated in our study showed significant improvement in functional ability and locomotion after surgery. All patients were maintaining f unctional ability at follow up duration of 12 months (1 year. 75% patients were walking normally, 10% cases were walking with internal rotation of leg and 5% cases were walking with midtarsal varus foot with AFO with medial bar support. CONCLUSION : Our st udy showed and established that excellent results can be obtained in congenital talipes equinovarus (CTEV patients by soft tissue release with bony corrective surgery. The team work of devoted surgeons, paramedical and rehabilitation staff in whole durati on of camps to achieve the goal. With an aim to help more number of CTEV cases by surgery, our team has started doing surgeries in small institutions, and organize charity camps to help poor patients and mankind even in small clinics

  11. Spinal cord bypass surgery with intercostal and spinal accessory nerves: an anatomical feasibility study in human cadavers.

    Science.gov (United States)

    Haque, Raqeeb M; Malone, Hani R; Bauknight, Martin W; Kellner, Michael A; Ogden, Alfred T; Martin, John H; Tanji, Kurenai; Winfree, Christopher J

    2012-02-01

    Despite extensive study, no meaningful progress has been made in encouraging healing and recovery across the site of spinal cord injury (SCI) in humans. Spinal cord bypass surgery is an unconventional strategy in which intact peripheral nerves rostral to the level of injury are transferred into the spinal cord below the injury. This report details the feasibility of using spinal accessory nerves to bypass cervical SCI and intercostal nerves to bypass thoracolumbar SCI in human cadavers. Twenty-three human cadavers underwent cervical and/or lumbar laminectomy and dural opening to expose the cervical cord and/or conus medullaris. Spinal accessory nerves were harvested from the Erb point to the origin of the nerve's first major branch into the trapezius. Intercostal nerves from the T6-12 levels were dissected from the lateral border of paraspinal muscles to the posterior axillary line. The distal ends of dissected nerves were then transferred medially and sequentially inserted 4 mm deep into the ipsilateral cervical cord (spinal accessory nerve) or conus medullaris (intercostals). The length of each transferred nerve was measured, and representative distal and proximal cross-sections were preserved for axonal counting. Spinal accessory nerves were consistently of sufficient length to be transferred to caudal cervical spinal cord levels (C4-8). Similarly, intercostal nerves (from T-7 to T-12) were of sufficient length to be transferred in a tension-free manner to the conus medullaris. Spinal accessory data revealed an average harvested nerve length of 15.85 cm with the average length needed to reach C4-8 of 4.7, 5.9, 6.5, 7.1, and 7.8 cm. The average length of available intercostal nerve from each thoracic level compared with the average length required to reach the conus medullaris in a tension-free manner was determined to be as follows (available, required in cm): T-7 (18.0, 14.5), T-8 (18.7, 11.7), T-9 (18.8, 9.0), T-10 (19.6, 7.0), T-11 (18.8, 4.6), and T-12 (15

  12. Charcot arthropathy of the knee after unsuccessful spinal stenosis surgery: A case report.

    Science.gov (United States)

    Cıvan, Melih; Yazıcıoğlu, Önder; Çakmak, Mehmet; Akgül, Turgut

    2017-01-01

    Charcot arthropathy was first described in 1868 by Jean Martin Charcot as a progressive and destructive joint disease. Diabetes, polyneuropathy, syphilis, syrengomyelia and chronic alcoholism are the main causes of the disease. In this study we present a Charcot arthropathy of the knee seen after unsuccessful spinal stenosis surgery. We report here a case of 62 years old patient with Charcot arthropathy at her left knee developed one year after spinal stenosis surgery. The patient's knee joint was already beyond the fragmentation and coalescence stages at the moment of physical examination. Patient had already been treated for Charcot foot four years before spinal surgery. Because of an unsuccessful spinal surgery, proximal migration of the level of the sensorineural loss negatively affected the polyneuropathy and eventually resulted in Charcot knee joint in a short period of time. However, the etiology of the neuropathic arthropathy hasn't been well described yet, it is usually seen at patients with diabetes mellitus as a long-term complication with or without polyneuropathy. In addition to the spinal canal pathologies, it is reported that Charcot arthropathy can be seen even after spinal anesthesia procedures. In conclusion, spinal procedures should be applied with extra caution on the patients with polyneuropathy or any neuropathic arthropathy. It should be remembered that it is possible to encounter unexpected complications such as proximally migration of the level of sensorineural loss and progression of the actual disease after spinal procedures of these patients. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  13. Predictive factors for perioperative blood transfusion in surgeries for correction of idiopathic, neuromuscular or congenital scoliosis

    Directory of Open Access Journals (Sweden)

    Alexandre Fogaça Cristante

    2014-12-01

    Full Text Available OBJECTIVE: To evaluate the association of clinical and demographic variables in patients requiring blood transfusion during elective surgery to treat scoliosis with the aim of identifying markers predictive of the need for blood transfusion. METHODS: Based on the review of medical charts at a public university hospital, this retrospective study evaluated whether the following variables were associated with the need for red blood cell transfusion (measured by the number of packs used during scoliosis surgery: scoliotic angle, extent of arthrodesis (number of fused levels, sex of the patient, surgery duration and type of scoliosis (neuromuscular, congenital or idiopathic. RESULTS: Of the 94 patients evaluated in a 55-month period, none required a massive blood transfusion (most patients needed less than two red blood cell packs. The number of packs was not significantly associated with sex or type of scoliosis. The extent of arthrodesis (r = 0.103, surgery duration (r = 0.144 and scoliotic angle (r = 0.004 were weakly correlated with the need for blood transfusion. Linear regression analysis showed an association between the number of spine levels submitted to arthrodesis and the volume of blood used in transfusions (p = 0.001. CONCLUSION: This study did not reveal any evidence of a significant association between the need for red blood cell transfusion and scoliotic angle, sex or surgery duration in scoliosis correction surgery. Submission of more spinal levels to arthrodesis was associated with the use of a greater number of blood packs.

  14. Effects of Strontium Ranelate on Spinal Interbody Fusion Surgery in an Osteoporotic Rat Model

    Science.gov (United States)

    Tsai, Tsung-Ting; Ho, Natalie Yi-Ju; Lai, Po-Liang; Fu, Tsai-Sheng; Niu, Chi-Chien; Chen, Lih-Huei; Chen, Wen-Jer

    2017-01-01

    Osteoporosis is a bone disease that afflicts millions of people around the world, and a variety of spinal integrity issues, such as degenerative spinal stenosis and spondylolisthesis, are frequently concomitant with osteoporosis and are sometimes treated with spinal interbody fusion surgery. Previous studies have demonstrated the efficacy of strontium ranelate (SrR) treatment of osteoporosis in improving bone strength, promoting bone remodeling, and reducing the risk of fractures, but its effects on interbody fusion surgery have not been adequately investigated. SrR-treated rats subjected to interbody fusion surgery exhibited significantly higher lumbar vertebral bone mineral density after 12 weeks of treatment than rats subjected to the same surgery but not treated with SrR. Furthermore, histological and radiographic assessments showed that a greater amount of newly formed bone tissue was present and that better fusion union occurred in the SrR-treated rats than in the untreated rats. Taken together, these results show significant differences in bone mineral density, PINP level, histological score, SrR content and mechanical testing, which demonstrate a relatively moderate effect of SrR treatment on bone strength and remodeling in the specific context of recovery after an interbody fusion surgery, and suggest the potential of SrR treatment as an effective adjunct to spinal interbody fusion surgery for human patients. PMID:28052066

  15. Refractive changes following corrective surgery for thyroid-related orbitopathy.

    Science.gov (United States)

    Kinori, Michael; Godfrey, Kyle J; Whipple, Katherine M; Kikkawa, Don O; Granet, David B

    2017-02-01

    Thyroid-related orbitopathy (TRO) is a common and recognizable manifestation of Graves' disease, caused by an increase in orbital fat volume, increased extraocular muscle diameter, and fibrosis. Together, within the bony confines of the orbit, these changes might alter the shape and position of the globe, potentially inducing refractive shifts. These refractive changes may then be affected by corrective surgical interventions for TRO such as orbital decompression and strabismus surgery. We studied refractive changes in patients with TRO who underwent strabismus surgery with or without orbital decompression. Manifest refraction was performed preoperatively and postoperatively in 33 patients who met inclusion criteria. Statistically significant postoperative refractive changes were found for cylinder, axis, and spherical equivalent. Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  16. Transient cortical blindness as a complication of posterior spinal surgery in a pediatric patient.

    Science.gov (United States)

    Nathan, Senthil T; Jain, Viral; Lykissas, Marios G; Crawford, Alvin H; West, Constance E

    2013-09-01

    Postoperative vision loss after spinal surgery is a well-known but devastating complication that may result from direct ocular ischemia, embolism to the central retinal artery, ischemic optic neuropathy, or occipital cortical ischemia. The occipital cortex is situated in the posterior border zone of the middle and posterior cerebral arteries and is susceptible to ischemic damage. Transient cortical blindness as a cause of postoperative vision loss has never been reported after spine surgery in a child. We report an 11-year-old female patient with muscular dystrophy who underwent posterior spinal fusion and instrumentation under hypotensive anesthesia for scoliosis who developed transient cortical blindness.

  17. The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery.

    Science.gov (United States)

    Bekker, Alex; Haile, Michael; Kline, Richard; Didehvar, Sorosch; Babu, Ramesh; Martiniuk, Frank; Urban, Michael

    2013-01-01

    Surgery induces a variety of metabolic, endocrine, and immune changes collectively known as the "stress response," which may often lead to prolonged postoperative convalescence. Anesthetic management may modulate this physiological response, thus affecting the postoperative course. We hypothesized that the intraoperative administration of dexmedetomidine (DEX), a sympatholytic agent, would reduce the stress response and improve the quality of recovery in patients undergoing major surgery. We conducted a prospective randomized double-blinded study of 54 patients undergoing multilevel spinal fusion. Anesthesia was maintained using either propofol/fentanyl/dexmedetomidine (PFD) or propofol/fentanyl/placebo-saline (PFS). The quality of recovery (a primary endpoint) was assessed using a 40-item quality of recovery questionnaire and a 9-question Fatigue Severity Scores. The tests were carried out preoperatively on postoperative days (POD) 1, 2, 3, and 30. Blood samples were collected at baseline, in the postanesthesia care unit, and at POD 1 and were analyzed for levels of cortisol, C-reactive proteins (CRP), and cytokines interleukin (IL)-1α, IL-1β, IL-1ra, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α. Data were analyzed using SPSS software (version 18) using a multivariate and mixed model approach to test for the effect of surgery and drug group. Pairwise comparisons were assessed by means of the t test or rank tests after correcting for multiple comparisons. The global 40-item quality of recovery questionnaire scores showed a significant effect of time (F(4,114)=22.63, Psize was not sufficient to detect differences either in the incidence of complications or in clinically relevant outcomes.

  18. Prevention of neurological complications in correction of severe spinal deformity%重视重度脊柱畸形矫形中的神经并发症

    Institute of Scientific and Technical Information of China (English)

    邱勇

    2014-01-01

    Spinal or neurological deifcit is one of the most severe complications in surgical correction of scoliosis, which may lead to catastrophic results. The neurological complications related to correction surgery for scoliosis, especially severe scoliosis, are now becoming the focus of spine surgeons. Since the differences exist in patient distribution, etiology and surgical procedures, the rate of neurological complications reported in previous literatures differs. The etiology of scoliosis has been proven to be a related factor for neurological complications in correction of severe scoliosis, and the patients with non-idiopathic scoliosis would take more risks than idiopathic scoliosis patients. Osteotomy, particularly 3-column osteotomy, is another risk factor for neurological complications. Due to complicated procedures in ocrrection of scoliosis, great attetion should paid to the operation plan. Meanwhile, prevention of neurological complications should be focused on and intra-operative neuro-monitoring is a necessity for any scoliosis surgery.

  19. Development of bioceramic material for spinal surgery implants

    Science.gov (United States)

    Sablina, T.; Savchenko, N.; Pshenichnyy, A.; Grigoriev, M.; Buyakova, S.; Kulkov, S.

    2016-07-01

    Highly porous zirconia-based ceramics were prepared. The ceramic samples sintered at 1600°C had porosities from 40% to 43%, with pore size ranges as follows: “big pore” 100-220 pm and “small pore” 0.8-8 pm. This makes the ceramic structure to be very similar to the structure of the natural spinal bone. The level of mechanical properties of the synthesized zirconia-based ceramics is determined by the pore sizes. The values of the compressive strength and the effective Young's modulus are very similar to those characteristics of the natural spinal bone.

  20. Spinal and pelvic corrections in a patient with spondylocostal dysplasia syndrome and hemimyelomeningocele

    Directory of Open Access Journals (Sweden)

    Ali Al Kaissi

    2014-01-01

    Full Text Available Congenital malformation complex of the spine and the spinal cord can be a syndromic entity rather than a symptom complex. The spinal cord lesion is usually bilaterally symmetrical, but, there are occasional cases with one or more hemivertebrae, often associated with a central bony spur splitting the cord (diastematomyelia, in which one leg is virtually normal while the other is severely paralysed. Hemimyelomeningocele over the lumbar area may be associated with extensive spine malsegmentation compatible with the diagnosis of spondylocostal dysplasia syndrome. In this report, we present a 3-year-old girl who underwent neurological evaluation and spinal imaging studies for extensive spine malsegmentation compatible with spondylocostal dysostosis syndrome associated with hemimyelomeningocele. She had a series of corrective orthopaedic interventions to reconstruct her pelvic girdle and spine deformities, with a satisfactory outcome.

  1. The prevalence and risk factors of the Syndrome of Inappropriate Anti-Diuretic Hormone secretion (SIADH following spinal surgery

    Directory of Open Access Journals (Sweden)

    Bahram Mobini

    2008-06-01

    Full Text Available

    • BACKGROUND: The Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH secretion is the most common etiology of normovolemic hyponatremia, which occurs following non-physiologic release of antidiuretic hormone (ADH from the posterior pituitary, or an ectopic source. SIADH has been reported as a complication of cardiothoracic, brain, and spinal surgeries. This study was conducted to assess the prevalence of SIADH following spinal surgeries and to identify the underlying risk factors.
    • METHODS: Samples were patients undergoing any spinal surgery at the Hospitals of Shafa Yahyaian and Rasoul Akram, Tehran, Iran in a 2-year period. Blood and urine sodium concentrations and osmolarity were measured before and after surgery. The amount of hemorrhage, as well as the patients' fluid input and output during surgery were recorded. Fluid input and output was also recorded on the first postoperative day.
    • RESULTS: The prevalence of SIADH following spinal surgeries was 60.3%. Mean duration of surgery in SIADH patients was longer than in others. Mean amount of hemorrhage and total fluid loss during surgery were significantly higher in SIADH patients than in healthy individuals.
    • CONCLUSIONS: SIADH is the principal cause of hyponatremia following spinal surgeries; the reported prevalence rates vary widely from 5 to 100%. SIADH following surgery has been attributed to stress, and in spinal or neurological surgeries to dural damage or traction of neuronal pathways. Time is of the essence in the treatment of hyponatremia and prevention of complications that may increase the mortality and morbidity of spinal surgeries.
    • KEYWORDS: Inappropriate ADH Syndrome, spinal surgeries, hyponatremia.

  2. Spinal Cord Protection with Allopurinol in Aortic Surgery

    Directory of Open Access Journals (Sweden)

    Aşkın Ender Topal

    2004-01-01

    Full Text Available In this experimental study, we examined the advantage of the retrogradeallopurinol appliement through the inferior vena cava during aortic surgeryto prevent the complications of spinal cord ischemia. This study wasexamined on 14 kangal dogs. In the first (control group, no preventivemethod was used. In the second (allopurinol group, allopurinol wasdelivered by retrograde way through the inferior vena cava. Aorts werecross-clamped for 75 minutes in the both groups to create spinal cordischemia. At the end of this period, the operations were finished and Tarlovscore was applied to dogs. After 1 day, the dogs were taken to reoperationand the spinal cords of the dogs were taken out to make theimmunohistochemical study with bcl-2 oncoprotein. At the end of this study,Tarlov scores were established 0.28 ± 0.49 in the first group and 4.14 ± 0.14in the second group. The immunohistochemical study with bcl-2oncoprotein demonstrated no cell prevention in the first group and 100 %cell prevention in the second group, respectively.According to this experimental study, allopurinol appliement throughthe inferior vena cava has a preventive effect on the spinal cord ischemia.

  3. Mental function and morbidity after acute hip surgery during spinal and general anaesthesia.

    Science.gov (United States)

    Bigler, D; Adelhøj, B; Petring, O U; Pederson, N O; Busch, P; Kalhke, P

    1985-07-01

    Forty elderly patients (mean age 78.9 years) undergoing acute surgery for hip fracture were given at random either spinal analgesia with bupivacaine 0.75% or general anaesthesia with diazepam, fentanly and N2O/O2. Mental function was studied pre-operatively with an abbreviated mental test and 1 week and 3 months postoperatively in both groups. Mortality and number of complications was similar in the two groups, but a shorter time of ambulation was seen in the spinal group compared to the general anaesthetic group. No persistent impairment in mental function was found after acute hip surgery under spinal or general anaesthesia and the only advantage of regional technique was a shorter time of ambulation.

  4. Pain management following spinal surgeries: An appraisal of the available options

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2015-01-01

    Full Text Available Spinal procedures are generally associated with intense pain in the postoperative period, especially for the initial few days. Adequate pain management in this period has been seen to correlate well with improved functional outcome, early ambulation, early discharge, and preventing the development of chronic pain. A diverse array of pharmacological options exists for the effective amelioration of post spinal surgery pain. Each of these drugs possesses inherent advantages and disadvantages which restricts their universal applicability. Therefore, combination therapy or multimodal analgesia for proper control of pain appears as the best approach in this regard. The current manuscript discussed the pathophysiology of postsurgical pain including its nature, the various tools for assessment, and the various pharmacological agents (both conventional and upcoming available at our disposal to respond to post spinal surgery pain.

  5. Pain management following spinal surgeries: An appraisal of the available options

    Science.gov (United States)

    Bajwa, Sukhminder Jit Singh; Haldar, Rudrashish

    2015-01-01

    Spinal procedures are generally associated with intense pain in the postoperative period, especially for the initial few days. Adequate pain management in this period has been seen to correlate well with improved functional outcome, early ambulation, early discharge, and preventing the development of chronic pain. A diverse array of pharmacological options exists for the effective amelioration of post spinal surgery pain. Each of these drugs possesses inherent advantages and disadvantages which restricts their universal applicability. Therefore, combination therapy or multimodal analgesia for proper control of pain appears as the best approach in this regard. The current manuscript discussed the pathophysiology of postsurgical pain including its nature, the various tools for assessment, and the various pharmacological agents (both conventional and upcoming) available at our disposal to respond to post spinal surgery pain. PMID:26288544

  6. Early rehabilitation improves neurofunctional outcome after surgery in children with spinal tumors

    Institute of Scientific and Technical Information of China (English)

    Nezire Kose; Ozge Muezzinoglu; Sevil Bilgin; Sevilay Karahan; Ilkay Iskay; Burcak Bilginer

    2014-01-01

    To investigate the effect of early rehabilitation on neurofunctional outcome after surgery in chil-dren with spinal tumors, this study reviewed the medical charts and radiographic records of 70 pediatric patients (1-17 years old) who received spinal tumor surgical removal. The peddiatric patients received rahabilitation treatment at 4 (range, 2-7) days after surgery for 10 (range, 7-23) days. Results from the Modiifed McCormick Scale, Functional Independence Measure for Chil-dren, American Spinal Injury Association Impairment Scale and Karnofsky Performance Status Scale demonstrated that the sensory function, motor function and activity of daily living of pedi-atric children who received early rehabilitation were signiifcantly improved. Results also showed that tumor setting and level localization as well as patients’s clinical symptoms have no inlfuences on neurofunctional outcomes.

  7. [Caudal and spinal anesthesia in sub-umbilical surgery in children. Apropos of 1875 cases].

    Science.gov (United States)

    Aguemon, A R; Terrier, G; Lansade, A; Favereau, J P; Nathan, N; Feiss, P

    1996-01-01

    Caudal and spinal anaesthesia are two techniques widely used in European children. The aim of this retrospective study was to evaluate the applicability of this practice in developing countries. The study concerned 1875 children, 1 day to 17 years old. isobaric 0.5% bupivacaine was used for spinal anaesthesia (n = 730) and mixture a of 1% lidocaine-0.25% bupivacaine with epinephrine 1/200,000 for caudal anaesthesia (n = 1,145). Spinal anaesthesia was performed in neonates and infants (< 3 years) and caudal anaesthesia in children (aged 14 days to 17 years) undergoing urological and lower extremity surgery. No variation of heart rate, blood pressure or blood oxygen saturation (SpO2) were observed during surgery. Failure of the technique was less than 1%. These two regional anaesthesia techniques are easy to perform and are inexpensive. This is advantageous for developing countries.

  8. Taylor Approach of Spinal Anaesthesia in a case of Ankylosing Spondylitis for Hip Fracture Surgery

    Directory of Open Access Journals (Sweden)

    Urmila Palaria

    2011-11-01

    Full Text Available Ankylosing Spondylitis (AS is a chronic inflammatory rheumatic disease primarily affecting the axial joints manifesting as stiffnesss of the spine. Patient with ankylosing spondylitis is a challenge to anaesthesiologists in terms of airway management and neuraxial blocks. Modified paramedian approach (Taylor approach of spinal anaesthesia can be used as an alternative to technically difficult cases in patients undergoing lower limb surgeries.

  9. Taylor Approach of Spinal Anaesthesia in a case of Ankylosing Spondylitis for Hip Fracture Surgery

    OpenAIRE

    Urmila Palaria; Mohd Asim Rasheed; D C Punera; Umesh K Bhadani

    2011-01-01

    Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease primarily affecting the axial joints manifesting as stiffnesss of the spine. Patient with ankylosing spondylitis is a challenge to anaesthesiologists in terms of airway management and neuraxial blocks. Modified paramedian approach (Taylor approach) of spinal anaesthesia can be used as an alternative to technically difficult cases in patients undergoing lower limb surgeries.

  10. Cerebral venous thrombosis following spinal surgery in a patient with Factor V Leiden mutation.

    Science.gov (United States)

    Yılmaz, Baran; Ekşi, Murat Şakir; Akakın, Akın; Toktaş, Zafer Orkun; Demir, Mustafa Kemal; Konya, Deniz

    2016-08-01

    Cerebral venous thrombosis is a devastating event leading to high mortality and morbidity rates. We present a case of cerebral venous thrombosis that occurred following spinal surgery in a patient with Factor V Leiden mutation and G1691A heterozygosity. Possible prevention and treatment strategies have been discussed.

  11. The 100 most cited papers in spinal deformity surgery: a bibliometric analysis

    Directory of Open Access Journals (Sweden)

    Shane C. O’Neill

    2014-10-01

    Full Text Available Spinal deformity is a condition that has been recognized for many millennia. There have been major advances in the treatment of spinal deformity in recent years and studies outlining new ideas can inspire others to further advance the speciality. The number of citations a paper receives may indicate the influence of that paper. It is therefore important that we evaluate and analyze the most cited works in our field. The aim of this study is to identify the 100 most cited papers relevant to spinal deformity surgery in the literature. A search through the Thomson Reuters Web of ScienceTM for citations related to spinal deformity surgery was performed. The number of citations, mean citation number (total number citations/years since publication, journal, authors, year of publication and country of origin of the top 100 papers was recorded. The top 100 papers were cited a combined 17,646 times, ranging from 453 to 112. The majority of papers originated from the United States (71 and were published in 20 different journals. The decade 1990-1999 was the most prolific, with 36 of the 100 papers published during this time. Papers pertaining to the management of scoliosis (49 were the most common. This study identifies the top 100 most cited papers in the field of spinal deformity surgery. While citation is not a specific marker of the scientific quality of a paper, it is a surrogate for the influence a paper has had on the orthopedic community. This list of papers provides an invaluable resource for both those in training and those actively practicing and involved in the further development of spinal deformity surgery.

  12. The 100 most cited papers in spinal deformity surgery: a bibliometric analysis.

    Science.gov (United States)

    O'Neill, Shane C; Butler, Joseph S; McGoldrick, Niall; O'Leary, Robert; Synnott, Keith

    2014-10-27

    Spinal deformity is a condition that has been recognized for many millennia. There have been major advances in the treatment of spinal deformity in recent years and studies outlining new ideas can inspire others to further advance the speciality. The number of citations a paper receives may indicate the influence of that paper. It is therefore important that we evaluate and analyze the most cited works in our field. The aim of this study is to identify the 100 most cited papers relevant to spinal deformity surgery in the literature. A search through the Thomson Reuters Web of Science™ for citations related to spinal deformity surgery was performed. The number of citations, mean citation number (total number citations/years since publication), journal, authors, year of publication and country of origin of the top 100 papers was recorded. The top 100 papers were cited a combined 17,646 times, ranging from 453 to 112. The majority of papers originated from the United States (71) and were published in 20 different journals. The decade 1990-1999 was the most prolific, with 36 of the 100 papers published during this time. Papers pertaining to the management of scoliosis (49) were the most common. This study identifies the top 100 most cited papers in the field of spinal deformity surgery. While citation is not a specific marker of the scientific quality of a paper, it is a surrogate for the influence a paper has had on the orthopedic community. This list of papers provides an invaluable resource for both those in training and those actively practicing and involved in the further development of spinal deformity surgery.

  13. Recurrent radiculopathy caused by epidural gas after spinal surgery: report of four cases and literature review.

    Science.gov (United States)

    Sasani, Mehdi; Ozer, A Fahir; Oktenoglu, Tunc; Cosar, Murat; Karaarslan, Ercan; Sarioglu, Ali C

    2007-05-01

    The article presents and discusses 4 cases in which symptomatic epidural gas developed after different surgeries on the lumbar spine. To raise spinal surgeons' awareness of this potential problem. Vacuum phenomenon (gas accumulation in an intervertebral disc) is relatively common. Gas can also spontaneously enter and collect in the epidural space, but symptomatic epidural gas after spinal surgery is very rare. To date, only 5 such cases after lumbar surgery have been reported. The primary disorders in the 4 new cases were disc extrusion at L2-L3 (Case 1), disc degeneration and herniation at L4-L5 (Case 2), stenosis of the lumbar spinal canal (Case 3), and disc herniation at L5-S1 with spinal canal stenosis (Case 4). The corresponding surgeries performed were L2-L3 microdiscectomy, L4-L5 microdiscectomy with instrumentation, right unilateral hemilaminotomy with complete instrumentation, and L5-S1 microdiscectomy. All 4 patients developed unexpected postoperative complaints of low back and radicular pain. Each was investigated with computed tomography and magnetic resonance imaging. The images revealed epidural gas collections compressing the thecal sac and/or nerve roots. Conservative management was effective in all but 1 case. In the latter case, computed tomography-guided needle aspiration was performed, but this did not resolve the problem. Surgery led to a favorable outcome, and follow-up lumbar computed tomography showed no epidural gas. Epidural gas after lumbar surgery is very rare but can cause unexpected postoperative back or radicular pain. Combined computed tomography and magnetic resonance imaging should be used to identify the problem and rule out other disorders. Conservative treatment should be the first-line approach but surgery is often necessary if this does not resolve the problem.

  14. Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

    Science.gov (United States)

    Uribe, Juan S; Beckman, Joshua; Mummaneni, Praveen V; Okonkwo, David; Nunley, Pierce; Wang, Michael Y; Mundis, Gregory M; Park, Paul; Eastlack, Robert; Anand, Neel; Kanter, Adam; Lamarca, Frank; Fessler, Richard; Shaffrey, Chris I; Lafage, Virginie; Chou, Dean; Deviren, Vedat

    2017-03-01

    The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t -test and chi-square test were used to evaluate and compare outcomes. A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

  15. [Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous].

    Science.gov (United States)

    Verdú-López, Francisco; Beisse, Rudolf

    2014-01-01

    Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  16. Nutritional risk, malnutrition and nutritional support among hospitalized patients in orthopedics/spinal surgery of a Hohhot teaching hospital.

    Science.gov (United States)

    Wang, Nannan; Dong, Yalin; Huo, Ting; Shao, Yanqing; Xing, Wenhua; Li, Shuwen

    2016-01-01

    The evolution of nutritional status (the prevalence of nutritional risk, malnutrition, overweight and obesity) and the nutritional support of the hospitalized patients from admission to discharge or over a two-week period in orthopedics/ spinal surgery of a teaching hospital in Hohhot were investigated. 432 patients from two wards of the orthopedics/spinal surgery from Jan to Dec 2013, the traditional spinal surgery and the minimally invasive spinal surgery, were selected and detected in this study. The Nutritional Risk Score 2002 (NRS 2002) was used to determine the patients' nutritional status within 48 h after admission and during their hospitalization. The overall prevalence of nutritional risk, malnutrition, overweight and obesity at admission was 11.6%, 12.7%, 35.9% and 7.41%, respectively. Overall, there were 88.0% of the patients who were at nutritional risk received nutritional support, while 14.1% of non-risk patients received a redundant nutritional support. The overall prevalence of nutritional risk changed from 11.6% at admission to 19.4% upon discharge (pmalnutrition changed from 12.7% to 20.6% (prisk screening tool for patients in spinal surgery of orthopedics department. Patients' prevalence of nutritional risk and malnutrition increased significantly in spinal surgery of this hospital. Some inappropriate uses of nutritional support were observed in orthopedics/spinal surgery, and nutritional support guidelines or protocols should be promoted by a professional committee.

  17. Active self-correction of spinal posture in pain-free women in response to the command "straighten your back".

    Science.gov (United States)

    Barczyk-Pawelec, Katarzyna; Sipko, Tomasz

    2017-10-01

    Evidence is limited regarding the regional changes in spinal posture after self-correction. The aim of the present study was to evaluate whether active self-correction improved standing and sitting spinal posture. Photogrammetry was used to assess regional spinal curvatures and vertical global spine orientation (GSO) in 42 asymptotic women aged 20-24 years. Upper thoracic spine angle and GSO increased in response to self-correction, while the thoracolumbar and lumbosacral angles decreased. Self-correction in the standing position resulted in decreased inclination of the upper thoracic and thoracolumbar spinal angles. Correction of sitting posture reduced the angle of the upper thoracic spine and GSO. The effects of active self-correction on spinal curvature and GSO were different for the standing versus sitting position; the greatest effects of active correction were noted in the thoracic spine. Balanced and lordotic postures were most prevalent in the habitual and actively self-corrected standing positions, whereas the kyphotic posture was most prevalent in the habitual sitting position, indicative that self-correction back posture in the standing position could be an important health-related daily activity, especially during prolonged sitting.

  18. Unilateral versus Bilateral Instrumentation in Spinal Surgery: A Systematic Review

    OpenAIRE

    2015-01-01

    Study Design Systematic review. Clinical Questions (1) What is the comparative efficacy of unilateral instrumentation compared with bilateral instrumentation in spine surgery? (2) What is the safety of unilateral instrumentation compared with bilateral instrumentation in spine surgery? Methods Electronic databases and reference lists of key articles were searched up to September 30, 2014, to identify studies reporting the comparative efficacy and safety of unilateral versus bilateral instrume...

  19. Anterior cervical surgery methods for central cord syndrome without radiographic spinal fracture-dislocation

    Institute of Scientific and Technical Information of China (English)

    Chengwei JING; Qin FU; Xiaojun XU

    2009-01-01

    This study was aimed to explore the anterior cervical surgery methods to treat central cord syndrome without radiographic spinal fracture-dislocation (CCSWORFD), retrospectively analyze the cases of CCSWORFD, and evaluate the curative effect of anterior cervical surgery methods for CCSWORFD. Twenty four cases of CCSWORFD (19 males and 5 females), all suffering from cervical hyperextension injury, between 45-68 (average 59) years old, were operated on by anterior cervical surgery methods. Among these, 18 cases had been followed up for 6-24 (average 15) months; 18 cases, who had anterior decompression and plate fixation with titanium mesh bone grafting or iliac bone grafting achieved reliable effects based on the Japanese Orthopedics Association (JOA) evaluation (improved scores of cases with titanium mesh bone grafting, t = 2.800, P0.05). Most of these cases had degeneration of cervical vertebra. The decompression which relieves the oppression to the spinal cord can help lessen edema of the spinal cord, and early fixation for stability of cervical vertebra is better for the recovery of spinal cord injury. Anterior operation with titanium mesh bone grafting or iliac bone grafting are both reliable curative methods for CCSWORFD, and titanium mesh bone grafting can avoid the trauma of the supplying graft. Mesh bone grafting can also shorten hospital stay.

  20. [Effect of dexmedetomidine infusion on postoperative recovery for patients undergoing major spinal surgery during propofol anesthesia].

    Science.gov (United States)

    Li, B Y; Geng, Z Y; Wang, D X

    2016-06-18

    To evaluate the effect of intraoperative dexmedetomidine (DEX) infusion during propofol intravenous anesthesia on postoperative recovery after major spinal surgery. Sixty patients aged 18 to 65 (American Society of Anesthesiologists, ASA I-II), scheduled for spinal surgery from January 2014 to May 2014 were randomized into two groups. The DEX group (n=30) received 0.5 μg/kg of DEX ten minutes before anesthesic induction, followed by an infusion of DEX at 0.2 μg/(kg×h) intraoperatively and the control group (n=30) was given identical amounts of normal saline. At the end of surgery, the patients of both groups received patient-controlled intravenous analgesia (PCIA) with morphine 0.5 mg/h (1 mg demand dose and 8 min lockout). Heart rate and mean arterial pressure (MAP) were continually monitored during operation and in the post-anesthesia care unit (PACU). The propofol and sufentanil consumptions during operation and the morphine consumption 48 h after surgery were recorded. The time for recovery and extubation were recorded. The followed-up evaluations were performed to assess Ramsay scores, visual analogue scale (VAS) pain scores as well as side effects in PACU and 48 h after surgery. Heart rate of DEX group was lower than that of control group after intubation and extubation and in PACU 10 min (Panesthesic induction, the sufentanil consumption during operation and the cumulative consumption of morphine 2 h and 6 h after surgery were decreased (P<0.05). There were no differences between the two groups as to the time for recovery or extubation. Compared with control group, the VAS pain scores were significantly decreased (P<0.01), the incidence of postoperative nausea and vomiting in DEX group were significantly decreased (P<0.05) 48 h after surgery. Intraoperative infusion of DEX improved quality of recovery, provided good analgesia, and decreased morphine use and the incidence of postoperative nausea and vomiting after major spinal surgery.

  1. Perioperative spinal cord infarction in nonaortic surgery: report of three cases and review of the literature.

    Science.gov (United States)

    Hobai, Ion A; Bittner, Edward A; Grecu, Loreta

    2008-06-01

    Paraplegia caused by a spinal cord infarction (SCI) is a devastating perioperative complication, most often associated with aortic and spine surgery. We present two other clinical scenarios in which perioperative SCI may occur. They happened during surgical procedures performed with epidural anesthesia, in the presence of several specific risk factors such as spinal stenosis, vascular disease, intraoperative hypotension, or the use of epinephrine in the local anesthetic solution. Second, SCI may occur during episodes of postoperative hypotension in patients with a history of aortic aneurysms.

  2. Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery

    Science.gov (United States)

    Ellakany, Mohamed Hamdy

    2014-01-01

    Aim: A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia. Background: Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can’t tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be beneficial in such patients. Materials and Methods: A total of 60 patients classified according to American Society of Anesthesiology (ASA) as class II or III undergoing surgeries for abdominal malignancy, like colonic or gastric carcinoma, divided into two groups, 30 patients each. Group G, received general anesthesia, Group S received a segmental (T9-T10 injection) thoracic spinal anesthesia with intrathecal injection of 2 ml of hyperbaric bupivacaine 0.5% (10 mg) and 20 ug fentanyl citrate. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups. Results: Spinal anesthesia was performed easily in all 30 patients, although two patients complained of paraesthesiae, which responded to slight needle withdrawal. No patient required conversion to general anesthesia, six patients required midazolam for anxiety and six patients required phenylephrine and atropine for hypotension and bradycardia, recovery was uneventful and without sequelae. The two groups were comparable with respect to gender, age, weight, height, body mass index, ASA classification, preoperative oxygen saturation and preoperative respiratory rate and operative time. Conclusion: This preliminary study has shown that segmental thoracic spinal anesthesia can be used successfully and effectively for open surgeries for abdominal malignancies by experienced anesthetists. It showed shorter postanesthesia care unit stay

  3. Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery

    Science.gov (United States)

    Elakany, Mohamed Hamdy; Abdelhamid, Sherif Ahmed

    2013-01-01

    Background: Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries. Materials and Methods: Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary dissection. They were randomly divided into two groups. The thoracic spinal group (S) (n = 20) underwent segmental thoracic spinal anesthesia with bupivacaine and fentanyl at T5-T6 interspace, while the other group (n = 20) underwent general anesthesia (G). Intraoperative hemodynamic parameters, intraoperative complications, postoperative discharge time from post-anesthesia care unit (PACU), postoperative pain and analgesic consumption, postoperative adverse effects, and patient satisfaction with the anesthetic techniques were recorded. Results: Intraoperative hypertension (20%) was more frequent in group (G), while hypotension and bradycardia (15%) were more frequent in the segmental thoracic spinal (S) group. Postoperative nausea (30%) and vomiting (40%) during PACU stay were more frequent in the (G) group. Postoperative discharge time from PACU was shorter in the (S) group (124 ± 38 min) than in the (G) group (212 ± 46 min). The quality of postoperative analgesia and analgesic consumption was better in the (S) group. Patient satisfaction was similar in both groups. Conclusions: Segmental thoracic spinal anesthesia has some advantages when compared with general anesthesia and can be considered as a sole anesthetic in breast cancer surgery with axillary lymph node clearance. PMID:25885990

  4. COMPARATIVE STUDY OF SPINAL ANESTHESIA AND GENERAL ANESTHESIA IN CHILDREN UNDERGOING SURGERIES BELOW UMBILICUS

    Directory of Open Access Journals (Sweden)

    Ashish

    2014-09-01

    Full Text Available AIM: Aim of our study to compare the spinal anaesthesia and general anaesthesia in children undergoing surgeries below umbilicus. OBJECTIVE: to assess the patient comfort in pt. with GA and pt. with spinal anaesthesia, the adequate surgical condition, assess the hemodynamic change, assess the post op analgesia and to assess the post op complication. MATERIAL AND METHOD: 60 ASA grade I & II children of either sex, aged 5-12 yrs undergoing elective surgeries for the lower abdominal, perineal and lower limb surgeries were taken. After taking a detailed history, thorough general physical examination, all pertinent investigation were carried out to exclude any systemic disease. Patients were classified randomly into 2 groups (30 patients in each group. Group A: General anesthesia was given. Group P: subarachnoid block was given. Intraoperative monitoring consisted of SPO2, PR, NIBP, RR and assessment of duration of post-operative analgesia. P-value <0.05 consider significant. RESULT: Analysis revealed that there were no significant differences between the patients with respect to age, sex, duration and type of surgery In SAB since less general anaesthetic drug including parental opioid are used the risk and postoperative respiratory depression is minimal. The stress response to surgery is also limited and recovery is fast. Postoperatively complications like sore throat, laryngeal irritation, cough etc. was also less associated with it. CONCLUSION pediatric spinal anesthesia is not only a safe alternative to general anesthesia but often the anesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and flexibility is broken and is now found to be even more cost effective. It is much preferred technique special for common day case surgeries generally performed in the pediatric age group.

  5. Correction of low corneal astigmatism in cataract surgery

    Institute of Scientific and Technical Information of China (English)

    Pia; Leon; Marco; Rocco; Pastore; Andrea; Zanei; Ingrid; Umari; Meriem; Messai; Corrado; Negro; Daniele; Tognetto

    2015-01-01

    · AIM: To evaluate and compare aspheric toric intraocular lens(IOL) implantation and aspheric monofocal IOL implantation with limbal relaxing incisions(LRI) to manage low corneal astigmatism(1.0-2.0 D) in cataract surgery.· METHODS: A prospective randomized comparative clinical study was performed. There were randomly recruited 102 eyes(102 patients) with cataracts associated with corneal astigmatism and divided into two groups. The first group received toric IOL implantation and the second one monofocal IOL implantation with peripheral corneal relaxing incisions. Outcomes considered were: visual acuity, postoperative residual astigmatism, endothelial cell count, the need for spectacles, and patient satisfaction. To determine the postoperative toric axis, all patients who underwent the toric IOL implantation were further evaluated using an OPD Scan III(Nidek Co, Japan). Follow-up lasted 6mo.· RESULTS: The mean uncorrected distance visual acuity(UCVA) and the best corrected visual acuity(BCVA) demonstrated statistically significant improvement after surgery in both groups. At the end of the follow-up the UCVA was statistically better in the patients with toric IOL implants compared to those patients who underwent implantation of monofocal IOL plus LRI. The mean residual refractive astigmatism was of 0.4 D for the toric IOL group and 1.1 D for the LRI group(P <0.01). No difference was observed in the postoperative endothelial cell count between the two groups.· CONCLUSION: The two surgical procedures demonstrated a significant decrease in refractive astigmatism. Toric IOL implantation was more effective and predictable compared to the limbal relaxing incision.

  6. Development of a preoperative predictive model for major complications following adult spinal deformity surgery.

    Science.gov (United States)

    Scheer, Justin K; Smith, Justin S; Schwab, Frank; Lafage, Virginie; Shaffrey, Christopher I; Bess, Shay; Daniels, Alan H; Hart, Robert A; Protopsaltis, Themistocles S; Mundis, Gregory M; Sciubba, Daniel M; Ailon, Tamir; Burton, Douglas C; Klineberg, Eric; Ames, Christopher P

    2017-03-24

    OBJECTIVE The operative management of patients with adult spinal deformity (ASD) has a high complication rate and it remains unknown whether baseline patient characteristics and surgical variables can predict early complications (intraoperative and perioperative [within 6 weeks]). The development of an accurate preoperative predictive model can aid in patient counseling, shared decision making, and improved surgical planning. The purpose of this study was to develop a model based on baseline demographic, radiographic, and surgical factors that can predict if patients will sustain an intraoperative or perioperative major complication. METHODS This study was a retrospective analysis of a prospective, multicenter ASD database. The inclusion criteria were age ≥ 18 years and the presence of ASD. In total, 45 variables were used in the initial training of the model including demographic data, comorbidities, modifiable surgical variables, baseline health-related quality of life, and coronal and sagittal radiographic parameters. Patients were grouped as either having at least 1 major intraoperative or perioperative complication (COMP group) or not (NOCOMP group). An ensemble of decision trees was constructed utilizing the C5.0 algorithm with 5 different bootstrapped models. Internal validation was accomplished via a 70/30 data split for training and testing each model, respectively. Overall accuracy, the area under the receiver operating characteristic (AUROC) curve, and predictor importance were calculated. RESULTS Five hundred fifty-seven patients were included: 409 (73.4%) in the NOCOMP group, and 148 (26.6%) in the COMP group. The overall model accuracy was 87.6% correct with an AUROC curve of 0.89 indicating a very good model fit. Twenty variables were determined to be the top predictors (importance ≥ 0.90 as determined by the model) and included (in decreasing importance): age, leg pain, Oswestry Disability Index, number of decompression levels, number of

  7. Impact of post-manipulation corrective core exercises on the spinal deformation and lumbar strength in golfers: a case study.

    Science.gov (United States)

    Shin, Chul-Ho; Kim, Minjeong; Park, Gi Duck

    2015-09-01

    [Purpose] This study examined spinal shape in professional golfers with chronic back pain, and analyzed the effects of a 4-week regimen of semi-weekly manipulation and corrective core exercises on spinal shape. [Subjects] Two golfers with chronic back pain. [Methods] The pelvis and spinal vertebrae were corrected using the Thompson "drop" technique. Angle and force were adjusted to place the pelvis, lumbar spine, and thoracic vertebrae in neutral position. The technique was applied twice weekly after muscle massage in the back and pelvic areas. The golfers performed corrective, warmup stretching exercises, followed by squats on an unstable surface using the Togu ball. They then used a gym ball for repetitions of hip rotation, upper trunk extension, sit-ups, and pelvic anterior-posterior, pelvic left-right, and trunk flexion-extension exercises. The session ended with cycling as a cool-down exercise. Each session lasted 60 minutes. [Results] The difference in height was measured on the left and right sides of the pelvic bone. The pelvic tilt changed significantly in both participants after the 4-week program. [Conclusion] In golfers, core muscles are critical and are closely related to spinal deformation. Core strengthening and spinal correction play a pivotal role in the correction of spinal deformation.

  8. Prevalence of Internet use amongst an elective spinal surgery outpatient population.

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2010-10-01

    Nationally 62% of individuals in Ireland have internet access. Previous published work has suggested that internet use is higher among those with low back pain. We aimed to determine the levels of internet access and use amongst an elective spinal outpatient population and determine what characteristics influence these. We distributed a self-designed questionnaire to patients attending elective spinal outpatient clinics. Data including demographics, history of surgery, number of visits, level of satisfaction with previous consultations, access to the internet, possession of health insurance, and details regarding use of the internet to research one\\'s spinal complaint were collected. 213 patients completed the questionnaire. 159 (75%) had access to the internet. Of this group 48 (23%) used the internet to research their spinal condition. Increasing age, higher education level, and possession of health insurance were all significantly associated with access to the internet (p < 0.05). A higher education level predicted greater internet use while possession of insurance weakly predicted non-use (p < 0.05). In our practice, internet access is consistent with national statistics and use is comparable to previous reports. Approximately, one quarter of outpatients will use the internet to research their spinal condition. Should we use this medium to disseminate information we need to be aware some groups may not have access.

  9. Prevalence of Internet use amongst an elective spinal surgery outpatient population.

    Science.gov (United States)

    Baker, Joseph F; Devitt, Brian M; Kiely, Paul D; Green, James; Mulhall, Kevin J; Synnott, Keith A; Poynton, Ashley R

    2010-10-01

    Nationally 62% of individuals in Ireland have internet access. Previous published work has suggested that internet use is higher among those with low back pain. We aimed to determine the levels of internet access and use amongst an elective spinal outpatient population and determine what characteristics influence these. We distributed a self-designed questionnaire to patients attending elective spinal outpatient clinics. Data including demographics, history of surgery, number of visits, level of satisfaction with previous consultations, access to the internet, possession of health insurance, and details regarding use of the internet to research one's spinal complaint were collected. 213 patients completed the questionnaire. 159 (75%) had access to the internet. Of this group 48 (23%) used the internet to research their spinal condition. Increasing age, higher education level, and possession of health insurance were all significantly associated with access to the internet (p internet use while possession of insurance weakly predicted non-use (p internet access is consistent with national statistics and use is comparable to previous reports. Approximately, one quarter of outpatients will use the internet to research their spinal condition. Should we use this medium to disseminate information we need to be aware some groups may not have access.

  10. Remote Cerebellar Hemorrhage Presenting with Cerebellar Mutism after Spinal Surgery: An Unusual Case Report

    OpenAIRE

    Sen,Halil Murat; Guven, Mustafa; Aras, Adem Bozkurt; Cosar,Murat

    2017-01-01

    Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has n...

  11. Cortical blindness following spinal surgery: very rare cause of perioperative vision loss.

    Science.gov (United States)

    Goni, Vijay; Tripathy, Sujit Kumar; Goyal, Tarun; Tamuk, Tajir; Panda, Bijnya Birajita; Bk, Shashidhar

    2012-12-01

    A 38-year-old man was operated with posterior spinal decompression and pedicle screw instrumentation for his L2 fracture with incomplete neurological deficit. In the recovery, he complained of blindness in both eyes after twelve hours. Computed tomographic scan and magnetic resonance angiography revealed bilateral occipital lobe infarcts. He remained permanently blind even after three years follow-up. Though rare, perioperative vision loss is a potential complication following spine surgery in prone position. We report a rare occurrence of cortical blindness following lumbar spine surgery.

  12. Does a kaolin-impregnated hemostatic dressing reduce intraoperative blood loss and blood transfusions in pediatric spinal deformity surgery?

    Science.gov (United States)

    Abbott, Emily M; Nandyala, Sreeharsha V; Schwend, Richard M

    2014-09-01

    Retrospective case-control study. To evaluate the hemostatic benefits of using a kaolin-impregnated dressing during pediatric spinal deformity correction surgery. Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin-impregnated hemostatic dressing. Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46 females, 19 males, 12.7±4.5 yr, 10.2±4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33 females, 19 males, 13.9±3.2 yr, 10.4±4.3 levels fused) who underwent intraoperative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgical procedures from July 2010 to August 2011. No other major changes in the use of antifibrinolytics or perioperative, surgical, or anesthesia technique were noted. Statistical differences were analyzed using analysis of covariance in R with P value of less than 0.05. The statistical model included sex, age, weight, scoliosis type, the number of vertebral levels fused, and surgery duration as covariates. The treatment group had 40% less intraoperative estimated blood loss than the control group (974 mL vs. 1620 mL) (Pkaolin-impregnated intraoperative trauma pad seems to be an effective and inexpensive method to reduce intraoperative blood loss and transfusion volume in pediatric spinal deformity surgery. 3.

  13. Predictors of ambulatory function after decompressive surgery for metastatic epidural spinal cord compression.

    Science.gov (United States)

    Chaichana, Kaisorn L; Woodworth, Graeme F; Sciubba, Daniel M; McGirt, Matthew J; Witham, Timothy J; Bydon, Ali; Wolinsky, Jean Paul; Gokaslan, Ziya

    2008-03-01

    Metastatic epidural spinal cord compression (MESCC) is a relatively common and debilitating complication of metastatic disease that often results in neurological deficits. This study was designed to explore associations with maintaining and regaining ambulatory function after decompressive surgery for MESCC. Seventy-eight patients undergoing decompressive surgery for MESCC at an academic tertiary care institution between 1995 and 2005 were retrospectively reviewed. Fisher's exact analysis was used to compare preoperative ambulatory and nonambulatory patients. Multivariate Cox proportional hazards regression was used to identify associations with either maintaining or regaining the ability to walk. Patients were followed for 7.1 +/- 1.6 (mean +/- standard deviation) months after surgery. Preoperative nonambulatory patients required more extensive surgery (increased operative spinal levels and number of laminectomies) and had more surgical site complications (wound dehiscences and cerebrospinal fluid leaks) compared with preoperative ambulatory patients. From the multivariate analysis, preoperative ability to walk (relative risk [RR], 2.320; 95% confidence interval [CI], 1.301-4.416; P return of ambulation after surgery for patients with MESCC.

  14. Tension Pneumothorax as a Complication of Inadvertent Pleural Tears During Posterior Spinal Surgery.

    Science.gov (United States)

    Lewis, Stephen J; Keshen, Sam G N; Lewis, Noah D H; Dear, Taylor E; Mehrkens, Arne; Niazi, Ahtsham U

    2014-07-01

    To review and expose the occurrences of tension pneumothorax as a result of pleural tear during posterior spinal surgery. Intraoperative reports were retrospectively reviewed for 2 patients who underwent posterior spinal fusion and experienced pleural tear and subsequent tension pneumothorax. Surgical decisions for recognition and treatment were also reviewed. Unrecognized pleural tearing led to the formation of tension pneumothorax in both patients studied. Onset of respiratory signs and symptoms were delayed, occurring in the recovery room for the first patient and intraoperatively for the second. Both patients were successfully treated with conversion to open pneumothorax and placement of chest tubes. Tension pneumothorax is a complication that can arise during posterior thoracic spinal surgery as a result of an inadvertent pleural tear. Awareness of this potentially fatal complication will greatly help in the timely recognition and treatment of this condition if this situation occurs. The authors recommend a low threshold for chest tube placement in patients with known or suspected pleural tears or in patients with undiagnosed respiratory failure undergoing posterior thoracic spine surgery. Copyright © 2014 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  15. Osteoconductive hydroxyapatite coated PEEK for spinal fusion surgery

    Energy Technology Data Exchange (ETDEWEB)

    Hahn, Byung-Dong, E-mail: cera72@kims.re.kr [Functional Ceramics Group, Korea Institute of Materials Science, 797 Changwon-daero, Seongsan-gu, Changwon, Gyeong-Nam, 641-010 (Korea, Republic of); Park, Dong-Soo; Choi, Jong-Jin; Ryu, Jungho; Yoon, Woon-Ha; Choi, Joon-Hwan; Kim, Jong-Woo; Ahn, Cheol-Woo [Functional Ceramics Group, Korea Institute of Materials Science, 797 Changwon-daero, Seongsan-gu, Changwon, Gyeong-Nam, 641-010 (Korea, Republic of); Kim, Hyoun-Ee [School of Materials Science and Engineering, Seoul National University, San 56-1 Sillim-Dong, Gwanak-gu, Seoul, 151-742 (Korea, Republic of); Yoon, Byung-Ho; Jung, In-Kwon [GENOSS, Gyeonggi R and DB Center, Iui-dong, Yeongtong-gu, Suwon, Gyeonggi-do, 443-270 (Korea, Republic of)

    2013-10-15

    Polyetheretherketone (PEEK) has attracted much interest as biomaterial for interbody fusion cages due to its similar stiffness to bone and good radio-transparency for post-op visualization. Hydroxyapatite (HA) coating stimulates bone growth to the medical implant. The objective of this work is to make an implant consisting of biocompatible PEEK with an osteoconductive HA surface for spinal or orthopedic applications. Highly dense and well-adhered HA coating was developed on medical-grade PEEK using aerosol deposition (AD) without thermal degradation of the PEEK. The HA coating had a dense microstructure with no cracks or pores, and showed good adhesion to PEEK at adhesion strengths above 14.3 MPa. The crystallinity of the HA coating was remarkably enhanced by hydrothermal annealing as post-deposition heat-treatment. In addition, in vitro and in vivo biocompatibility of PEEK, in terms of cell adhesion morphology, cell proliferation, differentiation, and bone-to-implant contact ratio, were remarkably enhanced by the HA coating through AD.

  16. Intrathecal morphine attenuates acute opioid tolerance secondary to remifentanil infusions during spinal surgery in adolescents

    Directory of Open Access Journals (Sweden)

    Tripi PA

    2015-09-01

    Full Text Available Paul A Tripi,1 Matthew E Kuestner,1 Connie S Poe-Kochert,2 Kasia Rubin,1 Jochen P Son-Hing,2 George H Thompson,2 Joseph D Tobias3 1Division of Pediatric Anesthesiology, 2Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, 3Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA Introduction: The unique pharmacokinetic properties of remifentanil with a context-sensitive half-life unaffected by length of infusion contribute to its frequent use during anesthetic management during posterior spinal fusion in children and adolescents. However, its intraoperative administration can lead to increased postoperative analgesic requirements, which is postulated to be the result of acute opioid tolerance with enhancement of spinal N-methyl-D-aspartate receptor function. Although strategies to prevent or reduce tolerance have included the coadministration of longer acting opioids or ketamine, the majority of these studies have demonstrated little to no benefit. The current study retrospectively evaluates the efficacy of intrathecal morphine (ITM in preventing hyperalgesia following a remifentanil infusion.Methods: We retrospectively analyzed 54 patients undergoing posterior spinal fusion with segmental spinal instrumentation, to evaluate the effects of ITM on hyperalgesia from remifentanil. Patients were divided into two groups based on whether they did or did not receive remifentanil during the surgery: no remifentanil (control group (n=27 and remifentanil (study group (n=27. Data included demographics, remifentanil dose and duration, Wong–Baker visual analog scale postoperative pain scores, and postoperative intravenous morphine consumption in the first 48 postoperative hours.Results: The demographics of the two study groups were similar. There were no differences in the Wong–Baker visual analog

  17. Sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery

    Science.gov (United States)

    Ersoy, Ayşın; Kara, Deniz; Ervatan, Zekeriya; Çakırgöz, Mensure; Kıran, Özlem

    2015-01-01

    Objectives: To compare midazolam and propofol sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery with bispectral index monitoring. Methods: This prospective and randomized study was completed in the Department of Anesthesiology, Okmeydani Training and Research Hospital, Istanbul, Turkey between February 2013 and December 2014. Sixty patients undergoing elective hip surgery under spinal anesthesia in the geriatric age group with albumin levels below 3 g/dl were randomly divided into Group I and Group II. After administration of spinal block, Group I were given 0.05 mg/kg bolus midazolam, and then 0.02-0.1 mg/kg/hr dose infusion was begun. In Group II, 1 mg/kg bolus propofol was given within 10 minutes, and then 1-3 mg/kg/hr infusion was begun. The systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, peripheral oxygen saturation values, respiratory rate, and Wilson’s 5-stage sedation score were recorded at 15-minute intervals. At the end of the operation, the recovery time and surgeon satisfaction were recorded. Results: The recovery times for patients in Group I were found to be longer than in Group II (p<0.05). The respiration rate in patients in Group I at the start of surgery, 15th minute of surgery, and after surgery were lower than in Group II (p<0.05). Conclusion: We conclude that propofol is more reliable in terms of hemodynamic stability than midazolam, as it causes less respiratory depression and faster recovery in the propofol group. PMID:26446330

  18. Health-related quality of life of patients following selected types of lumbar spinal surgery: A pilot study

    Directory of Open Access Journals (Sweden)

    Androwich Ida

    2007-12-01

    Full Text Available Abstract Background Over 500,000 spinal surgeries are performed annually in the United States. Although pain relief and improved health-related quality of life (HRQOL are expectations following lumbar spinal surgery, there is limited research regarding this experience from the individual's perspective. In addition, no studies have examined the HRQOL of persons who have had this surgery using a comprehensive approach. The intent of this study was to address this deficiency by an assessment of both the individual and environmental factors that impact perceived HRQOL using the Wilson and Cleary Model for Health-Related Quality of Life in persons who have undergone lumbar spinal surgery. Methods This was a pilot study of 57 adult patients undergoing elective lumbar spinal surgery for either herniated disk and/or degenerative changes. Individuals completed questionnaires measuring perceived pain, mood, functional status, general health perceptions, social support and HRQOL preoperatively and three months following surgery. Descriptive statistics, dependent t-tests, and MANOVAs were used to describe and compare the differences of the study variables over time. Results Preliminary results indicate overall perceived physical HRQOL was significantly improved postoperatively (t [56] = 6.45, p Conclusion Although perceived physical HRQOL was significantly improved three months postoperatively, fatigue and lack of vigor were issues for subjects postoperatively. Excessive fatigue and low vigor may have implications for successful rehabilitation and return to work for patients following lumbar spinal surgery. Further research is needed with a larger sample size and subgroup analyses to confirm these results.

  19. Subcision Using a Spinal Needle Cannula and a Thread for Prominent Nasolabial Fold Correction

    Directory of Open Access Journals (Sweden)

    Sang-Yeul Lee

    2013-05-01

    Full Text Available Deepening of the nasolabial crease is an esthetically unpleasing aging phenomenon occurring in the midface. Various treatment modalities have been introduced to improve the appearance of prominent nasolabial folds, all of which have pros and cons. Currently, a minimally invasive technique using synthetic dermal fillers is most commonly used. A simple and easy subcision procedure using a wire scalpel has also been used and reported to be effective for prominent nasolabial fold correction, with minimal complications. As an alternative to the wire scalpel, we used a 20-gauge metal type spinal needle cannula (Hakko Co. and 4-0 Vicryl suture (Ethicon Inc. for subcision of nasolabial folds. This technique is less expensive than the use of a wire scalpel and easily available when needed. Therefore, on the basis of favorable results, our modified subcision technique may be considered effective for prominent nasolabial fold correction.

  20. Unintended durotomy in lumbar degenerative spinal surgery: a 10-year systematic review of the literature.

    Science.gov (United States)

    Ghobrial, George M; Theofanis, Thana; Darden, Bruce V; Arnold, Paul; Fehlings, Michael G; Harrop, James S

    2015-10-01

    OBJECT Unintended durotomy is a common occurrence during lumbar spinal surgery, particularly in surgery for degenerative spinal conditions, with the reported incidence rate ranging from 0.3% to 35%. The authors performed a systematic literature review on unintended lumbar spine durotomy, specifically aiming to identify the incidence of durotomy during spinal surgery for lumbar degenerative conditions. In addition, the authors analyzed the incidence of durotomy when minimally invasive surgical approaches were used as compared with that following a traditional midline open approach. METHODS A MEDLINE search using the term "lumbar durotomy" (under the 2015 medical subject heading [MeSH] "cerebrospinal fluid leak") was conducted on May 13, 2015, for English-language medical literature published in the period from January 1, 2005, to May 13, 2015. The resulting papers were categorized into 3 groups: 1) those that evaluated unintended durotomy rates during open-approach lumbar spinal surgery, 2) those that evaluated unintended durotomy rates during minimally invasive spine surgery (MISS), and 3) those that evaluated durotomy rates in comparable cohorts undergoing MISS versus open-approach lumbar procedures for similar lumbar pathology. RESULTS The MEDLINE search yielded 116 results. A review of titles produced 22 potentially relevant studies that described open surgical procedures. After a thorough review of individual papers, 19 studies (comprising 15,965 patients) pertaining to durotomy rates during open-approach lumbar surgery were included for analysis. Using the Oxford Centre for Evidence-Based Medicine (CEBM) ranking criteria, there were 7 Level 3 prospective studies and 12 Level 4 retrospective studies. In addition, the authors also included 6 studies (with a total of 1334 patients) that detailed rates of durotomy during minimally invasive surgery for lumbar degenerative disease. In the MISS analysis, there were 2 prospective and 4 retrospective studies. Finally

  1. NUTRITIONAL STATUS, VITAMIN D AND NASAL COLONIZATION IN SPINAL SURGERY

    Directory of Open Access Journals (Sweden)

    Diego Benone dos Santos

    2016-03-01

    Full Text Available ABSTRACT Objective: Evaluate the nutritional status, vitamin D, the serum albumin, and the nasal colonization by bacteria in a Brazilian population sample that included specifically patients undergoing spine surgery Methods: The serum albumin and vitamin D tests were performed on blood samples; nasal microbiological research was performed by swab and demographic information was collected. We studied the correlation between the tests and gender and age groups of patients. Results: Seventy-five patients were included. Of this total, 74 patients underwent testing of albumin levels, 64 of vitamin D and 41 underwent nasal swab. The mean of serum albumin was 3.76 g/dl (SD = 0.53 g/dl; 70.3% of subjects were considered normal and 29.7% showed hypoalbuminemia. Regarding vitamin D, the mean was 16.64 ng/ml (SD: 7.43 ng/ml; 64.1% of patients were considered deficient, 32.8% insufficient, and 3.1% were considered normal. There was significant difference between albumin and age (p=0.007, being that the greater the age, the lower the albumin. Hypoalbuminemia was significantly more frequent over 60 years (p<0.001. There was no correlation between vitamin D or nasal swab and age (p=0.603 and 0.725, respectively. The correlation between the tests and gender showed no significant difference in any of the parameters. Conclusion: The serum albumin and vitamin D levels and results of nasal swab were presented for a Brazilian sample of patients undergoing spine surgery. It was found correlation between hypoalbuminemia (inferring malnutrition and age group of patients. Almost all the patients had some degree of vitamin D deficiency, with no correlation with age.

  2. Increasing Incidence of Degenerative Spinal Diseases in Japan during 25 Years: The Registration System of Spinal Surgery in Tohoku University Spine Society.

    Science.gov (United States)

    Aizawa, Toshimi; Kokubun, Shoichi; Ozawa, Hiroshi; Kusakabe, Takashi; Tanaka, Yasuhisa; Hoshikawa, Takeshi; Hashimoto, Ko; Kanno, Haruo; Morozumi, Naoki; Koizumi, Yutaka; Sato, Tetsuro; Hyodo, Hironori; Kasama, Fumio; Ogawa, Shinji; Murakami, Eiichi; Kawahara, Chikashi; Yahata, Jun-Ichiro; Ishii, Yushin; Itoi, Eiji

    2016-01-01

    Spinal disorders affect mainly older people and cause pain, paralysis and/or deformities of the trunk and/or extremities, which could eventually disturb locomotive functions. For ensuring safe and high-quality treatment of spinal disorders, in 1987, the Tohoku University Spine Society (TUSS) was established by orthopedic departments in Tohoku University School of Medicine and its affiliated hospitals in and around Miyagi Prefecture. All spine surgeries have been enrolled in the TUSS Spine Registry since 1988. Using the data from this registration system between 1988 and 2012, we demonstrate here the longitudinal changes in surgical trends for spinal disorders in Japan that has rushed into the most advanced "aging society" in the world. In total, data on 56,744 surgeries were retrieved. The number of spinal surgeries has annually increased approximately 4-fold. There was a particular increase among patients aged ≥ 70 years and those aged ≥ 80 years, with a 20- to 90-fold increase. Nearly 90% of the spinal operations were performed for degenerative disorders, with their number increasing approximately 5-fold from 705 to 3,448. The most common disease for surgery was lumbar spinal stenosis (LSS) (35.9%), followed by lumbar disc herniation (27.7%) and cervical myelopathy (19.8%). In 2012, approximately half of the patients with LSS and cervical myelopathy were ≥ 70 years of age. In conclusion, the number of spinal operations markedly increased during the 25-year period, particularly among older patients. As Japan has a notably aged population, the present study could provide a near-future model for countries with aging population.

  3. The comparison of combined femoral-sciatic nerve block with spinal anesthesia at lower extremity surgery

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    Selim Almaz

    2014-06-01

    Full Text Available Introduction: In this study, we aimed to compare the spinal anesthesia technique with combined femoral-sciatic block technique in patients undergoing lower limb surgery. Methods: In this study, after obtaining the approval of the Dicle University Faculty of Medicine Ethics Committee, scheduled for elective lower extremity surgery, the ASA 1-2 groups, between the ages of 18-65, 60 patients were enrolled. Study was planned as a prospective, randomized and controlled. Patients were randomly divided into 2 groups as the spinal anesthesia (Group S and combined sciatic-femoral nerve block (Group CSF to be. Results: Demographic data similar between the groups (p> 0.05. The implementation period of the technique was long in the Group CSF compared with in the Group S (p <0.001. Surgery delivery time was shorter in the Group S compared with in the Group CSF (p <0.001. The time of motor block occurrence was longer in the Group CSF compared with in the Group S (p <0.001. The duration of motor block was long in the Group CSF compared with in the Group S (p <0.001. Conclusion: The each of two methods is safe and effective in lower extremity orthopedic surgery, but the application of peripheral nerve block to provide the long-term advantages such as postoperative analgesia and reducing postoperative analgesic consumption. J Clin Exp Invest 2014; 5 (2: 443-446

  4. Risk control and prevention of spinal cord damage due to surgery of thoracoabdominal aneurysms: medicolegal aspects.

    Science.gov (United States)

    de Mol, B; Hamerlijnck, R; Vermeulen, F E; de Geest, R

    1991-01-01

    Surgery of thoracoabdominal aneurysms is accompanied by many complications of which spinal cord damage is the most serious. Such a complication tends to be the subject of litigation and medicolegal assessment. This report presents a risk control concept focussed on the reduction of spinal cord damage after surgery for a thoracoabdominal aneurysm. This concept may provide a basis for a risk management program in major surgery. Apart from sparing the patient a serious complication, improvement of the quality of care and anticipation of a medicolegal assessment were considered valuable benefits of such an effort. It is described how the threat of litigation--also in Europe--may affect clinical practice. A definition of surgical failure is described related to the five elements of risk homeostasis: complexity, linkage, cascade, human factor and safety margins. Limitations of risk control in the surgery of thoracoabdominal aneurysms are described. Finally the role of perception of risks by patient and doctor as well as the importance of informed consent and adequate disclosure are described in respect of medical quality improvement and litigation.

  5. Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes.

    Science.gov (United States)

    Liu, Ning; Wood, Kirkham B

    2017-03-01

    OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

  6. Pulmonary Complications following Thoracic Spinal Surgery: A Systematic Review

    Science.gov (United States)

    Gabel, Brandon C.; Schnell, Eric C.; Dettori, Joseph R.; Jeyamohan, Shiveindra; Oskouian, Rod

    2016-01-01

    Study Design Systematic review. Objective To determine the frequency of pulmonary effusion, pneumothorax, and hemothorax in adult patients undergoing thoracic corpectomy or osteotomy for any condition and to determine if these frequencies vary by surgical approach (i.e., anterior, posterior, or lateral). Methods Electronic databases and reference lists of key articles were searched through September 21, 2015, to identify studies specifically evaluating the frequency of pulmonary effusion, pneumothorax, and hemothorax in patients undergoing thoracic spine surgery. Results Fourteen studies, 13 retrospective and 1 prospective, met inclusion criteria. The frequency across studies of pulmonary effusion ranged from 0 to 77%; for hemothorax, 0 to 77%; and for pneumothorax, 0 to 50%. There was no clear pattern of pulmonary complications with respect to surgical approach. Conclusions There is insufficient data to determine the risk of pulmonary complications following anterior, posterior, or lateral approaches to the thoracic spine. Methods for assessing pulmonary complications were not well reported, and data is sparse. PMID:27099821

  7. Importance of Radiological Evaluation of Global Spinal Balance Together with Lower Limb Alignment in Planning Lumbar Spine Deformity Surgery - Illustrative Case Presentation.

    Science.gov (United States)

    Głowacki, Mariusz; Walecki, Jerzy; Kołakowski, Przemysław; Kolońska, Danuta

    2017-01-01

    The presented case illustrates the critical role of a detailed preoperative radiological evaluation in complex spine surgery. A 49-year-old patient was admitted for a revision surgery after L3-L5 fusion. Preoperative assessment showed preserved sagittal balance, coronal imbalance and valgus knee deformity. The patient reported pain of 8-10 in VAS (Visual Analogue Scale) and had an ODI (Oswestry Disability Index) of 60%. The first step of the surgery was L2-S1 fusion with decompression and spine deformity correction. The second step involved anti-valgus osteotomy of the right tibial bone. The assessment of global spinal balance together with lower extremity alignment should be strongly recommended.

  8. Anterior Spinal Artery Syndrome: Reversible Paraplegia after Minimally Invasive Spine Surgery

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    J. Bredow

    2014-01-01

    Full Text Available Background Context. Percutaneous balloon kyphoplasty is an established minimally invasive technique to treat painful vertebral compression fractures, especially in the context of osteoporosis with a minor complication rate. Purpose. To describe the heparin anticoagulation treatment of paraplegia following balloon kyphoplasty. Study Design. We report the first case of an anterior spinal artery syndrome with a postoperative reversible paraplegia following a minimally invasive spine surgery (balloon kyphoplasty without cement leakage. Methods. A 75-year-old female patient underwent balloon kyphoplasty for a fresh fracture of the first vertebra. Results. Postoperatively, the patient developed an acute anterior spinal artery syndrome with motor paraplegia of the lower extremities as well as loss of pain and temperature sensation with retained proprioception and vibratory sensation. Complete recovery occurred six hours after bolus therapy with 15.000 IU low-molecular heparin. Conclusion. Spine surgeons should consider vascular complications in patients with incomplete spinal cord syndromes after balloon kyphoplasty, not only after more invasive spine surgery. High-dose low-molecular heparin might help to reperfuse the Adamkiewicz artery.

  9. [Spinal cord stimulation and failed back surgery syndrome. Clinical results with laminectomy electrodes].

    Science.gov (United States)

    García March, Guillermo; Bordes, Vicente; Roldán, Pedro; Real, Luis; González Darder, José Manuel

    2015-01-01

    Spinal cord stimulation is a widely-accepted technique in the treatment of back pain resulting from failed back surgery. Classically, stimulation has been carried out with percutaneous electrodes implanted under local anaesthesia and sedation. However, the ease of migration and the difficulty of reproducing electrical paresthesias in large areas with such electrodes has led to increasing use of surgical plate leads, which have the disadvantage of the need for general anaesthesia and a laminectomy for implantation. Our objective was to report the clinical results, technical details, advantages and benefits of laminectomy lead placement under epidural anaesthesia in failed back surgery syndrome cases. Spinal cord stimulation was performed in a total of 119 patients (52 men and 67 women), aged between 31 and 73 years (average, 47.3). Epidural anaesthesia was induced with ropivacaine. In all cases we inserted the octapolar or 16-polar lead in the epidural space through a small laminectomy. The final position of the leads was the vertebral level that provided coverage of the patient's pain. The electrodes were connected at dual-channel or rechargeable pulse generators. After a mean follow-up of 4.7 years, the results in terms of improvement of the previous painful situation was satisfactory, with an analgesia level of 58% of axial pain and 60% of radicular pain in more than 70% of cases. None of the patients said that the surgery stage was painful or unpleasant. No serious complications were included in the group, but in 6 cases the system had to be explanted because of ineffectiveness or intolerance of long-term neurostimulation. This study, with a significant number of patients, used epidural anaesthesia for spinal cord stimulation of lead implants by laminectomy in failed back surgery syndromes. The technique seems to be safe and effective. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  10. Spinal cord compression due to undiagnosed thoracic meningioma following lumbar surgery in an elderly patient: a case report.

    Science.gov (United States)

    Knafo, S; Lonjon, G; Vassal, M; Bouyer, B; Lonjon, N

    2013-12-01

    As spinal surgery in elderly patients is becoming increasingly frequent, comorbidities likely to be decompensated after such procedures must be kept in mind. We report here the case of an 82-year-old woman who presented rapidly progressive spinal cord compression following lumbar surgery for radiculopathy. Investigations showed a thoracic intradural extramedullary compressive lesion, which after removal turned out to be a meningioma. We suggest that radiculopathy and non-specific degenerative modifications partially masked this lesion, and that lumbar surgery caused this acute neurological deterioration. Therefore, we advice caution in older patients among whom such ambiguous clinical presentation is frequent. Copyright © 2013. Published by Elsevier Masson SAS.

  11. Augmentation of motor evoked potentials using multi-train transcranial electrical stimulation in intraoperative neurophysiologic monitoring during spinal surgery.

    Science.gov (United States)

    Tsutsui, Shunji; Iwasaki, Hiroshi; Yamada, Hiroshi; Hashizume, Hiroshi; Minamide, Akihito; Nakagawa, Yukihiro; Nishi, Hideto; Yoshida, Munehito

    2015-02-01

    Transcranial motor evoked potentials (TcMEPs) are widely used to monitor motor function during spinal surgery. Improvements in transcranial stimulation techniques and general anesthesia have made it possible to record reliable and reproducible potentials. However, TcMEPs are much smaller in amplitude compared with compound muscle action potentials (CMAPs) evoked by maximal peripheral nerve stimulation. In this study, multi-train transcranial electrical stimulation (mt-TES) was introduced to enhance TcMEPs, and the optimal setting of mt-TES was investigated. In 30 patients undergoing surgical correction of spinal deformities (4 males and 26 females with normal motor status; age range 11-75 years), TcMEPs from the abductor hallucis (AH) and quadriceps femoris (QF) were analyzed. A multipulse (train) stimulus with an individual pulse width of 0.5 ms and an inter-pulse interval of 2 ms was delivered repeatedly (2-7 times) at different rates (2, 5, and 10 Hz). TcMEP amplitudes increased with the number of train stimuli for AH, with the strongest facilitation observed at 5 Hz. The response amplitude increased 6.1 times on average compared with single-train transcranial electrical stimulation (st-TES). This trend was also observed in the QF. No adverse events (e.g., seizures, cardiac arrhythmias, scalp burns, accidental injury resulting from patient movement) were observed in any patients. Although several facilitative techniques using central or peripheral stimuli, preceding transcranial electrical stimulation, have been recently employed to augment TcMEPs during surgery, responses are still much smaller than CMAPs. Changing from conventional st-TES to mt-TES has potential to greatly enhance TcMEP responses.

  12. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

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    Tsuyoki Minato

    2016-01-01

    Full Text Available We present a rare case of spinal epidural hematoma (SEH after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

  13. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    Science.gov (United States)

    Minato, Tsuyoki; Miyagi, Masayuki; Saito, Wataru; Shoji, Shintaro; Nakazawa, Toshiyuki; Inoue, Gen; Imura, Takayuki; Minehara, Hiroaki; Matsuura, Terumasa; Kawamura, Tadashi; Namba, Takanori; Takahira, Naonobu; Takaso, Masashi

    2016-01-01

    We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case. PMID:26989542

  14. [Research on Optical Parameter along Puncture Path in Spinal Surgery Navigation Based on Near Infrared Spectroscopy].

    Science.gov (United States)

    Wang, Yuyan; Qian, Zhiyu; Li, Weitao; Liu, Yangyang; Xie, Jieru

    2015-06-01

    Accurate placement of pedicle screws is a key factor of spinal surgery. Investigation of a new real-time intra-operative monitoring method is an important area of clinical application research which makes a contribution to planting pedicle screw accurately. Porcine spines were chosen as experimental objects. The changes of reduced scattering coefficient (μ'(s)) along normal puncture path, medial perforation path and lateral perforation path were measured and studied. A conclusion is drawn that there are two distinct peaks throughout the puncture process, appearing at the junction of cancellous bone and cortical bone, at the beginning and at the end, respectively. The reduced scattering coefficient is proved to be a good monitoring factor which can identify whether the screw is about to reach the critical position of the spine puncture. Moreover, the variation provides an important reference for spinal surgical navigation process.

  15. Renin-angiotensin system inhibitors and troponin elevation in spinal surgery.

    Science.gov (United States)

    McClendon, Jamal; Smith, Timothy R; Thompson, Sara E; Sugrue, Patrick A; Sauer, Andrew J; O'Shaughnessy, Brian A; Carabini, Louanne; Koski, Tyler R

    2014-07-01

    Renin-angiotensin system (RAS) inhibition by angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) has been shown to reduce cardiovascular mortality and non-fatal myocardial infarction (MI) in high-risk surgical patients. However, their effect in spinal surgery has not been explored. Our objective was to determine the effect of RAS inhibitors on postoperative troponin elevation in spinal fusions, and to examine their correlation with hospital stay. We retrospectively analyzed 208 consecutive patients receiving spinal fusions ⩾5 levels between 2007-2010 with a mean follow-up of 1.7 years. Inclusion criteria were age ⩾18 years, elective fusions for kyphoscoliosis, and semi-elective fusions for tumor or infection. Exclusion criteria were trauma and follow-up troponin elevation (⩾0.04 ng/mL), peak troponin level, and hospital stay. The results featured 208 patients with a mean body mass index (BMI) 28.5 kg/m(2) who underwent 345 spinal fusions. ACEI/ARB were withheld the day prior to surgery in 121 patients with 11 patients noteworthy for intra-operative electrocardiogram changes, 126 patients with troponin elevation, and 14 MI identified prior to discharge. Multivariate logistic regression identified BMI (p=0.04), estimated blood loss (p=0.015), and preoperative ACEI/ARB (p=0.015, odds ratio=2.7) as significant independent predictors for postoperative troponin elevation. Multivariate linear regression showed preoperative Oswestry Disability Index (p=0.002), unplanned return to operating room (p=0.007), pneumonia prior to hospital discharge (ptroponin elevation and increased hospital stay.

  16. Effects of Multilevel Facetectomy and Screw Density on Postoperative Changes in Spinal Rod Contour in Thoracic Adolescent Idiopathic Scoliosis Surgery

    Science.gov (United States)

    Kokabu, Terufumi; Sudo, Hideki; Abe, Yuichiro; Ito, Manabu; Ito, Yoichi M.; Iwasaki, Norimasa

    2016-01-01

    Flattening of the preimplantation rod contour in the sagittal plane influences thoracic kyphosis (TK) restoration in adolescent idiopathic scoliosis (AIS) surgery. The effects of multilevel facetectomy and screw density on postoperative changes in spinal rod contour have not been documented. This study aimed to evaluate the effects of multilevel facetectomy and screw density on changes in spinal rod contour from before implantation to after surgical correction of thoracic curves in patients with AIS prospectively. The concave and convex rod shapes from patients with thoracic AIS (n = 49) were traced prior to insertion. Postoperative sagittal rod shape was determined by computed tomography. The angle of intersection of the tangents to the rod end points was measured. Multiple stepwise linear regression analysis was used to identify variables independently predictive of change in rod contour (Δθ). Average Δθ at the concave and convex side were 13.6° ± 7.5° and 4.3° ± 4.8°, respectively. The Δθ at the concave side was significantly greater than that of the convex side (P Risser sign (P = 0.032), the preoperative main thoracic Cobb angle (P = 0.031), the preoperative TK angle (P = 0.012), and the number of facetectomy levels (P = 0.007). Furthermore, a Δθ at the concave side ≥14° significantly correlated with the postoperative TK angle (P = 0.003), the number of facetectomy levels (P = 0.021), and screw density at the concave side (P = 0.008). Rod deformation at the concave side suggests that corrective forces acting on that side are greater than on the convex side. Multilevel facetectomy and/or screw density at the concave side have positive effects on reducing the rod deformation that can lead to a loss of TK angle postoperatively. PMID:27564683

  17. Perioperative management of a patient with recently placed drug-eluting stents requiring urgent spinal surgery.

    Science.gov (United States)

    Roth, Eira; Purnell, Chad; Shabalov, Olga; Moguillansky, Diego; Hernandez, Caridad A; Elnicki, Michael

    2012-08-01

    Patients receiving drug-eluting coronary stents (DES) require antiplatelet therapy for at least 12 months to prevent stent thrombosis (ST), a potentially calamitous event. Since interruption of antiplatelet therapy is the greatest risk factor for ST, it is imperative that the decision to discontinue these agents be based on an accurate assessment of the patient's risk for bleeding complications. Individuals who are regarded as being at a high risk are those undergoing intracranial, spinal or intraocular surgeries. These patients require alternative agents during the perioperative period to minimize both their risk of perioperative thrombosis and intraoperative hemorrhage. We report the case of a woman who required spinal surgery 3 months after she underwent placement of two drug-eluting stents. The patient's clopidogrel was stopped 5 days prior to surgery and an infusion of eptifibatide was used to "bridge" antiplatelet therapy during the perioperative period. Postoperatively, anticoagulation therapy was reinstituted using aspirin with clopidogrel. This case serves as a successful example of bridging therapy using a short acting and gycoprotein (GP) IIb/IIIa inhibitor as a means of maintaining antiplatelet therapy during the perioperative period to minimize the risk of stent thrombosis and the risk of intraoperative bleeding.

  18. Factors Leading to a Poor Functional Outcome in Spinal Meningioma Surgery: Remarks on 173 Cases.

    Science.gov (United States)

    Raco, Antonino; Pesce, Alessandro; Toccaceli, Giada; Domenicucci, Maurizio; Miscusi, Massimo; Delfini, Roberto

    2017-04-01

    Spinal meningiomas are common spinal tumors, in most cases benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement, or spinal root involvement can bring a less favorable prognosis. To correlate these data with clinical/functional outcome. Two hundred twenty-four consecutive patients with spinal meningiomas treated from 1976 to 2013 in our institution were analyzed; among these, 51 were excluded for incomplete clinical data or follow-up. The remaining 173 cases were classified in regards to sex, age, symptoms, axial location, Simpson grade resection, and functional pre-/postoperative status. Most recurring onset symptoms were pain (32.9%) and motor deficit (31.8%); thoracic spine was the most severely affected (69.8%). Functional improvement on the follow-up was observed in 86.7% of cases; 6.4% of patients resulted stable and 6.9% worsened. A low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42.2%); a gross total resection (Simpson grades I and II) was conducted in 98.8%, and a macroscopically complete removal without dural resection or coagulation (Simpson grade III) was performed in 1.2%. Of the meningiomas, 98.3% were classified as WHO grade I. Recurrence rate was 2.3%, and 7 cases presented complications (4 of 7 required surgical procedure). We can affirm that negative prognostic factors in our study were anterior or anterolateral axial location, prolonged presentation before diagnosis, WHO grade >I, Simpson grade resections II and III, sphincter involvement, and worse functional grade at onset.

  19. The use of a photogrammetric method for the three-dimensional evaluation of spinal correction in scoliosis.

    Science.gov (United States)

    Berthonnaud, Eric; Papin, Patrice; Deceuninck, Julie; Hilmi, Radwan; Bernard, Jean Claude; Dimnet, Joannes

    2016-06-01

    Clinical parameters, characterizing the spinal deformations due to scoliosis, are still directly measured on the spinal curve plane projections. A 3D spinal curve has been reconstructed from its two projections, using photogrammetric techniques. Each spinal curve is a compound of several plane regions, where it is purely flexed, and short zones of connection, where abduction and axial rotation components are concentrated. All spinal curves are represented as linear chains of regional planes articulated together. The regional plane is represented by a triangle, where one summit corresponds to the point of maximum offset. The set of weight forces, representing pelvis and spine, forms a bundle of vertical forces. The dispersion of the bundle illustrates the postural stability of patients. The first objective was to numerically describe the changes of the 3D spinal feature, due to the correcting treatment. Changes are calculated from the comparison between 3D radiologic situations, between before and after treatment. The second objective was to determine the direction of the external force, which would be the most efficient for correcting the patient set spine/rib cage. A mild mechanical analysis is proposed, for representing the transit of the external force, from rib cage to thoracic regional plane.

  20. Isolated long thoracic nerve paralysis - a rare complication of anterior spinal surgery: a case report

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    Ameri Ebrahim

    2009-06-01

    Full Text Available Abstract Introduction Isolated long thoracic nerve injury causes paralysis of the serratus anterior muscle. Patients with serratus anterior palsy may present with periscapular pain, weakness, limitation of shoulder elevation and scapular winging. Case presentation We present the case of a 23-year-old woman who sustained isolated long thoracic nerve palsy during anterior spinal surgery which caused external compressive force on the nerve. Conclusion During positioning of patients into the lateral decubitus position, the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure.

  1. Measurement of vascular permeability in spinal cord using Evans Blue spectrophotometry and correction for turbidity.

    Science.gov (United States)

    Warnick, R E; Fike, J R; Chan, P H; Anderson, D K; Ross, G Y; Gutin, P H

    1995-05-01

    Vascular permeability can be visualized by Evans Blue (EB) extravasation and quantified by spectrophotometry after formamide extraction of the tissue. However, formamide extracts show significant turbidity, which may contribute to the total optical density at the wavelength of measurement (e.g., 620 lambda). We developed a simple method for estimating the component of the total optical density of a dyed specimen contributed by turbidity. Our method, which uses a determination of turbidity made at another point of the light spectrum (740 lambda), was more precise than two other EB quantification techniques. We therefore recommend it for individual correction of formamide extracts of spinal cord specimens. The application of this technique to the brain remains to be determined.

  2. Lumbo-pelvic related indexes: impact on adult spinal deformity surgery.

    Science.gov (United States)

    Boissière, Louis; Vital, Jean-Marc; Aunoble, Stéphane; Fabre, Thierry; Gille, Olivier; Obeid, Ibrahim

    2015-06-01

    Lumbo-pelvic indexes appeared recently in the literature taking advantage from the relationship between pelvic incidence (PI) and lumbar lordosis (LL). Schwab proposed to subtract LL from PI (PI-LL) as Boissière proposed the lumbar lordosis index (LLI), which is the ratio between LL and PI (LL/PI). Both indexes have been described to weight LL by a constant parameter not affected by degenerative processes, the PI. The aim of this study is to evaluate these parameters in adult spinal deformity (ASD) by analyzing their relationship with spinal malalignment and vertebral osteotomies. Two groups of patients with an ASD were realized; an adult scoliosis group (n = 78) and a postoperative flat-back syndrome group (n = 20). In the adult scoliosis group, 28 patients underwent an osteotomy [pedicle subtraction osteotomy (PSO) or Smith Petersen osteotomy] and 50 patients were corrected by posterior fusion without osteotomy. In the postoperative flat-back syndrome group all patients underwent a PSO. All patients had preoperative and postoperative full spine EOS radiographies to measure spino-pelvic parameters. The lack of lordosis was calculated, after prediction of theoretical LL from Legaye's formula, by subtracting measured LL to theoretical LL. Correlation analysis between the different parameters was performed. Both lumbo-pelvic parameters highly correlated with spinal malalignment (r = 0.97 for PI-LL and r = -0.97 for LLI for total patients) and were highly predictive of a spinal osteotomy performance (r = 0.88 for PI-LL >28° and r = 0.94 for LLI Sagittal vertical axis (r = 0.67) and pelvic tilt (r = 0.64) correlated moderately with spinal malalignment for total patients. The LLI was more correlated with spinal osteotomies in the adult scoliosis group (r = 0.86 for PI-LL >28° and r = 0.94 for LLI flat-back syndrome group (Youden index = 0.95 for PI-LL >28° vs 0.90 for LLI sagittal correction. They can be used as well for the interpretation of clinical series in ASD.

  3. Remote Cerebellar Hemorrhage Presenting with Cerebellar Mutism after Spinal Surgery: An Unusual Case Report.

    Science.gov (United States)

    Sen, Halil Murat; Guven, Mustafa; Aras, Adem Bozkurt; Cosar, Murat

    2017-05-01

    Dural injury during spinal surgery can subsequently give rise to a remote cerebellar hemorrhage (RCH). Although the incidence of such injury is low, the resulting hemorrhage can be life threatening. The mechanism underlying the formation of the hemorrhage is not known, but it is mostly thought to develop after venous infarction. Cerebellar mutism (CM) is a frequent complication of posterior fossa operations in children, but it is rarely seen in adults. The development of CM after an RCH has not been described. We describe the case of a 65-year old female who lost cerebrospinal fluid after inadvertent opening of the dura during surgery. Computerized tomography performed when the patient became unable to speak revealed a bilateral cerebellar hemorrhage.

  4. The beneficial effect of Batroxobin on blood loss reduction in spinal fusion surgery

    DEFF Research Database (Denmark)

    Hu, Hui-Min; Chen, Li; Frary, Charles Edward

    2015-01-01

    Objective Our objective was to evaluate the efficacy and safety of Batroxobin on blood loss during spinal operations. Methods After obtaining approval from the ethics committee at the hospital along with informed written consent, we performed a double-blind, randomized, placebo-controlled study...... with 100 patients who were randomized equally into 2 groups (Batroxobin and placebo). Patients received either 2 ku IV 15 min before surgery and followed 1 ku IM of Batroxobin following surgery, or an equivalent volume of placebo (normal saline). Cost of Batroxobin treatment is amounted to 84.75 euros......, when appropriate, were used to compare the 2 groups, and differences were considered significant if the P value was after...

  5. Thoracic and lumbar spinal surgery under local anesthesia for patients with multiple comorbidities: A consecutive case series

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    Muhammad Babar Khan

    2014-01-01

    Full Text Available Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia. Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS and Oswestry Disability Index (ODI scores. Results: Five patients had interlaminar decompressions for stenosis alone, while two patients had laminectomies for debulking of tumors. The mean duration of surgery was 79.8 ± 16.6 min, the mean estimated blood loss was 157.1 ± 53.4 ml, the mean dose of local anesthetic was 1.9 ± 0.7 mg/kg, and the mean length of hospital stay after surgery was 3.2 ± 1.2 days. There were no intraoperative complications. The surgery resulted in improved VAS and ODI scores consistent with significant improvement in pain (P = 0.017 and functionality (P = 0.011. Conclusions: Performing spinal surgery under local anesthesia is a safe and effective alternative when patient′s major comorbidities preclude a general anesthetic. For all the seven patients studied, spinal surgery, performed under a local anesthetic, resulted in a statistically significant reduction in pain and improvement in function.

  6. Comparison of Anesthesia Quality for Arthroscopic Knee Surgery: Combined Sciatic Femoral Block and Unilateral Spinal Anesthesia

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    Sinem Sarı

    2015-08-01

    Full Text Available Objective: We aimed to evaluate the quality of anesthesia of combined sciatic and femoral 3-in-1 nerve blocks (CSFB and unilateral spinal anesthesia technique with low-dose levobupivacaine in outpatients undergoing knee arthroscopy surgery. Materials and Methods: Forty American Society of Anesthesiologists (ASA physical status I-II patients were randomly allocated into two groups and unilateral spinal anesthesia with low-dose levobupivacaine (group S, n=20 or CSFB (group B, n=20 was performed. Besides the quality of anesthesia, anesthetic effectiveness, hemodynamic values, duration of the technique application, maximum motor and sensorial block levels and durations, the first analgesics need, and total analgesic consumptions during postoperative 24 hours and determined complications were compared between the two groups. Results: The quality of anesthesia was better in group S, no patient received either sedation or analgesic intraoperatively while first analgesic need and number of patient was higher (p=0.014, p<0.001, p=0.032 respectively. The duration of technical application was shorter while maximum motor and sensorial block levels were higher in group S (p<0.0001, p=0.008, p<0.001 respectively. Motor block duration was significantly longer in group B (p<0.0001. Conclusion: We concluded that CSFB practice is an effective anesthetic alternative for unilateral spinal anesthesia. Introduction

  7. Lumbalgia y ciática crónicas: ¿Usamos adecuadamente los opiáceos? ¿Cirugía de raquis o morfina en el paciente mayor? Chronic lumbar and sciatic pain: Are we using opioids correctly? Spinal surgery vs morphine in the elderly

    Directory of Open Access Journals (Sweden)

    F. J. Robaina Padrón

    2009-02-01

    -invasive techniques for spinal surgery, thus obliging many patients to undergo protracted treatment with potent opiates. Recent publications have alerted us to the risk of addiction resulting from prolonged opiate treatment, the frequency of addiction varying between 5 and 24%. Clearly, there is a risk to patients, society in general and physicians. Visits to the hospital emergency departments due to fentanyl abuse increased 50-fold between 1994 and 2002. Not all healthcare professionals keep their knowledge up-to-date and develop the skills required to provide effective treatment (guilty of ignorance. Opiates can activate neurophysiological pronociceptor mechanisms, creating a situation of increased pain sensitivity, which has been described as opiate-induced hypersensitivity (OIH. The long-term decrease in analgesic efficacy is most probably related to OIH; between 18% and 41% of patients may abuse these medications. Between 1999 and 2002, the number of deaths associated with opiate intoxication increased by 91.2% in the USA. There is a need for more in-depth studies on the relationship between cerebral structural changes and the neuro-physiological / neurochemical mechanisms of nociceptor transmission in relation to chronic opiate use. There is talk of "medicine flying blind" in the prescription of opiates for the long-term management of lumbar pain of musculo-skeletal origin. Recently, in the field of surgical instrumentation, as well as in the market of analgesic medication, there has been a certain distrust of the results of published studies. There are sufficient scientific reasons, both basic and clinical, to seriously question the long-term use of potent opiates for the control of noncancer low back pain. The guidelines and protocols developed by primary and specialist care professionals (management by processes encourages better management and control of this type of pain. There is no need to continue with the current situation of opting out of spinal surgery in the old or

  8. Comparison of techniques for correction of magnification of pelvic x-rays for hip surgery planning

    NARCIS (Netherlands)

    The, Bertram; Kootstra, Johan W. J.; Hosman, Anton H.; Verdonschot, Nico; Gerritsma, Carina L. E.; Diercks, Ron L.

    2007-01-01

    The aim of this study was to develop an accurate method for correction of magnification of pelvic x-rays to enhance accuracy of hip surgery planning. All investigated methods aim at estimating the anteroposterior location of the hip joint in supine position to correctly position a reference object f

  9. Addition of intrathecal Dexamethasone to Bupivacaine for spinal anesthesia in orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Nadia Bani-hashem

    2011-01-01

    Full Text Available Objectives: Spinal anesthesia has the advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anesthetic. Intrathecal local anesthetics have limited duration. Different additives have been used to prolong spinal anesthesia. The effect of corticosteroids in prolonging the analgesic effects of local anesthetics in peripheral nerves is well documented. The purpose of this investigation was to determine whether the addition of dexamethasone to intrathecal bupivacaine would prolong the duration of sensory analgesia or not. Methods: We conducted a randomized, prospective, double-blind, case-control, clinical trial. A total of 50 patients were scheduled for orthopedic surgery under spinal anesthesia. The patients were randomly allocated to receive 15 mg hyperbaric bupivacaine 0.5% with 2 cc normal saline (control group or 15 mg hyperbaric bupivacaine 0.5% plus 8 mg dexamethasone (case group intrathecally. The patients were evaluated for quality, quantity, and duration of block; blood pressure, heart rate, nausea, and vomiting or other complications. Results: There were no signification differences in demographic data, sensory level, and onset time of the sensory block between two groups. Sensory block duration in the case group was 119±10.69 minutes and in the control group was 89.44±8.37 minutes which was significantly higher in the case group (P<0.001. The duration of analgesia was 401.92±72.44 minutes in the case group; whereas it was 202±43.67 minutes in the control group (P<0.001. The frequency of complications was not different between two groups. Conclusion: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia without any changes in onset time and complications.

  10. National Administrative Databases in Adult Spinal Deformity Surgery: A Cautionary Tale.

    Science.gov (United States)

    Buckland, Aaron J; Poorman, Gregory; Freitag, Robert; Jalai, Cyrus; Klineberg, Eric O; Kelly, Michael; Passias, Peter G

    2017-08-15

    Comparison between national administrative databases and a prospective multicenter physician managed database. This study aims to assess the applicability of National Administrative Databases (NADs) in adult spinal deformity (ASD). Our hypothesis is that NADs do not include comparable patients as in a physician-managed database (PMD) for surgical outcomes in adult spinal deformity. NADs such as National Inpatient Sample (NIS) and National Surgical Quality Improvement Program (NSQIP) provide large numbers of publications owing to ease of data access and lack of IRB approval requirement. These databases utilize billing codes, not clinical inclusion criteria, and have not been validated against PMDs in ASD surgery. The NIS was searched for years 2002 to 2012 and NSQIP for years 2006 to 2013 using validated spinal deformity diagnostic codes. Procedural codes (ICD-9 and CPT) were then applied to each database. A multicenter PMD including years 2008 to 2015 was used for comparison. Databases were assessed for levels fused, osteotomies, decompressed levels, and invasiveness. Database comparisons for surgical details were made in all patients, and also for patients with ≥ 5 level spinal fusions. Approximately, 37,368 NIS, 1291 NSQIP, and 737 PMD patients were identified. NADs showed an increased use of deformity billing codes over the study period (NIS doubled, 68x NSQIP, P databases (6.4-12.7) compared with PMD (27.5-32.3). When limited to patients with ≥5 levels, invasiveness, levels fused, and use of 3-CO remained significantly higher in the PMD compared with NADs (P databases NIS and NSQIP do not capture the same patient population as is captured in PMDs in ASD. Physicians should remain cautious in interpreting conclusions drawn from these databases. 4.

  11. Minimally invasive scoliosis surgery assisted by O-arm navigation for Lenke Type 5C adolescent idiopathic scoliosis: a comparison with standard open approach spinal instrumentation.

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    Zhu, Weiguo; Sun, Weixiang; Xu, Leilei; Sun, Xu; Liu, Zhen; Qiu, Yong; Zhu, Zezhang

    2017-04-01

    OBJECTIVE Recently, minimally invasive scoliosis surgery (MISS) was introduced for the correction of adult scoliosis. Multiple benefits including a good deformity correction rate and fewer complications have been demonstrated. However, few studies have reported on the use of MISS for the management of adolescent idiopathic scoliosis (AIS). The purpose of this study was to investigate the outcome of posterior MISS assisted by O-arm navigation for the correction of Lenke Type 5C AIS. METHODS The authors searched a database for all patients with AIS who had been treated with either MISS or PSF between November 2012 and January 2014. Levels of fusion, density of implants, operation time, and estimated blood loss (EBL) were recorded. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. The accuracy of pedicle screw placement was assessed according to postoperative axial CT images in both groups. The 22-item Scoliosis Research Society questionnaire (SRS-22) results and complications were collected during follow-up. RESULTS The authors retrospectively reviewed the records of 45 patients with Lenke Type 5C AIS, 15 who underwent posterior MISS under O-arm navigation and 30 who underwent posterior spinal fusion (PSF). The 2 treatment groups were matched in terms of baseline characteristics. Comparison of radiographic parameters revealed no obvious difference between the 2 groups immediately after surgery or at the final follow-up; however, the MISS patients had significantly less EBL (p scoliosis surgery is an effective and safe alternative to open surgery for patients with Lenke Type 5C AIS. Compared with results of the open approach, the outcomes of MISS are promising, with reduced morbidity. Before the routine use of MISS, however, long-term data are needed.

  12. A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2014-01-01

    Full Text Available Background: The impact of early mobilization on perioperative comorbidities and length of stay (LOS has shown benefits in other medical/surgical subspecialties. However, few spinal series have specifically focused on the "pros" of early mobilization for spinal surgery, other than in acute spinal cord injury. Here we reviewed how early mobilization and other adjunctive measures reduced morbidity and LOS in both medical and/or surgical series, and focused on how their treatment strategies could be applied to spinal patients. Methods: We reviewed studies citing protocols for early mobilization of hospitalized patients (day of surgery, first postoperative day/other in various subspecialties, and correlated these with patients′ perioperative morbidity and LOS. As anticipated, multiple comorbid factors (e.g. hypertension, high cholesterol, diabetes, hypothyroidism, obesity/elevated body mass index hypothyroidism, osteoporosis, chronic obstructive pulmonary disease, coronary artery disease and other factors contribute to the risks and complications of immobilization for any medical/surgical patient, including those undergoing spinal procedures. Some studies additionally offered useful suggestions specific for spinal patients, including prehabilitation (e.g. rehabilitation that starts prior to surgery, preoperative and postoperative high protein supplements/drinks, better preoperative pain control, and early tracheostomy, while others cited more generalized recommendations. Results: In many studies, early mobilization protocols reduced the rate of complications/morbidity (e.g. respiratory decompensation/pneumonias, deep venous thrombosis/pulmonary embolism, urinary tract infections, sepsis or infection, along with the average LOS. Conclusions: A review of multiple medical/surgical protocols promoting early mobilization of hospitalized patients including those undergoing spinal surgery reduced morbidity and LOS.

  13. Comparison of propofol and midazolam on patients undergoing spinal surgery with intraoperative wake-up test: randomized clinical trial.

    Science.gov (United States)

    Canbay, Ozgur; Altiparmak, Basak; Celebi, Nalan; Karagoz, Heves; Saricaoglu, Fatma

    2015-01-01

    Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5 mg kg(-1) for group P or midazolam 0.5 mg kg(-1) for group M with remifentanil 0.5 μg kg(-1) and cisatracurium 0.15 mg kg(-1) for both groups. At the maintenance of anesthesia O2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10 mg kg(-1)h(-1) and in group M, midazolam 0.5 mg mg kg(-1) were preferred. Approximately 15 min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BIS frequency throughout the operation was recorded. The eye opening time was 9 ± 2.15 min in group P and 7 ± 3.15 min in group M. Motor movement time was 12 ± 2.55 min in group P and 21.25 ± 3.93 min in group M. Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  14. CHANGES IN THE SAGITTAL BALANCE IN CONGENITAL SCOLIOSIS CORRECTION SURGERY

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    José Antonio Mancuso Filho

    Full Text Available ABSTRACT Objective: This study aimed to determine whether surgery leads to changes in sagittal balance in patients with congenital scoliosis. Methods: We retrospectively reviewed all cases of scoliosis operated in a tertiary hospital between January 2009 and January 2013. In all cases the deformity in the coronal and sagittal planes, kyphosis, and lordosis were measured, using the Cobb method, and spinopelvic parameters: pelvic incidence (PI, sacral slope (SS, and pelvic tilt (PT. Results A hundred and eleven medical records were analyzed, but the sample resulted in 10 patients, six of whom were females (60%. The average age was 13.4 years. In the comparative analysis between pre and postoperative, only the coronal deformity (12.37; CI 95% [7.88-16.86]; p<0.001, the sagittal deformity (12.71; CI 95% [4.21-21.22]; p=0.011, and the lumbar lordosis (9.9; CI 95% [0.38-19.42]; p=0.043 showed significant change. Conclusion: There was no change in the spinopelvic parameters of patients with congenital scoliosis undergoing surgery at IOF-FMUSP between 2009 and 2013; however, it was observed decrease in lumbar lordosis, and deformity angle in the sagittal and coronal planes.

  15. Pre-emptive and multi-modal perioperative pain management may improve quality of life in patients undergoing spinal surgery.

    Science.gov (United States)

    Lee, Byung Ho; Park, Jin-Oh; Suk, Kyung-Soo; Kim, Tae-Hwan; Lee, Hwan-Mo; Park, Moon-Soo; Lee, Seung-Hwan; Park, Sangun; Lee, Ju-Yeon; Ko, Su-Kyoung; Moon, Seong-Hwan

    2013-01-01

    Compared to an abundance of data on surgical techniques for degenerative spine conditions and the outcomes thereof, little is available to guide optimal perioperative pain management after spinal surgery. The aim of this study was to survey patterns of perioperative pain management after spinal surgery and to investigate the effects of perioperative pain management, such as pre-emptive analgesia and multi-modal postoperative pain management, on acute postoperative satisfaction, pain reduction, and health-related quality of life in patients undergoing spinal surgery. Non-blind multicenter prospective observational clinical series. Seventeen tertiary hospitals (14 hospitals attached to medical colleges and 3 general hospitals). Pain management protocols of 393 patients (153 men, 240 women; mean age of 67 years, ranging from 21 to 91 years) from 17 tertiary hospitals after spinal surgery for degenerative spine disease were evaluated using a self-administered questionnaire. A total of 79 (20%) patients received pre-emptive analgesics, which included cyclooxygenase-2 (COX-2) inhibitors, with or without administration of anticonvulsants, immediately before surgery at the time of antibiotic prophylaxis. Postoperative pain was managed mainly by multi-modal therapy (363 cases, 92%), along with various combinations of patient controlled anesthesia (PCA), conventional nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, and narcotics. Self-reported levels of pain were not significantly different among postoperative multiple modalities of pain management, but were different significantly for pre-emptive pain management regimens (P multi-modal pain management after spinal surgery may lead to better health-related quality of life, greater patient satisfaction, and less postoperative pain.

  16. Virtual Modeling of Postoperative Alignment Following Adult Spinal Deformity (ASD) Surgery Helps Predict associations between Compensatory Spinopelvic Alignment Changes, Overcorrection and Proximal Junctional Kyphosis (PJK).

    Science.gov (United States)

    Lafage, Renaud; Bess, Shay; Glassman, Steve; Ames, Christopher; Burton, Doug; Hart, Robert; Kim, Han Jo; Klineberg, Eric; Henry, Jensen; Line, Breton; Scheer, Justin; Protopsaltis, Themistocles; Schwab, Frank; Lafage, Virginie

    2017-02-09

    Retrospective review of a prospective multicenter database. To develop a method to analyze sagittal alignment, free of PJK's influence, and then compare PJK to non-PJK patients using this method. Proximal Junctional Kyphosis (PJK) following Adult Spinal Deformity (ASD) surgery remains problematic as it alters sagittal alignment. This study proposes a novel virtual modeling technique that attempts to eliminate the confounding effects of PJK on postoperative spinal alignment. A virtual spinal modeling technique was developed on a retrospective ASD cohort of patients with multilevel spinal fusions to the pelvis with at least 2 year post-operative follow-up. The virtual post-op alignment (VIRTUAL) was created from the post-op alignment of the instrumented segments and the pre-op alignment of the unfused segments. VIRTUAL was validated by comparisons to actual 2-year post-op alignment (REAL) in NOPJK patients. Patients were then divided into two groups: PJK and NOPJK based on the presence/absence of PJK at 2 years post-op. PJK and NOPJK patients were compared using VIRTUAL and REAL. 458 patients (78F, mean 57.9y) were analyzed. The validation of VIRTUAL versus REAL demonstrated correlation coefficients above 0.7 for all measures except SVA (r = 0.604). At 2-years, REAL alignment in PJK patients demonstrated a smaller PI-LL and a larger thoracic kyphosis than NOPJK patients, but similar SVA, TPA, and PT. An analysis of VIRTUAL demonstrated that PJK patients had a smaller PI-LL, PT, SVA, and TPA than NOPJK patients (p VIRTUAL alignments revealed that postoperative PJK may develop partially as a compensatory mechanism to the over-correction of sagittal deformities. Future research will evaluate the appropriate thresholds for deformity correction according to age and ASD severity. 3.

  17. Acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery: a case report

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2012-03-01

    Full Text Available Abstract Introduction Spinal anesthesia is a widely used general purpose anesthesia. However, serious complications, such as intracranial subdural hemorrhage, can rarely occur. Case presentation We report the case of a 73-year-old Japanese woman who had acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery. Conclusion This case highlights the need to pay attention to acute intracranial subdural hemorrhage as a complication after spinal anesthesia. If the headache persists even in a supine position or nausea occurs abruptly, computed tomography or magnetic resonance imaging of the brain should be conducted. An intracranial subdural hematoma may have a serious outcome and is an important differential diagnosis for headache after spinal anesthesia.

  18. Return to work after spinal stenosis surgery and the patient’s quality of life

    Directory of Open Access Journals (Sweden)

    Aleksandra Truszczyńska

    2013-06-01

    Full Text Available Introduction: The return to work of patients who undergo spinal surgery poses important medical and social challenge. Objectives: 1 To establish whether patients who undergo spinal stenosis surgery later return to work. 2 To establish the patient's attitude towards employment. 3 To assess the quality of life of the patients and its influence on their attitude to work. Materials and Methods: The study population consisted of 58 patients aged from 21 to 80 years (the mean age was 52.33±14.12. There were 29 women (50% and 29 men (50% in the group. The patients' quality of life was measured by the use of the WHOQOL-BREF instrument. Individual interviews were conducted 3 to 8 months (a mean of 5.72 months ±1.6 after the surgery. Results: 1 Although 13 patients (22.3% returned to work, 44 (75.9% did not, these being manual workers of vocational secondary education. 2 Almost half of the patients (27 patients, i.e. 44% intend to apply for disability pension, 16 patients (27.6% consider themselves unfit to work, 22 patients (37.9% do not feel like working again. 3 The quality of life of the patients decreased. Domain scores for the WHOQOL-BREF are transformed to a 0-100 scale. The mean physical health amounted to 60.67 (±16.31, the mean psychological health was 58.78 (±16.01, while the mean social relations with family and friends were 59.91 (±20.69, and the mean environment 59.62 (±12.48. Conclusions: 1 A total of 75% of the patients operated for lumbar spinal stenosis do not return to their preoperative work. Difficulties in returning to work and decreased quality of life are associated with female sex, lower-level education, hard physical work and low income. 2 Physical health, psychological health, social relations and environment decreased to the mean of approximately 60. 3 The quality of life of the patients who did return to work was similar to that of healthy people.

  19. Return to work after spinal stenosis surgery and the patient's quality of life.

    Science.gov (United States)

    Truszczyńska, Aleksandra; Rąpała, Kazimierz; Truszczyński, Olaf; Tarnowski, Adam; Łukawski, Stanisław

    2013-06-01

    The return to work of patients who undergo spinal surgery poses important medical and social challenge. 1) To establish whether patients who undergo spinal stenosis surgery later return to work. 2) To establish the patient's attitude towards employment. 3) To assess the quality of life of the patients and its influence on their attitude to work. The study population consisted of 58 patients aged from 21 to 80 years (the mean age was 52.33±14.12). There were 29 women (50%) and 29 men (50%) in the group. The patients' quality of life was measured by the use of the WHOQOL-BREF instrument. Individual interviews were conducted 3 to 8 months (a mean of 5.72 months ±1.6) after the surgery. 1) Although 13 patients (22.3%) returned to work, 44 (75.9%) did not, these being manual workers of vocational secondary education. 2) Almost half of the patients (27 patients, i.e. 44%) intend to apply for disability pension, 16 patients (27.6%) consider themselves unfit to work, 22 patients (37.9%) do not feel like working again. 3) The quality of life of the patients decreased. Domain scores for the WHOQOL-BREF are transformed to a 0-100 scale. The mean physical health amounted to 60.67 (±16.31), the mean psychological health was 58.78 (±16.01), while the mean social relations with family and friends were 59.91 (±20.69), and the mean environment 59.62 (±12.48). 1) A total of 75% of the patients operated for lumbar spinal stenosis do not return to their preoperative work. Difficulties in returning to work and decreased quality of life are associated with female sex, lower-level education, hard physical work and low income. 2) Physical health, psychological health, social relations and environment decreased to the mean of approximately 60. 3) The quality of life of the patients who did return to work was similar to that of healthy people.

  20. Increasing Rates of Imaging in Failed Back Surgery Syndrome Patients: Implications for Spinal Cord Stimulation.

    Science.gov (United States)

    Farber, S Harrison; Han, Jing L; Petraglia Iii, Frank W; Gramer, Robert; Yang, Siyun; Pagadala, Promila; Parente, Beth; Xie, Jichun; Petrella, Jeffrey R; Lad, Shivanand P

    2017-09-01

    Failed back surgery syndrome (FBSS) has a high incidence following spinal surgery, is notoriously refractory to treatment, and results in high health care utilization. Spinal cord stimulation (SCS) is a well-accepted modality for pain relief in this population; however, until recently magnetic resonance imaging (MRI) was prohibited due to risk of heat conduction through the device. We examined trends in imaging use over the past decade in patients with FBSS to determine its impact on health care utilization and implications for patients receiving SCS. Retrospective. Inpatient and outpatient sample. We identified patients from 2000 to 2012 using the Truven MarketScan database. Annual imaging rates (episodes per 1000 patient months) were determined for MRI, computed tomography (CT) scan, x-ray, and ultrasound. A multivariate Poisson regression model was used to determine imaging trends over time, and to compare imaging in SCS and non-SCS populations. A total of 311,730 patients with FBSS were identified, of which 5.17% underwent SCS implantation (n = 16,118). The median (IQR) age was 58.0 (49.0 - 67.0) years. Significant increases in imaging rate ratios were found in all years for each of the modalities. Increases were seen in the use of CT scans (rate ratio [RR] = 3.03; 95% confidence interval [CI]: 2.79 - 3.29; P imaging procedures overall (P pain symptomatology. Miscoding cannot be precluded, as this sample is taken from a large nationwide database. We found a significant trend for increased use of advanced imaging modalities between the years 2000 and 2012 in FBSS patients. Those patients treated with SCS were 50% less likely to receive an MRI (as expected, given prior incompatibility of neuromodulation devices), yet 32% and 27% more likely to receive CT and x-ray, respectively. Despite the decrease in the use of MRI in those patients treated with SCS, their overall imaging rate increased by 19% compared to patients without SCS. This underscores the utility of MR

  1. The effect of July admission on inpatient morbidity and mortality after adult spinal deformity surgery

    Science.gov (United States)

    De la Garza-Ramos, Rafael; Passias, Peter G.; Schwab, Frank J.; Lafage, Virginie

    2016-01-01

    Background Some studies have suggested patients who undergo surgery in July have worse outcomes compared to patients treated during other months. The purpose of this study is to compare inpatient morbidity and mortality among patients who underwent adult spinal deformity (ASD) surgery in July with those who underwent surgery in other months. Methods Admission data for patients who underwent ASD surgery were extracted from the Nationwide Inpatient Sample for the years 2002 to 2011. Only adult patients (over 21 years of age) and elective admissions to teaching hospitals were included. A multivariable regression analysis was performed to examine the independent effect of July admissions on overall complications, major complications, and inpatient mortality. Results A total of 27,794 patients were identified, with 2,023 (7.8%) admitted in July and 25,771 (92.2%) in other months. Overall complication rates in July (43.1%) were not different from rates in other months (44.9%, p=0.468). Similarly, major complication rates were similar; 12.9% in July and 12.4% in other months (p=0.764). Mortality was not different between groups (p=0.807). After multivariable analysis, July admissions were not found to increase the odds of developing any complication (OR 0.94; 95% CI, 0.77 - 1.12; p=0.403), major complications (OR 1.04; 95% CI, 0.76 - 1.41; p=0.788) or inpatient mortality (OR 1.35; 95% CI, 0.31 - 5.84; p=0.684). Conclusion In this study of a nationwide database, patients who underwent ASD surgery in July did not have increased odds of developing a complication or inpatient mortality compared to patients admitted in other months. PMID:26913223

  2. Quality of life in children and adolescents undergoing spinal deformity surgery.

    Science.gov (United States)

    McKean, Greg M; Tsirikos, Athanasios I

    2017-01-01

    Quality of life measurements evaluate surgical results from patients' reported outcomes. To assess the impact of spinal deformity treatment using the Scoliosis Research Society-22 questionnaire. SRS-22 data was collected in 545 consecutive patients (425 females-120 males) pre-operatively, 6-, 12- and 24-months post-operatively. Variables included type and age of surgery (mean: 15.14 ± 2.07 years), gender, diagnosis and year of surgery. Age at surgery was divided in: 10-12, 13-15, and 15-19 years. Mean pre-operative SRS-22 scores for the whole group were: function 3.77 ± 0.75; pain 3.7 ± 0.97; self-image 3.14 ± 0.66; mental health 3.86 ± 0.77; total 3.62 ± 0.66. Mean 2-year post-operative scores were: function 4.39 ± 0.42; pain 4.59 ± 0.56; self-image 4.39 ± 0.51; mental health 4.43 ± 0.56; satisfaction 4.81 ± 0.40; total 4.52 ± 0.37 (padolescents.

  3. Spinal mepivacaine with fentanyl for outpatient knee arthroscopy surgery: a randomized controlled trial.

    Science.gov (United States)

    O'Donnell, Dermot; Manickam, Baskar; Perlas, Anahi; Karkhanis, Reena; Chan, Vincent W S; Syed, Khalid; Brull, Richard

    2010-01-01

    The foremost limitation of local anesthetic solutions for spinal anesthesia in the outpatient setting is prolonged motor blockade and delayed ambulation. The purpose of this study was to determine if the addition of intrathecal fentanyl to low-dose spinal mepivacaine provides adequate anesthesia with shorter duration of functional motor blockade for ambulatory knee surgery compared with spinal mepivacaine alone. Following institutional review board approval and informed consent, 34 patients undergoing unilateral knee arthroscopy were enrolled in this study. The patients were randomly assigned to receive either 30 mg of isobaric mepivacaine 1.5% plus fentanyl 10 microg (M + F group) or 45 mg of isobaric mepivacaine 1.5% alone (M group) intrathecally. Postoperatively, the times to achieve sensory block regression to the S1 dermatome and to attain functional motor block recovery enabling ambulation were recorded. All assessments were blinded. The time to completion of Phase I recovery was shorter in the M + F group (104.6 +/- 28.4 min) than in the M group (129.1 +/- 30.4 min; P = 0.023). Regression of sensory blockade to S1 was earlier in the M + F group (118.4 +/- 53.5 min) than in the M group (169.7 +/- 38.9 min; P = 0.003). Patients in the M + F group (176.4 +/- 40.3 min) were able to ambulate significantly earlier than those in the M group (205.6 +/- 31.4 min; P = 0.025). No cases of transient or persistent neurological dysfunction were noted. When compared with 45 mg isobaric mepivacaine 1.5%, an intrathecal dose of 30 mg isobaric mepivacaine 1.5% plus 10 microg fentanyl produces reliable anesthesia, hastens block regression, shortens stay in Phase I recovery, and enables earlier ambulation for patients undergoing unilateral knee arthroscopy (Registration no. NCT00803725).

  4. A case description of speech disturbance and treatment following corrective surgery for stress velopharyngeal incompetence.

    Science.gov (United States)

    Macrae, Toby; Stierwalt, Julie A G; Behel, Kensley A

    2015-01-01

    The purpose of this study was to determine the effectiveness of a motor learning guided (MLG) approach to speech treatment in a unique case of speech disturbance following surgery for stress velopharyngeal incompetence (SVPI). The patient was a 20-year-old female college student. Treatment took place over 6 sessions and focused on eliciting productions through a hierarchy of clinician support, with an emphasis on self-evaluation and -correction. Acoustic measurements and ratings from the treating clinician and unfamiliar listeners revealed a speech disturbance following surgery that was corrected following speech treatment. The patient's main difficulty appeared to be in producing the vocalic/postvocalic approximant, /r/, although vowel distortions were also noted. These difficulties may be explained by the structural alteration and formation of scar tissue as a result of surgery. The results provide initial support for an MLG approach to treating an acquired speech disturbance following SVPI surgery; however, additional research is warranted.

  5. Dose optimisation for intraoperative cone-beam flat-detector CT in paediatric spinal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Petersen, Asger Greval [Region of Northern Jutland, Department of X-ray Physics, Broenderslev (Denmark); Eiskjaer, Soeren; Kaspersen, Jon [Aalborg University Hospital, The Spinal Unit, Department of Orthopaedic Surgery, Aalborg (Denmark)

    2012-08-15

    During surgery for spinal deformities, accurate placement of pedicle screws may be guided by intraoperative cone-beam flat-detector CT. The purpose of this study was to identify appropriate paediatric imaging protocols aiming to reduce the radiation dose in line with the ALARA principle. Using O-arm registered (Medtronic, Inc.), three paediatric phantoms were employed to measure CTDI{sub w} doses with default and lowered exposure settings. Images from 126 scans were evaluated by two spinal surgeons and scores were compared (Kappa statistics). Effective doses were calculated. The recommended new low-dose 3-D spine protocols were then used in 15 children. The lowest acceptable exposure as judged by image quality for intraoperative use was 70 kVp/40 mAs, 70 kVp/80 mAs and 80 kVp/40 mAs for the 1-, 5- and 12-year-old-equivalent phantoms respectively (kappa = 0,70). Optimised dose settings reduced CTDI{sub w} doses 89-93%. The effective dose was 0.5 mSv (91-94,5% reduction). The optimised protocols were used clinically without problems. Radiation doses for intraoperative 3-D CT using a cone-beam flat-detector scanner could be reduced at least 89% compared to manufacturer settings and still be used to safely navigate pedicle screws. (orig.)

  6. Imaging techniques for diagnosis after surgery for degenerative disc disease. Bildgebende Diagnostik nach spinaler Diskushernienoperation

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S. (Abt. fuer Osteologie, MR-Inst., Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria)); Kramer, J. (Abt. fuer Osteologie, MR-Inst., Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria)); Muehlbauer, M. (Neurochirurgische Univ.-Klinik, Vienna (Austria)); Kainberger, F. (Abt. fuer Osteologie, MR-Inst., Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria)); Imhof, H. (Abt. fuer Osteologie, MR-Inst., Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria))

    1993-10-01

    The magnetic resonance imaging findings recorded in patients after surgery for degenerative disc disease in the lumbar and cervical spine are discussed in comparison with conventional radiographs and computed tomography findings. In the lumbar spine normal postoperative findings in the immediate postoperative period can be demonstrated by MR imaging. Contrast-enhanced MR imaging can differentiate disc herniation from postoperative scar formation with a greater degree of confidence than other imaging modalities. MR imaging improves differentiation between other causes of failed back syndrome such as postoperative hematoma and infection, lateral spinal stenosis and arachnoiditis. In the cervical spine types of operative approaches, the appearance of bony stenosis and disc herniations by MR imaging are discussed. Computer tomography still has a role in the assessment of osseous complications such as central or foraminal stenosis. (orig.)

  7. Technical advances in minimally invasive surgery: direct decompression for lumbar spinal stenosis.

    Science.gov (United States)

    Lauryssen, Carl

    2010-12-15

    Literature review, technique overview, prospective and retrospective data analysis. To review current minimally invasive surgery (MIS) methods of decompression for lumbar spinal stenosis and present a decompression technique using a flexible microblade shaver system. Several MIS decompression techniques for stenosis have been developed to minimize damage to soft tissues and reduce the amount of posterior element resection. Decompression using linearly configured instruments may not be able to adequately address stenosis in the neural foramen. A flexible microblade shaver system is able to traverse the foramen, removing bone and ligament, using a ventral to dorsal approach, rather than medial to lateral. This enables it to effectively decompress the lateral recess and neural foramen while sparing posterior structures. Brief literature review of current MIS decompression techniques is presented. MIS decompression using a flexible microblade shaver system is described with 1 year outcomes from a small pilot study and a retrospective chart review at 2 centers. A small postmarket pilot study (n = 9) with 1 year results showed positive patient outcomes using Visual Analog Scale (decrease by 73%), Oswestry Disability Index(50% improvement), Zurich Claudication Questionnaire physical function and symptom severity (improved by 72% and 31%, respectively), and Short-Form 36 (SF-36) Physical Component Score (36% improvement). Sixty-seven patients from a retrospective chart review at 2 centers had an average of 2 levels per patient decompressed using a flexible microblade shaver system. No patient has returned for additional surgery and there have been no cases of neurologic impairment. Current decompression techniques may result in inadequate decompression of the neural foramen or excessive resection of the facet joint. MIS decompression using a flexible microblade shaver system represents a way to perform an effective, facet-preserving decompression for patients with lumbar

  8. Large Increase in Blood Pressure After Extubation and High Body Mass Index Elevate the Risk of Spinal Epidural Hematoma After Spinal Surgery.

    Science.gov (United States)

    Yamada, Kentaro; Abe, Yuichiro; Satoh, Shigenobu; Yanagibashi, Yasushi; Hyakumachi, Takahiko; Masuda, Takeshi

    2015-07-01

    Matched case-control study. To identify factors other than a multilevel procedure that increase the risk of symptomatic postoperative spinal epidural hematoma (SEH). Postoperative SEH is a potentially devastating complication of spinal surgery. Previous studies that reported risk factors for postoperative SEH all identified a multilevel procedure as a risk factor, but the other risk factors remain unclear. Patients who developed postoperative SEH requiring surgical evacuation were identified from database. Each patient was matched with 3 controls who underwent spinal decompression at the same number of levels in the same part of the spine by the same surgeon during the preceding or following year. Multiple logistic regression analysis was performed to identify the risk factors for postoperative SEH to obtain adjusted odds ratios with 95% confidence intervals. Clinical outcomes after evacuation were investigated separately divided with or without severe paralysis or time until the second surgery. Postoperative SEH evacuation was performed after 32 of 8250 (0.39%) spinal decompression procedures. The incidence was significantly higher after thoracic procedures (2.41%) than after cervical (0.21%) or lumbar (0.39%) procedures. Multivariate analysis identified a 50 mm Hg or greater increase in systolic blood pressure after extubation (adjusted odds ratio: 3.22, 95% confidence interval: 1.22-8.51) and higher body mass index (adjusted odds ratio 1.15, 95% confidence interval: 1.01-1.31) as risk factors. Among 14 patients with severe paralysis due to postoperative SEH, those who underwent evacuation within 24 hours of the onset had a significantly better improvement in clinical outcome and Frankel grade than did those after 24 hours. A 50 mm Hg or greater increase in systolic blood pressure after extubation and high body mass index were identified as risk factors for SEH. Appropriate blood pressure control especially at the end of surgery is important for the prevention of

  9. Surgery Followed by Radiotherapy Versus Radiotherapy Alone for Metastatic Spinal Cord Compression From Unfavorable Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Rades, Dirk, E-mail: Rades.Dirk@gmx.net [Department of Radiation Oncology, University of Lubeck (Germany); Huttenlocher, Stefan [Department of Radiation Oncology, University of Lubeck (Germany); Bajrovic, Amira [Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf (Germany); Karstens, Johann H. [Department of Radiation Oncology, Medical University Hannover (Germany); Adamietz, Irenaeus A. [Department of Radiation Oncology, Ruhr University Bochum (Germany); Kazic, Nadja [Department of Radiation Oncology, University of Sarajevo (Bosnia and Herzegowina); Rudat, Volker [Department of Radiation Oncology, Saad Specialist Hospital Al Khobar (Saudi Arabia); Schild, Steven E. [Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ (United States)

    2011-12-01

    Purpose: Despite a previously published randomized trial, controversy exists regarding the benefit of adding surgery to radiotherapy for metastatic spinal cord compression (MSCC). It is thought that patients with MSCC from relatively radioresistant tumors or tumors associated with poor functional outcome after radiotherapy alone may benefit from surgery. This study focuses on these tumors. Methods and Materials: Data from 67 patients receiving surgery plus radiotherapy (S+RT) were matched to 134 patients (1:2) receiving radiotherapy alone (RT). Groups were matched for 10 factors and compared for motor function, ambulatory status, local control, and survival. Additional separate matched-pair analyses were performed for patients receiving direct decompressive surgery plus stabilization of involved vertebrae (DDSS) and patients receiving laminectomy (LE). Results: Improvement of motor function occurred in 22% of patients after S+RT and 16% after RT (p = 0.25). Posttreatment ambulatory rates were 67% and 61%, respectively (p = 0.68). Of nonambulatory patients, 29% and 19% (p = 0.53) regained ambulatory status. One-year local control rates were 85% and 89% (p = 0.87). One-year survival rates were 38% and 24% (p = 0.20). The matched-pair analysis of patients receiving LE showed no significant differences between both therapies. In the matched-pair analysis of patients receiving DDSS, improvement of motor function occurred more often after DDSS+RT than RT (28% vs. 19%, p = 0.024). Posttreatment ambulatory rates were 86% and 67% (p = 0.30); 45% and 18% of patients regained ambulatory status (p = 0.29). Conclusions: Patients with MSCC from an unfavorable primary tumor appeared to benefit from DDSS but not LE when added to radiotherapy in terms of improved functional outcome.

  10. Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series

    OpenAIRE

    Barton, Cameron; Noshchenko, Andriy; Patel, Vikas; Cain, Christopher; Kleck, Christopher; Burger, Evalina

    2015-01-01

    Background Osteotomies including pedicle subtraction (PSO) and/or Smith-Peterson (SPO) are used to facilitate surgical correction of adult spinal deformity (ASD), but are associated with complications including instrumentation failure and rod fracture (RF). The purpose of this study was to determine incidence and risk factors for RF, including a clinically significant subset (CSRF), after osteotomy for ASD. Methods A retrospective review of clinical records was conducted on consecutive ASD pa...

  11. Risk of aspirin continuation in spinal surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Goes, R; Muskens, I S; Smith, T R; Mekary, R A; Broekman, M L D; Moojen, W A

    2017-08-17

    Aspirin is typically discontinued in spinal surgery because of increased risk of haemorrhagic complications. The risk of peri-operative continuation of aspirin in neurosurgery needed to be evaluated. To evaluate all available evidence about continuation of aspirin and to compare peri- and post-operative blood loss and complication rates between patients that continued aspirin and those who discontinued aspirin peri-operatively in spinal surgery. Systematic review and meta-analysis. A meta-analysis was conducted according to the PRISMA guidelines. Studies comparing aspirin continuation with discontinuation were included. Studies using a combination of anticlotting agents or non-spinal procedures were excluded. Operative outcomes (blood loss and operative length) and different complications (surgical site infection (SSI), stroke, myocardial infarction within 30 days post-operatively) were extracted. Overall prevalence and means were calculated for the reported outcomes in fixed-effects models with heterogeneity (I(2)) and effect modification (P-interaction) assessment. Out of 1339 studies, 3 case series were included in the meta-analysis. No significant differences in mean operating time were seen between the aspirin-continuing group (mean=201.8 minutes, 95%CI=193.3; 210.3; I(2)=95.4%; 170 patients) and the aspirin-discontinuing group (mean=178.4 minutes, 95%CI=119.1; 237.6; I(2)=93.5%; 200 patients); (P-interaction=0.78). No significant differences in mean peri-operative blood loss were seen between the aspirin-continuing group (mean=553.9 millilitres, 95%CI=468.0; 639.9; I(2)=83.4%; 170 patients) and the aspirin-discontinuing group (mean=538.7 millilitres, 95%CI=427.6; 649.8; I(2)=985.5%; 200 patients); (P-interaction=0.96). Similar non-significant differences between the 2 groups were found for cardiac events, stroke, and surgical site infections. This meta-analysis showed an absence of significant differences in peri-operative complications between aspirin

  12. Patients' Expectations on Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Qualitative Exploration.

    Science.gov (United States)

    Henssen, Dylan J H A; Scheepers, Nicole; Kurt, Erkan; Arnts, Inge; Steegers, Monique; Vissers, Kris; van Dongen, Robert; Engels, Yvonne

    2017-07-25

    Spinal cord stimulation (SCS) is an effective therapy to reduce pain in patients that suffer from failed back surgery syndrome (FBSS). In order to inform patients optimally prior to this therapy, knowing their expectations is crucial. Thirteen patients suffering from FBSS and scheduled for SCS were interviewed, using a semi-structured protocol. Patients were interviewed either at home or at their treating hospital. Data from these interviews were analyzed using directed content analysis. In addition to the qualitative interviews, an adjusted Brief Pain Inventory (BPI-) questionnaire was used to quantify expectations. The expectations of patients with regard to SCS could be subdivided into 13 categories, which could be grouped into six general themes: 1) physical well-being, 2) social well-being, 3) material well-being, 4) emotional well-being, 5) development and activity and 6) constraints of the procedure of SCS. These findings confirm patients' expectations about the improvement of their quality of life by SCS for FBSS. This indicates that assessing pain relief is not enough to adequately evaluate the effects of SCS. The small diversity within the studied population and the lack of patient-to-patient education are two possible limitations of this study. To improve education for patients prior to SCS surgery and to evaluate the effects of SCS, a multidimensional approach needs to be implemented. Possible disadvantages of SCS need to be discussed prior to the treatment. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Tramadol Versus Low Dose Tramadol-paracetamol for Patient Controlled Analgesia During Spinal Vertebral Surgery

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    Esad Emir

    2010-06-01

    Full Text Available Pain intensity may be high in the postoperative period after spinal vertebral surgery. The aim of the study was to compare the effectiveness and cost of patient controlled analgesia (PCA with tramadol versus low dose tramadol-paracetamol on postoperative pain. A total of 60 patients were randomly divided into two groups. One group received 1.5 mg/kg tramadol (Group T while the other group received 0.75 mg/kg tramadol plus 1 g of paracetamol (Group P intravenously via a PCA device immediately after surgery and the patients were transferred to a recovery room, Tramadol was continuously infused at a rate of 0.5 mL/h in both groups, at a dose of 10 mg/mL in Group T and 5 mg/mL in Group P. The bolus and infusion programs were adjusted to administer a 1 mL bolus dose of tramadol with a lock time of 10 minutes. In Group P, 1 g of paracetamol was injected intravenously every 6 hours. The four-point nausea scale, numeric rating scale for pain assessment, Ramsey sedation scale, blood pressure, heart rate, respiration rate, peripheral oxygen saturation values and side effects were recorded at 0, 15 and 30 minutes, and at 1, 2, 4, 6, 12, 18 and 24 hours. The time to reach an Aldrete score of 9 was also recorded. A cost analysis for both groups was performed. In Group P, the numeric rating scale scores were significantly lower than that in Group T at 0 and 15 minutes. The number of side effects, additional analgesic requirement and the total dose of tramadol were lower in Group P than in Group T. However, the total cost of postoperative analgesics was significantly higher in Group P than in Group T (p < 0.001. We conclude that PCA using tramadol-paracetamol could be used safely for postoperative pain relief after spinal vertebral surgery, although at a higher cost than with tramadol alone.

  14. Iloprost for children with pulmonary hypertension after surgery to correct congenital heart disease.

    Science.gov (United States)

    Xu, Zhuoming; Zhu, Limin; Liu, Xinrong; Gong, Xiaolei; Gattrell, William; Liu, Jinfen

    2015-06-01

    Congenital heart disease (CHD) can cause pulmonary hypertension (PH) in children, and surgery to correct CHD may be complicated by postoperative pulmonary hypertensive crises (PHC). Clinical data regarding the use of inhaled iloprost to treat children with PH are scarce. Our aim was to determine the efficacy and safety of iloprost in children with PH following surgery to correct CHD. This was a randomized, placebo-controlled study of 22 children (median age 7 months) undergoing surgery to achieve biventricular repair. The combined clinical endpoint was a decrease of more than 20% in the ratio of systolic pulmonary arterial pressure to systolic arterial pressure or pulmonary resistance to systemic resistance, with no PHC or death. Patients were randomized to receive low-dose iloprost (30 ng/kg/min), high-dose iloprost (50 ng/kg/min), or placebo, for 10 min every 2 hr in the first 48 hr after surgery. PHC were experienced by two patients who received placebo and one patient treated with high-dose iloprost. The combined clinical endpoint was reached by six patients administered low-dose iloprost (P = 0.005) and four administered high-dose iloprost (P = 0.077), compared with none in the placebo group. Patients treated with iloprost showed a significant reduction from baseline in mean pulmonary vascular resistance index (-2.2 Wood units, P iloprost to treat children with PH following surgery to correct CHD. © 2014 Wiley Periodicals, Inc.

  15. Does lumbar paraspinal muscles improve after corrective fusion surgery in degenerative flat black?

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    Jung Hwan Lee

    2017-01-01

    Conclusions: Severity of atrophy or fat infiltration of PSE showed correlation with degree of angular deformity in patients with DFB and with less improvement after corrective surgery. Dynamic parameters showed more prominent correlation with PSE conditions than static parameters and also showed segmental specificity between PSE and angular deformity.

  16. A large animal model of Spinal Muscular Atrophy and correction of phenotype

    Science.gov (United States)

    Duque, Sandra I.; Arnold, W. David; Odermatt, Philipp; Li, Xiaohui; Porensky, Paul N.; Schmelzer, Leah; Meyer, Kathrin; Kolb, Stephen J.; Schümperli, Daniel; Kaspar, Brian K.; Burghes, Arthur H. M.

    2015-01-01

    Objectives Spinal muscular atrophy (SMA) is caused by reduced levels of SMN which results in motoneuron loss. Therapeutic strategies to increase SMN levels including drug compounds, antisense oligonucleotides or scAAV9 gene therapy have proved effective in mice. We wished to determine whether reduction of SMN in postnatal motoneurons resulted in SMA in a large animal model, whether SMA could be corrected after development of muscle weakness and the response of clinically relevant biomarkers. Methods Using intrathecal delivery of scAAV9 expressing a shRNA targeting pig SMN1, SMN was knocked down in motoneurons postnatally to SMA levels. This resulted in an SMA phenotype representing the first large animal model of SMA. Restoration of SMN was performed at different time points with scAAV9 expressing human SMN (scAAV9-SMN) and electrophysiology measures and pathology were performed. Results Knockdown of SMN in postnatal motoneurons results in overt proximal weakness, fibrillations on electromyography (EMG) indicating active denervation, and reduced compound muscle action potential (CMAP) and motor unit number estimates (MUNE), like human SMA. Neuropathology showed loss of motoneurons and motor axons. Pre-symptomatic delivery of scAAV9-SMN prevented SMA symptoms indicating all changes are SMN dependent. Delivery of scAAV9-SMN after symptom onset had a marked impact on phenotype, electrophysiological measures and pathology. Interpretation High SMN levels are critical in postnatal motoneurons and reduction of SMN results in a SMA phenotype which is SMN dependent. Importantly, clinically relevant biomarkers including CMAP and MUNE are responsive to SMN restoration and abrogation of phenotype can be achieved even after symptom onset. PMID:25516063

  17. Planning the Surgical Correction of Spinal Deformities: Toward the Identification of the Biomechanical Principles by Means of Numerical Simulation

    Science.gov (United States)

    Galbusera, Fabio; Bassani, Tito; La Barbera, Luigi; Ottardi, Claudia; Schlager, Benedikt; Brayda-Bruno, Marco; Villa, Tomaso; Wilke, Hans-Joachim

    2015-01-01

    In decades of technical developments after the first surgical corrections of spinal deformities, the set of devices, techniques, and tools available to the surgeons has widened dramatically. Nevertheless, the rate of complications due to mechanical failure of the fixation or the instrumentation remains rather high. Indeed, basic and clinical research about the principles of deformity correction and the optimal surgical strategies (i.e., the choice of the fusion length, the most appropriate instrumentation, and the degree of tolerable correction) did not progress as much as the implantable devices and the surgical techniques. In this work, a software approach for the biomechanical simulation of the correction of patient-specific spinal deformities aimed to the identification of its biomechanical principles is presented. The method is based on three-dimensional reconstructions of the spinal anatomy obtained from biplanar radiographic images. A user-friendly graphical user interface allows for the planning of the desired deformity correction and to simulate the implantation of pedicle screws. Robust meshing of the instrumented spine is provided by using consolidated computational geometry and meshing libraries. Based on a finite element simulation, the program is able to predict the loads and stresses acting in the instrumentation as well as those in the biological tissues. A simple test case (reduction of a low-grade spondylolisthesis at L3–L4) was simulated as a proof of concept, and showed plausible results. Despite the numerous limitations of this approach which will be addressed in future implementations, the preliminary outcome is promising and encourages a wide effort toward its refinement. PMID:26579518

  18. Transcatheter closure of atrial septal defect in a patient with Noonan syndrome after corrective surgery

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    Mangovski Ljupčo

    2015-01-01

    Full Text Available Introduction. Transcatheter atrial septal defect (ASD closure is considered to be a gold standard for patients with the suitable anatomy as compared to cardiac surgery. Reocurrence of ASD after surgical closure is a very rare late complication which can be successfully managed with transcatheter procedure. Case report. We reported a female patient with Noonan syndrome who presented with hemodinamically significant ASD 37 years after the corrective cardiac surgery. Due to numerous comorbidities which included severe kyphoscoliosis, pectus excavatum and multiple surgeries we decided to perform transcatheter closure of ASD. The procedure itself was very challenging due to the patient’s short stature and heart’s orientation in the chest, but was performed successfully. The subsequent follow-up was uneventful and the patient reported improvement in the symptoms. Conclusion. Transcatheter closure of ASD in a patient with Noonan syndrome with the history of surgically corrected ASD can be performed successfully, despite challenging chest anatomy.

  19. Correlation between cervical lordosis and adjacent segment pathology after anterior cervical spinal surgery.

    Science.gov (United States)

    Lee, Soo Eon; Jahng, Tae-Ahn; Kim, Hyun Jib

    2015-12-01

    To evaluate the incidence and risk factors for adjacent segment pathology (ASP) after anterior cervical spinal surgery. Fourteen patients (12 male, mean age 47.1 years) who underwent single-level cervical disk arthroplasty (CDA group) and 28 case-matched patients (24 male, mean age 53.6 years) who underwent single-level anterior cervical discectomy and fusion (ACDF group) were included. Presence of radiologic ASP (RASP) was based on observed changes in anterior osteophytes, disks, and calcification of the anterior longitudinal ligament on lateral radiographs. The mean follow-up period was 43.4 months in the CDA group and 44.6 months in the ACDF group. At final follow-up, ASP was observed in 5 (35.7%) CDA patients and 16 (57.1%) ACDF patients (p = 0.272). The interval between surgery and ASP development was 33.8 months in the CDA group and 16.3 months in the ACDF group (p = 0.046). The ASP risk factor analysis indicated postoperative cervical angle at C3-7 being more lordotic in non-ASP patients in both groups. Restoration of lordosis occurred in the CDA group regardless of the presence of ASP, but heterotopic ossification development was associated with the presence of ASP in the CDA group. And the CDA group had significantly greater clinical improvements than those in the ACDF group when ASP was present. In both CDA and ACDF patients, RASP developed, but CDA was associated with a delay in ASP development. A good clinical outcome was expected in CDA group, even when ASP developed. Restoration of cervical lordosis was an important factor in anterior cervical spine surgery.

  20. Changes in retinal nerve fiber layer thickness after spinal surgery in the prone position: a prospective study

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    Baran Gencer

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Changes in ocular perfusion play an important role in the pathogenesis of ischemic optic neuropathy. Ocular perfusion pressure is equal to mean arterial pressure minus intraocular pressure. The aim of this study was to evaluate the changes in the intraocular pressure and the retinal nerve fiber layer thickness in patients undergoing spinal surgery in the prone position. METHODS: This prospective study included 30 patients undergoing spinal surgery. Retinal nerve fiber layer thickness were measured one day before and after the surgery by using optical coherence tomography. Intraocular pressure was measured by tonopen six times at different position and time-duration: supine position (baseline; 10 min after intubation (Supine 1; 10 (Prone 1, 60 (Prone 2, 120 (Prone 3 min after prone position; and just after postoperative supine position (Supine 2. RESULTS: Our study involved 10 male and 20 female patients with the median age of 57 years. When postoperative retinal nerve fiber layer thickness measurements were compared with preoperative values, a statistically significant thinning was observed in inferior and nasal quadrants (p = 0.009 and p = 0.003, respectively. We observed a statistically significant intraocular pressure decrease in Supine 1 and an increase in both Prone 2 and Prone 3 when compared to the baseline. Mean arterial pressure and ocular perfusion pressure were found to be significantly lower in Prone 1, Prone 2 and Prone 3, when compared with the baseline. CONCLUSIONS: Our study has shown increase in intraocular pressure during spinal surgery in prone position. A statistically significant retinal nerve fiber layer thickness thinning was seen in inferior and nasal quadrants one day after the spinal surgery.

  1. Orthognathic Surgery for the Correction of Severe Skeletal Class III Malocclusion.

    Science.gov (United States)

    Kafle, D; Upadhayaya, C; Chaurasia, N; Agarwal, A

    2016-01-01

    Skeletal Malocclusions results from the abnormal position of maxilla and mandible in relation with cranial base. These types of malocclusion are commonly treated by orthodontic teeth movement known as camouflage orthodontics. However severe skeletal malocclusions cannot be treated by orthodontics alone. Such cases need surgical intervention to align the position of the jaw along with orthodontic correction. This procedure is commonly known as Orthognathic Surgery. Orthognathic Surgery dates back to early eighteenth century but became popular on mid twentieth century. Though the prevalence of skeletal malocclusion is more than 1% the treatment facility was not available in Nepal till 2012. Here we present a case of Skeletal Class III malocclusion treated at Dhulikhel Hospital, Kathmandu University Hospital. For this case, double jaw surgery was performed by le-Fort I osteotomy and Bilateral Sagital Split Osteotomy. Orthognathic surgery has been routinely performed at this centre since then.

  2. Improvement in reflux gastroesophagitis in a patient with spinal muscular atrophy after surgical correction of kyphoscoliosis: a case report.

    Science.gov (United States)

    Yang, Jae Hyuk; Kasat, Niraj Sharad; Suh, Seung Woo; Kim, Seung Young

    2011-12-01

    Scoliosis, a three-dimensional deformity, has secondary effects on the gastrointestinal system. Reflux gastroesophagitis with hiatus hernia in patients with scoliosis is difficult to manage. We present a patient in whom primary correction of a spinal deformity was associated with resolution of symptoms of reflux. A 15-year-old girl with severe thoracolumbar kyphoscoliosis visited our scoliosis research institute complaining of back pain, positional imbalance, intermittent respiratory tract infections, and gastrointestinal discomfort such as pain, dysphagia, and heartburn for several years. On preoperative CT, her abdominal organs were in a deviant position, and esophagogastroduodenoscopy revealed severe reflux gastroesophagitis, Los Angeles classification (LA) Grade D, and a sliding hiatus hernia. After kyphoscoliosis correction, the patient's truncal balance and pain improved. Postoperatively, the patient reported abdominal pain and dysphagia that gradually subsided after 3 weeks. At 1 year, the patient had no abdominal complaints secondary to reflux gastroesophagitis, and episodes of recurrent respiratory tract infections were substantially reduced. Postoperative evaluation showed the reflux gastroesophagitis had improved to LA Grade A. Postoperative CT showed the abdominal cavity had expanded and the abdominal organs were more centered. The association between scoliosis and reflux gastroesophagitis is well documented. However, the secondary effects of scoliosis correction on gastrointestinal symptoms caused by reflux gastroesophagitis have not been investigated in detail. This patient illustrates the relationship between spinal deformity and gastrointestinal symptoms. Postural balance correction resulted in the alleviation of reflux gastroesophagitis symptoms secondary to hiatus hernia.

  3. Subdural and Cerebellar Hematomas Which Developed after Spinal Surgery: A Case Report and Review of the Literature

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    Ufuk Utku

    2013-01-01

    Full Text Available Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2 mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings.

  4. Clinical Outcomes of an Optimized Prolate Ablation Procedure for Correcting Residual Refractive Errors Following Laser Surgery

    Science.gov (United States)

    Chung, Byunghoon; Lee, Hun; Choi, Bong Joon; Seo, Kyung Ryul; Kim, Eung Kwon; Kim, Dae Yune

    2017-01-01

    Purpose The purpose of this study was to investigate the clinical efficacy of an optimized prolate ablation procedure for correcting residual refractive errors following laser surgery. Methods We analyzed 24 eyes of 15 patients who underwent an optimized prolate ablation procedure for the correction of residual refractive errors following laser in situ keratomileusis, laser-assisted subepithelial keratectomy, or photorefractive keratectomy surgeries. Preoperative ophthalmic examinations were performed, and uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction values (sphere, cylinder, and spherical equivalent), point spread function, modulation transfer function, corneal asphericity (Q value), ocular aberrations, and corneal haze measurements were obtained postoperatively at 1, 3, and 6 months. Results Uncorrected distance visual acuity improved and refractive errors decreased significantly at 1, 3, and 6 months postoperatively. Total coma aberration increased at 3 and 6 months postoperatively, while changes in all other aberrations were not statistically significant. Similarly, no significant changes in point spread function were detected, but modulation transfer function increased significantly at the postoperative time points measured. Conclusions The optimized prolate ablation procedure was effective in terms of improving visual acuity and objective visual performance for the correction of persistent refractive errors following laser surgery. PMID:28243019

  5. Use of market segmentation to identify untapped consumer needs in vision correction surgery for future growth.

    Science.gov (United States)

    Loarie, Thomas M; Applegate, David; Kuenne, Christopher B; Choi, Lawrence J; Horowitz, Diane P

    2003-01-01

    Market segmentation analysis identifies discrete segments of the population whose beliefs are consistent with exhibited behaviors such as purchase choice. This study applies market segmentation analysis to low myopes (-1 to -3 D with less than 1 D cylinder) in their consideration and choice of a refractive surgery procedure to discover opportunities within the market. A quantitative survey based on focus group research was sent to a demographically balanced sample of myopes using contact lenses and/or glasses. A variable reduction process followed by a clustering analysis was used to discover discrete belief-based segments. The resulting segments were validated both analytically and through in-market testing. Discontented individuals who wear contact lenses are the primary target for vision correction surgery. However, 81% of the target group is apprehensive about laser in situ keratomileusis (LASIK). They are nervous about the procedure and strongly desire reversibility and exchangeability. There exists a large untapped opportunity for vision correction surgery within the low myope population. Market segmentation analysis helped determine how to best meet this opportunity through repositioning existing procedures or developing new vision correction technology, and could also be applied to identify opportunities in other vision correction populations.

  6. Acute visual loss with ophthalmoplegia after spinal surgery: report of a case and review of the literature.

    Science.gov (United States)

    Mukherjee, Bipasha; Alam, Mohammad Shahid

    2014-09-01

    We report a case of a 15-year-old boy who presented with profound visual loss and complete ophthalmoplegia after an uneventful spinal surgery for removal of cervical osteoblastoma. Postoperative visual loss following nonocular surgery is, fortunately rare, yet a devastating complication. The most common cause is ischemic optic neuropathy, but it can also be due to central retinal occlusion or cortical blindness. Visual loss in conjunction with ophthalmoplegia is rarely seen, and there are very few reports in the literature. We also review the related literature and highlight the mechanism and preventive measures.

  7. Acute visual loss with ophthalmoplegia after spinal surgery: Report of a case and review of the literature

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    Bipasha Mukherjee

    2014-01-01

    Full Text Available We report a case of a 15-year-old boy who presented with profound visual loss and complete ophthalmoplegia after an uneventful spinal surgery for removal of cervical osteoblastoma. Postoperative visual loss following nonocular surgery is, fortunately rare, yet a devastating complication. The most common cause is ischemic optic neuropathy, but it can also be due to central retinal occlusion or cortical blindness. Visual loss in conjunction with ophthalmoplegia is rarely seen, and there are very few reports in the literature. We also review the related literature and highlight the mechanism and preventive measures.

  8. End tidal CO2 level (PETCO2 during laparoscopic surgery: comparison between spinal anaesthesia and general anaesthesia

    Directory of Open Access Journals (Sweden)

    Rahul S. Jadhav

    2017-01-01

    Full Text Available Background: Laparoscopy is a procedure which involves insufflations of the abdomen by a gas, so that endoscope can visualise intra abdominal content without being in direct contact with viscera or tissues. Its advantages are small incisions, less pain, less postoperative ileus, short hospital stay compared to traditional open method. Monitoring of end tidal carbon dioxide (PETCO2 and hemodynamics is very necessary during Laparoscopy surgery. This study is conducted to find out effects of CO2 insufflation on parameters like PETCO2, Mean arterial pulse pressure, SPO2 under spinal anaesthesia and general anaesthesia in ASA I and ASA II patients. Methods: The present study was conducted in the department of anaesthesiology from December 2014 to September 2015.This study was a prospective, randomized controlled, single blind. Each group consisted of 30 patients having Group A and Group B as patient undergoing laparoscopic surgery under Spinal anaesthesia and General anaesthesia respectively. Preoperatively patients in Group A (Spinal anaesthesia given inj. Midazolam 0.3mg/kg IM 45 before surgery and Group B (General anaesthesia inj. pentazocin 0.3mg/kg, inj. promethazine 0.5mg/kg, inj. Glycopyrrolate 0.004 mg/kg IM 45 before surgery. In operation theatre, intra operative pulseoximetre, ECG, SPO2, Heart rate (HR, Mean arterial pulse pressure and PETCO2 monitoring done. Amount of CO2 insufflated noted. Results: It was found from present study that in both group there was significant progressive rise in PETCO2 after CO2 insufflation, with peak at 30 min and thereafter plateau till the end of procedure (avg. duration 45-60 min. In group A i.e. laparoscopic surgery under spinal anaesthesia with (spontaneous respiration the rise in PETCO2 was significant as compared to the group B i.e. laparoscopic surgery under general anaesthesia with controlled ventilation. The heart rate increased after CO2 insufflation in both the group, but it was significant in

  9. A bleeding assessment tool correlates with intraoperative blood loss in children and adolescents undergoing major spinal surgery.

    Science.gov (United States)

    Anadio, Jennifer M; Sturm, Peter F; Forslund, Johan M; Agarwal, Sunil; Lane, Adam; Tarango, Cristina; Palumbo, Joseph S

    2017-04-01

    Screening laboratory studies for bleeding disorders are of little predictive value for operative bleeding risk in adults. Predicting perioperative bleeding in pediatric patients is particularly difficult as younger patients often have not had significant hemostatic challenges. This issue is distinctly important for high bleeding risk surgeries, such as major spinal procedures. The aim of this study was to determine if the score of a detailed bleeding questionnaire (BQ) correlated with surgical bleeding in pediatric patients undergoing major spinal surgery. A total of 220 consecutive pediatric patients (mean age 14.2years) undergoing major spinal surgery were administered the BQ preoperatively, as well as having routine screening laboratory studies (i.e., PT, aPTT, PFA) drawn. A retrospective analysis was conducted to determine if there was a correlation between either the results of the BQ and/or laboratory studies with operative outcomes. A BQ score>2 showed a strong positive correlation with intraoperative bleeding based on both univariate and multivariate analyses. In contrast, abnormalities in screening laboratory studies showed no significant correlation with operative bleeding outcomes. Relying on screening laboratory studies alone is inadequate. The BQ used here correlated with increased intraoperative hemorrhage, suggesting this tool may be useful for assessing pediatric surgical bleeding risk, and may also be useful in identifying a subset of patients with a very low bleeding risk that may not require laboratory screening. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Long-term outcome of surgical Class III correction as a function of age at surgery

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    Bailey, L'Tanya J.; Phillips, Ceib; Proffit, William R.

    2009-01-01

    Introduction In this study, we assessed whether the likelihood of a positive overjet 5 to 10 years after Class III surgery was affected by age at the surgery or the type of surgery and evaluated the amount and pattern of postsurgical growth. Methods Cephalometric measurements including overjet were evaluated from immediately postsurgery and long-term recall cephalograms of 104 patients who had had surgical Class III correction and at least 5-year recalls. The patients were classified as younger (surgery or 20 years for males) or older and by type of surgery (maxilla only vs mandibular only or 2 jaw). For the younger patients, the timing of treatment was based largely on serial cephalometric radiographs that eventually showed minimal or no mandibular growth. Results Long-term changes in overjet and other cephalometric characteristics in the younger and the older patients were similar. No patients in the sample had negative overjet in the long term, but zero overjet (<1 mm) was observed in some patients in all groups. Patients who had mandibular setback at any age were 2.6 times more likely to have zero overjet in the long term (P = .003) than those with maxillary surgery alone. For the younger patients, the likelihood of zero overjet in the long term was not significantly different from patients who were treated later (P = .87), with or without mandibular surgery. Conclusions The data support the use of serial cephalometric radiographs, with surgery deferred until little or no mandibular growth is observed, to determine the timing of Class III surgery in younger patients. PMID:18331934

  11. Coma from wall suction-induced CSF leak complicating spinal surgery.

    Science.gov (United States)

    Fehnel, Corey R; Razmara, Ali; Feske, Steven K

    2014-03-12

    A 72-year-old woman was admitted for elective L4/L5 laminectomy. The operative procedure was extradural, and a Jackson-Pratt (JP) drain was placed in the tissue bed and set to wall suction during skin closure. During closure, the patient developed a 15 s period of asystole. The patient was haemodynamically stable, but was comatose for 3 days postoperatively. Cardiac enzymes and EEG were unrevealing. Head CT showed traces of subarachnoid haemorrhage and signs suggestive of cerebral anoxia. JP drain at the incision produced 170-210 mL/day of fluid, positive for β-2 transferrin, indicating cerebrospinal fluid (CSF). The patient fully returned to baseline on hospital day 10. MRI on hospital day 8 normalised. The reversible coma and radiographic findings were most consistent with acute intracranial hypotension relating to acute loss of CSF. Because radiographic findings can mimic hypoxic-ischaemic injury, acute intracranial hypotension should be considered in the differential diagnosis of postoperative coma after cranial or spinal surgery.

  12. SPINAL ANESTHESIA A BETTER AND EFFECTIVE ALTERNATIVE TO GENERAL ANEASTHESIA IN SPINE SURGERIES: A PROSPECTIVE OPEN LABEL SINGLE ARM STUDY

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    Kumar Babu

    2014-11-01

    Full Text Available : INTRODUCTION: In all practical purposes various thoraco lumbar and lumbar surgeries like discectomy, laminectomy and spinal fusion procedures are usually performed under general anesthesia (GA. Our aim of this study is to assess whether spinal anesthesia is a better and effective alternative to general anesthesia in terms of economic advantage and functional recovery with both intra and post-operative heamodynamic stability. METHODS: In our study hundred patients with age group 25-45 yrs within the ASA criteria of class I-III were enrolled. All patients were randomly selected based on age, sex, ASS criteria, duration of surgery, heart rate (HR, mean arterial pressure (MAP, blood loss, previous history of risk factors and co morbidities. The severity of postoperative pain based on visual analogue scale (VAS and use of analgesics post operatively, were recorded. RESULTS: There were 41 males and 59 females. The mean age of the patient was 39.28±9.27 yrs. Six patients had hypertension, 11 with diabetes. Patients with ASA Grade I and II and III were 60, 34 and 6 respectively. There were no episodes of air way compromises, 2 patients had spinal aneasthesia failures, no incidence of post dural puncture headache, 3 patients had mean blood pressure fluctuations among them, one patient had post-operative paraperesis due to hematoma treated by immediate decompression, and 13 patients had usage of propofol sedation in terms of comfort. The duration of surgery (range was 77.25±22.44 min (40-120 Severity of postoperative pain after four hours of surgery on VAS was 3.24±0.46. Twenty two patients (22% required analgesics. Two patients had post-operative vomiting. CONCLUSIONS: In our study we have considered that spinal anesthesia for advantages such as less blood loss, intra operative blood pressure and heart rate changes, postoperative pain, quick functional recovery and lower incidence of pulmonary complications. Additionally, during spinal anesthesia

  13. Corrective surgery for deformity of the upper cervical spine due to ankylosing spondylitis

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    Bin Lin

    2014-01-01

    Full Text Available Rotational and flexion deformity of C1-C2 due to ankylosing spondylitis is rare. We did surgical correction in one such case by lateral release, resection of the posterior arch of C1 and mobilization of the vertebral arteries, wedge osteotomy of the lateral masses of C1 and internal fixation under general anesthesia. There were no vascular and neurological complications during the surgery. After operation the atlantoaxial rotational deformity was corrected and the normal cervical lordosis was restored. At 1 year followup his visual field and feeding became normal and internal fixation was stable.

  14. Does Spinal Fusion and Scoliosis Correction Improve Activity and Participation for Children With GMFCS level 4 and 5 Cerebral Palsy?

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    Sewell, Mathew David; Wallace, Charlie; Malagelada, Francesc; Gibson, Alex; Noordeen, Hilali; Tucker, Stewart; Molloy, Sean; Lehovsky, Jan

    2015-12-01

    Spinal fusion is used to treat scoliosis in children with cerebral palsy (CP). Following intervention, the WHO considers activity and participation should be assessed to guide intervention and assess the effects. This study assesses whether spinal fusion for scoliosis improves activity and participation for children with severe CP.Retrospective cohort study of 70 children (39M:31F) with GMFCS level 4/5 CP and significant scoliosis. Thirty-six underwent observational and/or brace treatment as the sole treatment for their scoliosis, and 34 underwent surgery. Children in the operative group were older and had worse scoliosis than those in the observational group. Questionnaire and radiographic data were recorded over a 2-year period. The ASKp was used to measure activity and participation.In the observational group, Cobb angle and pelvic obliquity increased from 51 (40-90) and 10 (0-30) to 70 (43-111) and 14 (0-37). Mean ASKp decreased from 16.3 (1-38) to 14.2 (1-36). In the operative group, Cobb angle and pelvic obliquity decreased from 81 (50-131) and 14 (1-35) to 38 (10-76) and 9 (0-24). Mean ASKp increased from 10.5 (0-29) to 15.9 (3-38). Spinal-related pain correlated most with change in activity and participation in both groups. There was no difference in mobility, GMFCS level, feeding or communication in either group before and after treatment.In children with significant scoliosis and CP classified within GMFCS levels 4 and 5, spinal fusion was associated with an improvement in activity and participation, whereas nonoperative treatment was associated with a small reduction. Pain should be carefully assessed to guide intervention.

  15. Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

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    Subramanian Vaidyanathan

    2012-01-01

    Full Text Available A 29-year-old man developed paraplegia at T-10 level due to road traffic accident in 1972. Both kidneys were normal and showed good function on intravenous urography. Division of external urethral sphincter was performed in 1973. In 1974, cystogram showed retrograde filling of left renal tract, which was hydronephrotic. Left ureteric reimplantation was performed. Following surgery, cystogram revealed marked retrograde filling of left renal tract as before. Penile sheath drainage was continued. In 1981, intravenous urography revealed bilateral severe hydronephrosis. Left ureteric reimplantation was performed again in 1983. Blood pressure was 220/140 mm Hg; this patient was prescribed atenolol. Cystogram showed gross left vesicoureteral reflux. Intermittent catheterisation was commenced in 2001. In 2007, proteinuria was 860 mg/day. This patient developed progressive renal failure and expired in 2012. In a spinal cord injury patient with vesicoureteral reflux, the treatment should focus on abolition of high intravesical pressures rather than surgical correction of vesicoureteric reflux. Detrusor hyperactivity and high intravesical pressures are the basic causes for vesicoureteral reflux in spinal cord injury patients. Therefore, it is important to manage spinal cord injury patients with neuropathic bladder by intermittent catheterisations along with antimuscarinic drug therapy in order to abolish high detrusor pressures and prevent vesicoureteral reflux. Angiotensin-converting enzyme inhibitors or angiotensin-receptor-blocking agents should be prescribed even in the absence of hypertension when a spinal cord injury patient develops vesicoureteral reflux and proteinuria.

  16. Prolonged gastroparesis after corrective surgery for Wilkie's syndrome: a case report

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    Aslam Muhammad I

    2008-04-01

    Full Text Available Abstract Introduction Wilkie's syndrome, a rare cause of intestinal obstruction, is related to anatomical and mechanical factors associated with the reduction of retroperitoneal fat padding. The diagnostic challenges of identifying vascular constriction between the aorta and superior mesenteric artery have been answered by advances in the field of computed tomography. Despite diagnostic confusion with intestinal dysmotility syndrome, conservative therapy with nutritional supplementation is the initial approach and duodenojejunostomy is favoured if non-surgical treatment fails. Case presentation We present a case of a 49-year-old woman with Wilkie's syndrome with persistent symptoms of gastroparesis for 15 months following corrective surgery. Conclusion Open and laparoscopic duodenojejunostomy have been described as the best surgical treatment options for Wilkie's syndrome, but further work needs to be done for patients with refractory symptoms of gastroparesis after these corrective surgeries.

  17. [Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis].

    Science.gov (United States)

    Rojas-Tomba, F; Gormaz-Talavera, I; Menéndez-Quintanilla, I E; Moriel-Durán, J; García de Quevedo-Puerta, D; Villanueva-Pareja, F

    2016-01-01

    To evaluate the incidence of venous thromboembolism in spine surgery with no chemical and mechanical prophylaxis, and to determine the specific risk factors for this complication. A historical cohort was analysed. All patients subjected to major spinal surgery, between January 2010 and September 2014, were included. No chemical or mechanical prophylaxis was administered in any patient. Active mobilisation of lower limbs was indicated immediately after surgery, and early ambulation started in the first 24-48 hours after surgery. Clinically symptomatic cases were confirmed by Doppler ultrasound of the lower limbs or chest CT angiography. A sample of 1092 cases was studied. Thromboembolic events were observed in 6 cases (.54%); 3 cases (.27%) with deep venous thrombosis and 3 cases (.27%) with pulmonary thromboembolism. A lethal case was identified (.09%). There were no cases of major bleeding or epidural haematoma. The following risk factors were identified: a multilevel fusion at more than 4 levels, surgeries longer than 130 minutes, patients older than 70 years of age, hypertension, and degenerative scoliosis. There is little scientific evidence on the prevention of thromboembolic events in spinal surgery. In addition to the disparity of prophylactic methods indicated by different specialists, it is important to weigh the risk-benefit of intra- and post-operative bleeding, and even the appearance of an epidural haematoma. Prophylaxis should be assessed in elderly patients over 70 years old, who are subjected to surgeries longer than 130 minutes, when 4 or more levels are involved. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  18. Clinical efficacy of CT-guided percutaneous huge ilio-psoas abscesses drainage combined with posterior approach surgery for the management of dorsal and lumbar spinal tuberculosis in adults.

    Science.gov (United States)

    Zou, Authrors Dexin; Zhou, Junlin; Zhou, Xiaobin; Jiang, Xiaobing

    2017-09-12

    To evaluate the clinical efficacy of CT-guided percutaneous huge ilio-psoas abscesses drainage combined with posterior approach surgery for the management of dorsal and lumbar spinal tuberculosis in 16 adult cases. Between January 2006 and June 2013, a total of 16 dorsal and lumbar spinal tuberculosis patients with huge ilio-psoas abscesses underwent two-stage CT-guided percutaneous abscesses drainage and posterior debridement, decompression, intervertebral fusion and instrumentation. Standard quadruple antituberculous chemotherapy was performed both before and after surgery. The average follow-up period was 26.7 months (range 18-38 months). There is no severe complication and relapse of spinal tuberculosis. The blood loss was 921.0±141.3mL, operation time was 174.8±15.7minutes. Kyphotic angle improved from 36.6±10.0° preoperatively to 8.1±1.8° postoperatively with 2.2±1.5° loss of correction at final follow-up. The solid bone fusion was achieved in all cases at average 6.6±2.2 months after surgery. Neurologic deficits were recovered in varing degrees except 4 cases remained the same. The postoperative quality of life significantly improved. The Oswestry Disability Index (ODI) decreased from 32.8±10.6 preoperatively to 14.4±7.9 at the final follow-up. CT-guided percutaneous drainage combined with posterior approach surgery was proved to be safe and effective for the management of dorsal and lumbar spinal tuberculosis with huge ilio-psoas abscesses in adults. Level IV, retrospective. Copyright © 2017. Published by Elsevier Masson SAS.

  19. The Effect of Concomitant Rib Deformity in Congenital Scoliosis on Spinal Curve Correction After Segmental Pedicle Screw Instrumentation.

    Science.gov (United States)

    Ameri, Ebrahim; Fouladi, Daniel F; Safari, Mir Bahram; Tari, Hossein Vahid; Ghandhari, Hassan

    2017-05-01

    A single-center, prospective study. To investigate the effect of rib anomaly on surgical curve correction outcome in congenital scoliosis. The presence of rib anomalies may complicate surgical correction of congenital scoliosis. The outcome of surgical correction, however, has not been documented in scoliotic patients with and without rib deformity. Percent Cobb angle decrease (CAD) after operation was calculated in 94 patients with congenital scoliosis. Posterior segmental pedicle screw instrumentation (posterior approach) with or without previous anterior spinal release and fusion (anterior approach) was the method of correction. The impact of vertebral anomaly and rib deformity on CAD was examined. Although the type of vertebral anomaly had no significant effect on the mean CAD, it was significantly lower in 56 patients with rib deformity compared with that in the remaining patients without rib deformity (35.14%±15.83% vs. 51.54%±17.82%, Prib abnormalities, and in those with same-level vertebral and rib deformities. Patients' sex and age at the time of operation, rib number abnormality, and the type of operation (ie, posterior-only approach vs. anterior and posterior approach) did not contribute significantly to Cobb angle change after operation. Concomitant rib deformities, particularly of complex and unilateral types, significantly compromise operative curve correction outcome in congenital scoliosis.

  20. Posterior spinal fusion for adolescent idiopathic scoliosis using a convex pedicle screw technique: a novel concept of deformity correction.

    Science.gov (United States)

    Tsirikos, A I; Mataliotakis, G; Bounakis, N

    2017-08-01

    We present the results of correcting a double or triple curve adolescent idiopathic scoliosis using a convex segmental pedicle screw technique. We reviewed 191 patients with a mean age at surgery of 15 years (11 to 23.3). Pedicle screws were placed at the convexity of each curve. Concave screws were inserted at one or two cephalad levels and two caudal levels. The mean operating time was 183 minutes (132 to 276) and the mean blood loss 0.22% of the total blood volume (0.08% to 0.4%). Multimodal monitoring remained stable throughout the operation. The mean hospital stay was 6.8 days (5 to 15). The mean post-operative follow-up was 5.8 years (2.5 to 9.5). There were no neurological complications, deep wound infection, obvious nonunion or need for revision surgery. Upper thoracic scoliosis was corrected by a mean 68.2% (38% to 48%, p scoliosis was corrected by a mean 71% (43.5% to 8.9%, p scoliosis was corrected by a mean 72.3% (41% to 90%, p Scoliosis Research Society Outcomes Questionnaire score improved from a mean 3.6 to 4.6 (2.4 to 4, p scoliosis, an improved thoracic kyphosis and normal global sagittal balance. Both patient satisfaction and functional outcomes were excellent. Cite this article: Bone Joint J 2017;99-B:1080-7. ©2017 The British Editorial Society of Bone & Joint Surgery.

  1. β-Type titanium alloys for spinal fixation surgery with high Young's modulus variability and good mechanical properties.

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    Liu, Huihong; Niinomi, Mitsuo; Nakai, Masaaki; Cho, Ken

    2015-09-01

    Along with a high strength, ductility, and work hardening rate, a variable Young's modulus is crucial for materials used as implant rods in spinal fixation surgery. The potential in this context of Ti-(9,8,7)Cr-0.2O (mass%) alloys is reported herein. The microstructural and mechanical properties of the alloys were systematically examined as a function of their chromium content, and the ion release of the optimized alloy was investigated to assess its suitability as an implant material. In terms of the deformation-induced ω-phase transformation required for a variable Young's modulus, the balance between β-phase stability and athermal ω-phase content is most favorable in the Ti-9Cr-0.2O alloy. In addition, this composition affords a high tensile strength (>1000MPa), elongation at break (∼20%), and work hardening rate to solution-treated (ST) samples. These excellent properties are attributed to the combined effects of deformation-induced ω-phase transformation, deformation twinning, and dislocation gliding. Furthermore, the ST Ti-9Cr-0.2O alloy proves resistant to metal ion release in simulated body fluid. This combination of a good biocompatibility, variable Young's modulus and a high strength, ductility, and work hardening rate is ideal for spinal fixation applications. Extensive efforts have been devoted over the past decades to developing β-type titanium alloys with low Young's moduli for biomedical applications. In spinal fixation surgery however, along with excellent mechanical properties, the spinal-support materials should possess high Young's modulus for showing small springback during surgery to facilitate manipulation but low Young's modulus close to bone once implanted to avoid stress shielding. None of currently used metallic biomaterials can satisfy these abovementioned requirements. In the present study, we have developed a novel alloy, Ti-9Cr-0.2O. Remarkably variable Young's modulus and excellent mechanical properties can be achieved in this

  2. Adult spinal deformity treated with minimally invasive surgery. Description of surgical technique, radiological results and literature review.

    Science.gov (United States)

    Domínguez, I; Luque, R; Noriega, M; Rey, J; Alía, J; Urda, A; Marco, F

    2017-09-06

    The prevalence of adult spinal deformity has been increasing exponentially over time. Surgery has been credited with good radiological and clinical results. The incidence of complications is high. MIS techniques provide good results with fewer complications. This is a retrospective study of 25 patients with an adult spinal deformity treated by MIS surgery, with a minimum follow-up of 6 months. Radiological improvement was SVA from 5 to 2cm, coronal Cobb angle from 31° to 6°, and lumbar lordosis from 18° to 38°. All of these parameters remained stable over time. We also present the complications that appeared in 4 patients (16%). Only one patient needed reoperation. We describe the technique used and review the references on the subject. We conclude that the MIS technique for treating adult spinal deformity has comparable results to those of the conventional techniques but with fewer complications. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Visual impairment corrected via cataract surgery and 5-year survival in a prospective cohort.

    Science.gov (United States)

    Fong, Calvin Sze-Un; Mitchell, Paul; Rochtchina, Elena; de Loryn, Tania; Tan, Ava Grace; Wang, Jie Jin

    2014-01-01

    To compare mortality risk between cataract surgical patients with corrected and persistent visual impairment. Cohort study. A total of 1864 consecutive patients, aged ≥64 years, undergoing phacoemulsification surgery at Westmead Hospital were followed annually for 5 years postoperatively. Visual impairment status in the surgical eye was categorized as none (presenting visual acuity [VA], ≥20/40), mild (VA Death Index. Of 901 patients with moderate-severe visual impairment before surgery, 60.4% (n = 544), 15.5% (n = 140), and 24.1% (n = 217) had no, mild, or moderate-severe visual impairment in the surgical eye, respectively, 1 month postoperatively. Age-standardized 5-year mortality rates were nonsignificantly lower in patients with either mild (24.7%, 95% confidence interval [CI] 16.5%-32.9%) or no visual impairment (24.1%, 95% CI 19.9%-28.4%) post surgery compared to that in patients whose moderate-severe visual impairment persisted (30.6%, 95% CI 23.3%-37.9%). After adjusting for age, sex, smoking, body mass index, and individual comorbid conditions, such as hypertension, diabetes, angina, myocardial infarction, stroke, transient ischemic attack, and kidney disease, patients with no visual impairment 1 month postoperatively had a lower mortality risk (HR 0.73, 95% CI 0.52-1.01) compared to those with persistent moderate-severe visual impairment after surgery. This finding was significant (HR 0.71, 95% CI 0.51-0.99) after additional adjustment for number of medications taken (continuous variable) and number (≥3 vs <3) of comorbid conditions. Correcting moderate-severe visual impairment in older patients with phacoemulsification surgery was associated with a lower mortality risk, compared to surgical patients whose visual impairment persisted postoperatively. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Emergency correction of coagulation before major surgery in two elderly patients on oral anticoagulation

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    Pechlaner Christoph

    2007-01-01

    Full Text Available Abstract Recommendations for urgent reversal of oral anticoagulation with vitamin K1 antagonists are largely derived from case series employing empirical dosing regimens with vitamin K1 and prothrombin complex concentrates. Data on the use of prothrombin complex concentrates in this indication are scarce in the elderly who are at high risk of both hemorrhagic and thrombotic complications. The two cases presented here describe patients older than 75 years who underwent rapid International Normalized Ratio (INR reversal with prothrombin complex concentrates for surgical treatment of a bleeding ruptured spleen and for emergency surgery of a dissecting aorta. Both patients had their INRs rapidly corrected to ≤ 1.6 and underwent operation without complications. Evidence on treatment of patients who present with elevated INR and who have major bleeding or need to undergo emergency surgery is based mainly on observational studies. The two elderly patients presented here underwent successful emergency surgery after their INRs had been corrected with the intravenous use of vitamin K1 in combination with prothrombin complex concentrate that was administered according to current guideline recommendations.

  5. Perioperative complications of scoliosis surgery in patients with Duchenne muscular dystrophy and spinal muscular atrophy, focussing on wound healing disorders.

    Science.gov (United States)

    Burow, Mareike; Forst, Raimund; Forst, Jürgen; Hofner, Benjamin; Fujak, Albert

    2017-06-01

    Patients with Duchenne muscular dystrophy (DMD) or spinal muscular atrophy (SMA), both neuromuscular diseases, sustain spinal scoliosis in the course of their disease. To reduce the concomitant major morbidity and to improve their quality of life, patients require surgical spine stabilization. This can lead to complications like respiratory, cardiac or neurological complications or wound healing disorders (WHD). To find out the different complexities and risk factors increasing the chance to develop a WHD, the inpatient database was analyzed. We performed a retrospective statistical study. Therefore, we analyzed the inpatient database of 180 patients (142 DMD and 38 SMA patients). The focus was on WHD. To figure out the risk factors leading to WHD, we conducted a logistic regression. Cardiac complications occurred most frequently, followed by pulmonary complications and neurological lesions. Fifty-seven out of 180 patients developed a WHD. In 23 cases the WHD was aseptic, in the other 34 cases dermal organisms, Pseudomonas species and intestinal organisms were responsible. By means of the logistic regression, we were able to identify two more risk factors, in addition to diagnosis and gender, for developing a WHD in our patients: the year of surgery and the direction of pelvic tilt. Most common complications following scoliosis surgery are respiratory and cardiac complications. WHD is a severe complication that implies a prolonged therapy. Some risk factors for developing WHD could be identified in this analysis. Specifically, these were the date of surgery and the direction of pelvic tilt.

  6. Vitreoretinal surgery for macular hole after laser assisted in situ keratomileusis for the correction of myopia

    Science.gov (United States)

    Arevalo, J F; Rodriguez, F J; Rosales-Meneses, J L; Dessouki, A; Chan, C K; Mittra, R A; Ruiz-Moreno, J M

    2005-01-01

    Ams: To describe the characteristics and surgical outcomes of full thickness macular hole surgery after laser assisted in situ keratomileusis (LASIK) for the correction of myopia. Methods: 13 patients (14 eyes) who developed a macular hole after bilateral LASIK for the correction of myopia participated in the study. Results: Macular hole formed 1–83 months after LASIK (mean 13 months). 11 out of 13 (84.6%) patients were female. Mean age was 45.5 years old (25–65). All eyes were myopic (range −0.50 to −19.75 dioptres (D); mean −8.4 D). Posterior vitreous detachment (PVD) was not present before and was documented after LASIK on 42.8% of eyes. Most macular hole were unilateral, stage 4 macular hole, had no yellow deposits on the retinal pigment epithelium, had no associated epiretinal membrane, were centric, and had subretinal fluid. The mean diameter of the hole was 385.3 μm (range 200–750 μm). A vitrectomy closed the macular hole on all eyes with an improvement on final best corrected visual acuity (VA) on 13 out of 14 (92.8%) patients. Conclusions: This study shows that vitreoretinal surgery can be successful in restoring vision for most myopic eyes with a macular hole after LASIK. PMID:16234445

  7. [Computer-assisted surgery-(CAS-)guided correction arthrodesis of the subtalar joint].

    Science.gov (United States)

    Richter, Martinus

    2010-10-01

    Restoration of a stable and plantigrade foot in deformities at the hindfoot and concomitant degenerative changes at the subtalar joint. Deformities at the hindfoot and concomitant degenerative changes at the subtalar joint. Active local infection or relevant vascular insufficiency. Prone position and posterolateral approach to the subtalar joint. Placement of dynamic reference bases in talus and calcaneus through stab incisions. Two-dimensional image acquisition for navigation. Definition of the axes of talus and calcaneus, and of the extent of correction. Exposure of the subtalar joint and removal of remaining cartilage. Computer- assisted surgery-(CAS-)guided correction and transfixation of the corrected position with two 2.5-mm Kirschner wires. Transplantation of autologous cancellous and cortical bone, if necessary. Three-dimensional (3-D) image acquisition for analysis of the accuracy of the correction and planning of the drillings for the screws. CAS-guided drilling and insertion of the screws. 3-D image acquisition for analysis of the accuracy of the correction implant position. Wound closure in layers. 15 kg partial weight bearing in an orthosis (e.g. Vacuped TM, OPED Inc., Valley, Germany) for 6 weeks, followed by full weight bearing in a stable standard shoe. From September 1, 2006 to August 31, 2008, 26 correction arthrodeses were performed. The accuracy was assessed by intraoperative 3-D imaging. All achieved angles/translations were within a maximum deviation of 2°/2 mm when compared to the planned correction. Complications that were associated with CAS were not observed. In all 25 cases that completed 2-year follow-up, timely fusion was registered.

  8. Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism

    Directory of Open Access Journals (Sweden)

    Priyanka Gupta

    2015-01-01

    Full Text Available Background and Aims: Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological evaluation and prompt management of complications. Studies have been rare comparing the recovery characteristics in paediatric neurosurgical patients. Hence, this study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in children undergoing spinal surgery. Methods: Sixty children, aged 1-12 years, undergoing elective surgery for lumbo-sacral spinal dysraphism were enrolled. Anaesthesia was induced with sevoflurane using a face mask. The children were then randomised to receive either sevoflurane or desflurane with oxygen and nitrous oxide, fentanyl (1 μg/kg/h and rocuronium. The anaesthetic depth was guided by bispectral index (BIS ® monitoring with a target BIS ® between 45 and 55. Perioperative data with regard to demographic profile, haemodynamics, emergence and extubation times, modified Aldrete score (MAS, pain (objective pain score, agitation (Cole′s agitation score, time to first analgesic and complications, thereof, were recorded. Statistical analysis was done using STATA 11.2 (StataCorp., College Station, TX, USA and data are presented as median (range or mean ± standard deviation. Results: The demographic profile, haemodynamics, MAS, pain and agitation scores and time to first analgesic were comparable in between the two groups (P > 0.05. The emergence time was shorter in desflurane group (2.75 [0.85-12] min as compared to sevoflurane (8 [2.5-14] min (P < 0.0001. The extubation time was also shorter in desflurane group (3 [0.8-10] min as compared to the sevoflurane group (5.5 [1.2-14] min (P = 0.0003. Conclusion: Desflurane provided earlier tracheal extubation and emergence as compared to sevoflurane in children undergoing surgery for lumbo-sacral spinal dysraphism.

  9. Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism

    Science.gov (United States)

    Gupta, Priyanka; Rath, Girija Prasad; Prabhakar, Hemanshu; Bithal, Parmod Kumar

    2015-01-01

    Background and Aims: Rapid recovery is desirable after neurosurgery as it enables early post-operative neurological evaluation and prompt management of complications. Studies have been rare comparing the recovery characteristics in paediatric neurosurgical patients. Hence, this study was carried out to compare the effect of sevoflurane and desflurane anaesthesia on emergence and extubation in children undergoing spinal surgery. Methods: Sixty children, aged 1–12 years, undergoing elective surgery for lumbo-sacral spinal dysraphism were enrolled. Anaesthesia was induced with sevoflurane using a face mask. The children were then randomised to receive either sevoflurane or desflurane with oxygen and nitrous oxide, fentanyl (1 μg/kg/h) and rocuronium. The anaesthetic depth was guided by bispectral index (BIS®) monitoring with a target BIS® between 45 and 55. Perioperative data with regard to demographic profile, haemodynamics, emergence and extubation times, modified Aldrete score (MAS), pain (objective pain score), agitation (Cole's agitation score), time to first analgesic and complications, thereof, were recorded. Statistical analysis was done using STATA 11.2 (StataCorp., College Station, TX, USA) and data are presented as median (range) or mean ± standard deviation. Results: The demographic profile, haemodynamics, MAS, pain and agitation scores and time to first analgesic were comparable in between the two groups (P > 0.05). The emergence time was shorter in desflurane group (2.75 [0.85–12] min) as compared to sevoflurane (8 [2.5–14] min) (P < 0.0001). The extubation time was also shorter in desflurane group (3 [0.8–10] min) as compared to the sevoflurane group (5.5 [1.2–14] min) (P = 0.0003). Conclusion: Desflurane provided earlier tracheal extubation and emergence as compared to sevoflurane in children undergoing surgery for lumbo-sacral spinal dysraphism. PMID:26379291

  10. Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2014-01-01

    Full Text Available Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl. Aims: We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB and intra- venous (IV fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture. Patients and Methods: In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB and Intravenous fentanyl group (FENT. In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000 was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 μg/kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant. Results: VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020. Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049. Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027. Patient acceptance was less in group FENT (P = 0.000031. Conclusion: Femoral nerve block provides better analgesia, patient

  11. Increase in spinal deformity surgery in patients age 60 and older is not associated with increased complications.

    Science.gov (United States)

    Sing, David C; Berven, Sigurd H; Burch, Shane; Metz, Lionel N

    2017-05-01

    Surgical treatment for adult spinal deformity improves patient quality of life; however, trends in surgical utilization in the elderly, who may be at higher risk for complications, remain unclear. To identify trends in the utilization of adult deformity and determine complication rates among older patients. This is a retrospective database analysis. The Nationwide Inpatient Sample database was queried from 2004 to 2011 to identify adult patients who underwent spinal fusion of eight or more levels using International Classification of Diseases, Ninth Revision (ICD-9) coding. Incidence of surgery, complication rates, length of stay, and total hospital charges. The incidence of surgery was normalized to United States census data by age group. Trends in complications, length of stay, and inflation-adjusted hospital charges were determined using linear regression and Cochran-Armitage trend testing. An estimated 29,237 patients underwent adult spinal deformity surgery with an increase from 2,137 to 5,030 cases per year from 2004 to 2011. Surgical incidence among patients 60 years and older increased from 1.9 to 6.5 cases per 100,000 people from 2004 to 2011 (pincreased from 0.59 to 0.93. Linear regression revealed that the largest increase in surgical utilization was for patients aged 65-69 years with an increase of 0.68 patients per 100,000 people per year (pincreased with age (≥60 vs. increased from $171,517 in 2004 to $303,479 in 2011 (pincreased 3.4-fold among patients ≥60 years from 2004 to 2011, with an associated 1.8-fold increase in hospital charges. Although the exact reasons for the striking increase in hospital charges remain unclear, some of the increase is likely related to decreasing reimbursement of charges by payors over the same period of time. The large majority of cases were performed in large academic centers, and growth in deformity trained spine specialists in these centers may have contributed to this trend. Despite the increased utilization of

  12. Acquired lumbar spinal stenosis.

    Science.gov (United States)

    Deasy, JoAnn

    2015-04-01

    Lumbar spinal stenosis is the most frequent reason for spinal surgery in patients over age 65 years. In this condition, narrowing of the lumbar spinal canal and nerve root canals leads to painful, debilitating compression of spinal nerves and blood vessels. As the population ages, an increasing number of patients will be diagnosed and treated for lumbar spinal stenosis by primary care providers. This article reviews the pathophysiology, diagnosis, and management of lumbar spinal stenosis in adults over age 50 years.

  13. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair

    DEFF Research Database (Denmark)

    Etz, Christian D; Weigang, Ernst; Hartert, Marc

    2015-01-01

    Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most...

  14. Spinal Infections

    Science.gov (United States)

    ... infections may occur following surgery or spontaneously in patients with certain risk factors. Risk factors for spinal infections include poor nutrition, immune suppression, human immunodeficiency virus (HIV) infection, cancer, diabetes and obesity. Surgical risk factors ...

  15. Cardiovascular effects and intraoperative pharmacokinetics of tramadol in sheep undergoing spinal surgery.

    Science.gov (United States)

    De Benedictis, Giulia Maria; Giorgi, Mario; Depase, Alice; De Vito, Virginia; Della Rocca, Giorgia; Bellini, Luca

    2017-02-06

    To evaluate the pharmacokinetics of two doses of tramadol during isoflurane anaesthesia in sheep and their ability to prevent the cardiovascular response induced by surgical stimulation. Prospective randomized controlled study. A total of 12 healthy sheep (mean weight, 47.5±7.9 kg) undergoing lumbar transpedicular intervertebral disk nucleotomy. Sheep were sedated with medetomidine, anaesthesia was induced with propofol and maintained with isoflurane at 1.5 vol.%. Baseline heart rate and blood pressure were measured and sheep were randomly assigned an intravenous injection of tramadol (4 or 6 mg kg(-1)). Fentanyl was injected as rescue analgesic if cardiovascular parameters were increased more than 20% compared to baseline. If those variables were below 20% of baseline, the concentration of isoflurane was gradually decreased until parameters returned to the original value. Blood collections were performed at pre-assigned times, and concentrations of tramadol and O-desmethyltramadol (M1) assessed by high-performance liquid chromatography. Time from premedication to anaesthesia induction, anaesthesia time, propofol dose and intraoperative body temperature were similar between doses. Cardiovascular variables remained between ±20% of baseline value, and no statistical difference was observed between treatments. Regardless of the dose of tramadol administered, arterial blood pressure was statistically higher than baseline 10 minutes after tramadol administration, but it gradually returned to previous values. A two-compartment model and a non-compartment model described the pharmacokinetics of tramadol and M1, respectively. Plasma concentrations of tramadol rapidly decreased in the first 2 hours for both doses with an elimination half-life of more than 40 minutes. The M1 maximum concentration was similar for both doses, and it was detected in plasma after 35 minutes. Both doses of tramadol provided adequate cardiovascular stability during spinal surgery in sheep

  16. Comparison of levobupivacaine and levobupivacaine with fentanyl in infraumbilical surgeries under spinal anaesthesia

    Science.gov (United States)

    Attri, Joginder Pal; Kaur, Gagandeep; Kaur, Sarabjit; Kaur, Ravneet; Mohan, Brij; Kashyap, Kamaljyoti

    2015-01-01

    Background: Intrathecal opioids added to low dose local anesthetics in spinal anaesthesia intensifies sensory block without affecting sympathetic blockade. Aim was to evaluate the safety and efficacy of intrathecal levobupivacaine plain versus levobupivacaine plus fentanyl in infraumbilical surgeries. Materials and Methods: In a prospective randomized double blind study, 100 patients of American Society of Anesthesiologists grades I and II of either sex, 20–65 years of age were included after approval from the Ethics Committee. Informed consent was taken and patients were randomly divided into two groups of 50 each, to receive either 2 ml of 0.5% isobaric levobupivacaine (group L) or 2 ml of 0.5% isobaric levobupivacaine + 25 μg fentanyl (group LF) intrathecally. Patients were monitored for sensory and motor block characteristics, postoperative analgesia, haemodynamics and side effects and complications for 24 h. Results: Onset of sensory block and time to maximum sensory block was rapid in group LF (4.8 ± 1.50 and 8.46 ± 1.87 min) as compared to group L (7.6 ± 1.46 and 15.80 ± 2.43 min) (P < 0.000). Maximum sensory block was T6 in group LF and T8 in group L. Maximum Bromage score was 2 in both groups but was achieved earlier in group LF (P < 0.000). Duration of sensory and motor block was significantly prolonged in group LF (270.98 ± 28.60 and 188.52 ± 9.81 min) as compared to group L (197.58 ± 11.20 and 152.76 ± 9.79 min). Total duration of analgesia was also prolonged in group LF (265.16 ± 26.18 min) as compared to group L (168.16 ± 11.08 min). Patients remained haemodynamically stable and side effects and complications were comparable in both groups. Data was analyzed using “Chi-square test” and “unpaired t-test.” Conclusion: Addition of fentanyl to levobupivacaine leads to early onset and prolonged duration of sensory and motor block as well as postoperative analgesia with stable haemodynamics and minimal side effects. PMID:26417124

  17. Prone position-related meralgia paresthetica after lumbar spinal surgery : a case report and review of the literature.

    Science.gov (United States)

    Cho, Keun-Tae; Lee, Ho Jun

    2008-12-01

    Lateral femoral cutaneous neuropathy occurring during spinal surgery is frequently related to iliac bone graft harvesting, but meralgia paresthetica (MP) can result from the patient being in the prone position. Prone position-related MP is not an uncommon complication after posterior spine surgery but there are only few reports in the literature on this subject. It is usually overlooked because of its mild symptoms and self-limiting course, or patients and physicians may misunderstand the persistence of lower extremity symptoms in the early postoperative period to be a reflection of poor surgical outcome. The authors report a case of prone position-related MP after posterior lumbar interbody fusion at the L3-4 and reviewed the literature with discussion on the incidence, pathogenesis, and possible risk factors related to this entity.

  18. Spinal versus general anaesthesia in surgery for inguinodynia (SPINASIA trial): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Zwaans, Willem A R; le Mair, Léon H P M; Scheltinga, Marc R M; Roumen, Rudi M H

    2017-01-14

    Chronic inguinodynia (groin pain) is a common complication following open inguinal hernia repair or a Pfannenstiel incision but may also be experienced after other types of (groin) surgery. If conservative treatments are to no avail, tailored remedial surgery, including a neurectomy and/or a (partial) meshectomy, may be considered. Retrospective studies in patients with chronic inguinodynia suggested that spinal anaesthesia is superior compared to general anaesthesia in terms of pain relief following remedial operations. This randomised controlled trial is designed to study the effect of type of anaesthesia (spinal or general) on pain relief following remedial surgery for inguinodynia. A total of 190 adult patients who suffer from unacceptable chronic (more than 3 months) inguinodynia, as subjectively judged by the patients themselves, are included. Only patients scheduled to undergo a neurectomy and/or a meshectomy by an open approach are considered for inclusion and randomised to spinal or general anaesthesia. Patients are excluded if pain is attributable to abdominal causes or if any contraindications for either type of anaesthesia are present. Primary outcome is effect of type of anaesthesia on pain relief. Secondary outcomes include patient satisfaction, quality of life, use of analgesics and (in)direct medical costs. Patient follow-up period is one year. The first patient was included in January 2016. The expected trial deadline is December 2019. Potential effects are deemed related to the entire setting of type of anaesthesia. Since any setting is multifactorial, all of these factors may influence the outcome measures. This is the first large randomised controlled trial comparing the two most frequently used anaesthetic techniques in remedial surgery for groin pain. There is a definite need for evidence-based strategies to optimise results of these types of surgery. Besides pain relief, other important patient-related outcome measures are assessed to

  19. Complications and outcomes of surgery for spinal meningioma: a Nationwide Inpatient Sample analysis from 2003 to 2010.

    Science.gov (United States)

    Ambekar, Sudheer; Sharma, Mayur; Kukreja, Sunil; Nanda, Anil

    2014-03-01

    The aim of the present study was to analyze the practice patterns, complications and outcome following surgery for spinal meningioma in the United States. We performed a retrospective cohort study using the Nationwide Inpatient Sample database from 2003 to 2010. In-patient mortality and discharge disposition were the outcome predictors. A total of 13,792 admissions for surgically managed spinal meningioma were identified. The number of admissions increased from 12.6% in 2003 to 14.7% in 2010. 1.2% patients were ≤18 years and 28.4% ≥70 years. 8.3% patients had high co-morbidity score. The total in-hospital complication rate was 6.4%. 42% of the admissions were discharged to facilities other than home or self-care. Patients in the pediatric and adult age groups had a significantly higher rate of adverse outcome. There was no difference in complication rates and adverse discharge disposition between the hospitals with varying case volumes. Caucasian patients with private insurance without co-morbidity had significantly lower complication rate and good outcome. Occurrence of spinal meningioma in the pediatric and adult age groups does not carry worse prognosis. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Correction

    DEFF Research Database (Denmark)

    Pinkevych, Mykola; Cromer, Deborah; Tolstrup, Martin

    2016-01-01

    [This corrects the article DOI: 10.1371/journal.ppat.1005000.][This corrects the article DOI: 10.1371/journal.ppat.1005740.][This corrects the article DOI: 10.1371/journal.ppat.1005679.].......[This corrects the article DOI: 10.1371/journal.ppat.1005000.][This corrects the article DOI: 10.1371/journal.ppat.1005740.][This corrects the article DOI: 10.1371/journal.ppat.1005679.]....

  1. A Systematic Review of Clinical Outcomes and Prognostic Factors for Patients Undergoing Surgery for Spinal Metastases Secondary to Breast Cancer.

    Science.gov (United States)

    Sciubba, Daniel M; Goodwin, C Rory; Yurter, Alp; Ju, Derek; Gokaslan, Ziya L; Fisher, Charles; Rhines, Laurence D; Fehlings, Michael G; Fourney, Daryl R; Mendel, Ehud; Laufer, Ilya; Bettegowda, Chetan; Patel, Shreyaskumar R; Rampersaud, Y Raja; Sahgal, Arjun; Reynolds, Jeremy; Chou, Dean; Weber, Michael H; Clarke, Michelle J

    2016-08-01

    Review of the literature. Surgery and cement augmentation procedures are effective palliative treatment of symptomatic spinal metastases. Our objective is to systematically review the literature to describe the survival, prognostic factors, and clinical outcomes of surgery and cement augmentation procedures for breast cancer metastases to the spine. We performed a literature review using PubMed to identify articles that reported outcomes and/or prognostic factors of the breast cancer patient population with spinal metastases treated with any surgical technique since 1990. The median postoperative survival for metastatic breast cancer was 21.7 months (8.2 to 36 months), the mean rate of any pain improvement was 92.9% (76 to 100%), the mean rate of neurologic improvement was 63.8% (53 to 100%), the mean rate of neurologic decline was 4.1% (0 to 8%), and the local tumor control rate was 92.6% (89 to 100%). Kyphoplasty studies reported a high rate of pain control in selected patients. Negative prognostic variables included hormonal (estrogen and progesterone) and human epidermal growth factor receptor 2 (HER2) receptor refractory tumor status, high degree of axillary lymph node involvement, and short disease-free interval (DFI). All other clinical or prognostic parameters were of low or insufficient strength. With respect to clinical outcomes, surgery consistently yielded neurologic improvements in patients presenting with a deficit with a minimal risk of worsening; however, negative prognostic factors associated with shorter survival following surgery include estrogen receptor/progesterone receptor negativity, HER2 negativity, and a short DFI.

  2. 10 kHz High-Frequency Spinal Cord Stimulation for Chronic Axial Low Back Pain in Patients With No History of Spinal Surgery: A Preliminary, Prospective, Open Label and Proof-of-Concept Study.

    Science.gov (United States)

    Al-Kaisy, Adnan; Palmisani, Stefano; Smith, Thomas E; Pang, David; Lam, Khai; Burgoyne, William; Houghton, Russell; Hudson, Emma; Lucas, Jonathan

    2017-01-01

    To explore the effectiveness of 10 kHz high frequency spinal cord stimulation (HF10 therapy) treatment of chronic low back pain in patients who have not had spinal surgery. Patients with chronic low back pain without prior spinal surgery were evaluated by a team of spine surgeons to rule out any spinal pathology amenable to surgical interventions and by a multidisciplinary pain team to confirm eligibility for the study. After a successful (>50% back pain reduction) trial of HF10 therapy, enrolled subjects underwent permanent system implantation and were followed-up one year post-implant. About 95% of the enrolled subjects (20/21) received the permanent system. At 12 months post-implant, both back pain VAS score and ODI were significantly reduced compared with baseline values (by 73% and 48%, respectively); an estimated quality-adjusted life year gain of 0.47 and a reduction in opioid use by 64% was observed. Four more patients among those unable to work at baseline due to back pain were employed at 12 months post-implant. There were no serious adverse events. HF10 therapy may provide significant back pain relief, reduction in disability, improvement quality of life, and reduction in opioid use in chronic low back pain not resulting from spinal surgery. © 2016 The Authors. Neuromodulation: Technology at the Neural Interface published by Wiley Periodicals, Inc. on behalf of International Neuromodulation Society.

  3. COMPARATIVE STUDY OF HEMODYNAMIC STABILITY AND COST EFFECTIVENESS BETWEEN GENERAL AND SPINAL ANAESTHESIA IN PATIENTS AGE GROUP (0-5YEARS IN LOWER ABDOMINAL AND LOWER EXTREMITIES SURGERIES

    Directory of Open Access Journals (Sweden)

    Jaitawat

    2015-12-01

    Full Text Available BACKGROUND AND AIMS Aim of this study was to compare the changes in heart rate, blood pressure, oxygen saturation and cost effectiveness between general anaesthesia and spinal anaesthesia in pediatric patients undergoing lower abdominal and lower limb surgeries for the same duration. MATERIAL AND METHODS Fifty ASA1 patients in age group 0-5 years of either sex undergoing lower abdominal and lower limb surgeries were randomly divided in to two groups (Group-I GA group-n25 and Group-II SA group-n25. Group1 was given general anaesthesia and group-II was given spinal anaesthesia. Haemodynamic parameters and side effects during intra operative and immediate post-operative period were recorded and cost of GA and SA was calculated. RESULTS Patients in both the groups were comparable in surgical procedures and duration of surgery. Haemodynamically children in spinal group (Group-II remained more stable intra operatively and no untoward incidence was observed in group-II. Spinal Anaesthesia was much more cost effective as compared to general anaesthesia. CONCLUSION Pediatric spinal anaesthesia is a safe and effective anaesthetic technique for lower abdominal and lower limb surgeries. It is much more cost effective as compared to general anaesthesia.

  4. Continuation of medically necessary platelet aggregation inhibitors - acetylsalicylic acid and clopidogrel - during surgery for spinal degenerative disorders: Results in 100 patients

    Directory of Open Access Journals (Sweden)

    Reza Akhavan-Sigari

    2014-01-01

    Full Text Available Background: Patients undergoing spinal surgery while under anticoagulation therapy are at risk of developing bleeding complications, even though lower incidences have been reported for joint arthroplasty surgery. There is a gap in the medical literature examining the incidence of postoperative spinal bleeding in patients who were under anticoagulation medication at the time of surgery. Methods: We prospectively followed a consecutive cohort of 100 patients (58 male, 42 female undergoing spinal surgery. The average patient age was 48.7 years and the minimum follow up time was 12 months. Diagnosis was lumbar spinal stenosis in 20, herniated lumbar discs in 63, degenerative cervical disc disease in 3, and cervical disc herniation in 14 cases. In our study, platelet aggregation inhibitors (clopidogrel and/or acetylsalicylic acid were given for the treatment of cardiovascular and cerebrovascular thrombotic events, to reduce risk of stroke in patients who have had transient ischemia of the brain or acute coronary syndrome, and as secondary prevention of atherosclerotic events (fatal or nonfatal myocardial infarction (MI. A cessation of anticoagulants (acetylsalicylic acid or clopidogrel in our patients in the peri- and postoperative period was contraindicated. Results: Sixty-three patients were on both clopidogrel and acetylsalicylic acid and 37 on acetylsalicylic acid only. None of the patients suffered any postoperative bleeding complication. Three patients suffered postoperative wound dehiscence and one patient had an infection that required reoperation. Conclusion: The question of whether preoperative platelet aggregation inhibitors must be stopped before elective spinal surgery has never been answered in the literature. In our prospective series, we have found no increase in the risk of postoperative spinal bleeding with the use of clopidogrel or acetylsalicylic acid. This finding suggests that spine surgery can be done without stopping

  5. Feasibility and potential value of flat-panel detector-based computed tomography in myelography after spinal surgery.

    Science.gov (United States)

    Kau, Thomas; Rabitsch, Egon; Celedin, Stefan; Jeschofnig, Barbara; Illiasch, Herbert; Eicher, Wolfgang; Uhl, Eberhard; Honl, Matthias; Hausegger, Klaus Armin

    2009-01-01

    The purpose of this study was to assess the value of myelography using flat-panel detector-based computed tomography (fpCT) in 5 patients in whom the image quality of multislice CT (MSCT) or MR imaging was limited by metal artifacts. The application of fpCT to myelographic imaging of the lumbar spine and cervicothoracic junction after surgery was feasible. Multiplanar, preferably sagittal, and 3D reconstructions adequately depicted disc space implants and provided high resolution images of osseous structures. The images obtained with fpCT allowed evaluation of anatomical details such as single nerve roots and proved especially valuable in a patient with impaired MR imaging results caused by metal artifacts from an intraoperative abrasion. In a case of recurrent disc herniation, imaging results of myelographic fpCT and MSCT scanning were in good agreement. The novel imaging technique the authors describe yielded adequate results in patients with a history of spinal surgery, may be superior to MSCT scanning in depicting osseous structures and metallic implants, and has the potential to provide multilevel spinal images. Myelographic fpCT scanning may be the preferred modality in patients with expected or known metal artifacts on myelographic MSCT scans and/or MR images.

  6. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study.

    Science.gov (United States)

    Lee, Trevor W R; Kowalski, Stephen; Falk, Kelsey; Maguire, Doug; Freed, Darren H; HayGlass, Kent T

    2016-01-01

    Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery. This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein (CRP, PTX3) and cardiovascular risk (sST2) biomarkers. The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005). This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia. ClinicalTrials.gov NCT00348920.

  7. The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

    Directory of Open Access Journals (Sweden)

    Mazda K Turel

    2017-01-01

    Conclusions: MIS surgery provides an opportunity for early pain relief in patients with discitis, osteomyelitis, spondylodiscitis, and/or epidural abscess by directly addressing the primary cause of pain. MIS surgery for discitis provides a higher diagnostic yield to direct antibiotic treatment. MIS surgery results in good long-term recovery.

  8. SEMAC-VAT MR Imaging Unravels Peri-instrumentation Lesions in Patients With Attendant Symptoms After Spinal Surgery.

    Science.gov (United States)

    Qi, Shun; Wu, Zhi-Gang; Mu, Yun-Feng; Gao, Lang-Lang; Yang, Jian; Zuo, Pan-Li; Nittka, Mathias; Liu, Ying; Wang, Hai-Qiang; Yin, Hong

    2016-04-01

    The study aimed for evaluating the diagnostic value of a 2D Turbo Spin Echo (TSE) magnetic resonance (MR) imaging sequence implanted slice-encoding metal artifact correction (SEMAC) and view-angle tilting (VAT) in patients with spinal instrumentation.Sixty-seven consecutive patients with an average age of 59.7 ± 17.8 years old (range: 32-75 years) were enrolled in this study. Both sagittal, axial T1-weighted and T2-weighted MRI images were acquired with a standard TSE sequence and a high-bandwidth TSE sequence implemented the SEMAC and VAT techniques. Three continuous sections around the instrumentation in axial and sagittal images were selected for quantitative evaluation. The measurement included cumulative areas of signal void on axial images and the length of spinal canal obscuration on sagittal images. Three radiologists independently evaluated all images blindly. The inter-observer reliability was evaluated with inter-class coefficient. We defined patients with discomfortable symptoms caused by spinal instrumentation as spinal instrumentation adverse reaction.Visualizations of all periprosthetic anatomic structures were significantly better for SEMAC-VAT compared with standard imaging. For axial images, the area of signal void at the level of the instrumentation were statistically reduced with SEMAC-VAT TSE sequences than with standard TSE sequences for T2-weighted images (9.9 ± 2.6 cm vs 29.8 ± 14.7 cm, P instrumentation was reduced from 5.2 ± 2.0 cm to 1.2 ± 0.6 cm on T2-weighted images (P instrumentation adverse reaction was 38.81%.MR images with SEMAC-VAT can significantly reduce metal artifacts for spinal instrumentation and improve delineation of the instrumentation and periprosthetic region. Furthermore, SEMAC-VAT technique can improve diagnostic accuracy in patients with post-instrumentation spinal diseases.

  9. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  10. Radiation Therapy without Surgery for Spinal Metastases: Clinical Outcome and Prognostic Factors Analysis for Pain Control.

    Science.gov (United States)

    Matsumura, Akira; Hoshi, Manabu; Takami, Masatsugu; Tashiro, Takahiko; Nakamura, Hiroaki

    2012-09-01

    The purpose of radiation therapy (RT) for patients with spinal metastases is pain relief and control of paralysis. The aim of the present study was to assess pain relief using RT and to evaluate prognostic factors for pain control. We evaluated 97 consecutive patients, of mean age 62.7 years (range 28 to 86), with spinal metastases that had been treated by RT. We evaluated the effects of RT using pain level assessed using a drug grading scale based on the World Health Organization standards. The following potential prognostic factors for pain control of RT were evaluated using multivariate logistic regression analysis: age, gender, tumor type, performance status (PS), number of spinal metastases, and a history of chemotherapy. Among the 97 patients who underwent RT for pain relief, 68 patients (70.1%) presented with pain reduction. PS (odds ratio: 1.931; 95% confidence interval: 1.244 to 2.980) was revealed by multivariate logistic regression analysis to be the most important prognostic factor for pain control using RT. In conclusion, we found that RT was more effective for patients with spinal metastases while they maintained their PS.

  11. Prognostic Factors for Satisfaction After Decompression Surgery for Lumbar Spinal Stenosis

    DEFF Research Database (Denmark)

    Paulsen, Rune Tendal; Bouknaitir, Jamal Bech; Fruensgaard, Søren

    2017-01-01

    BACKGROUND: Surgical treatment for lumbar spinal stenosis is associated with both short- and long-term benefits with improvements in patient function and pain. Even though most patients are satisfied postoperatively, some studies report that up to one-third of patients are dissatisfied. OBJECTIVE...

  12. Spinal Fusion

    Science.gov (United States)

    ... vertebrae. These include: treatment of a fractured (broken) vertebra; correction of deformity (spinal curves or slippages); elimination of pain from painful motion; treatment of instability; and treatment of some cervical disc herniations. One of the less controversial reasons ...

  13. Tethered Spinal Cord Syndrome

    Science.gov (United States)

    ... roots may be cut to relieve pain. In adults, surgery to free (detether) the spinal cord can reduce the size ... is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord ...

  14. Pectus excavatum in children: pulmonary scintigraphy before and after corrective surgery

    Energy Technology Data Exchange (ETDEWEB)

    Blickman, J.G.; Rosen, P.R.; Welch, K.J.; Papanicolaou, N.; Treves, S.T.

    1985-09-01

    Regional distribution of pulmonary function was evaluated preoperatively and postoperatively with xenon-133 perfusion and ventilation scintigraphy in 17 patients with pectus excavatum. Ventilatory preoperative studies were abnormal in 12 of 17 patients, resolving in seven of 12 postoperatively. Perfusion scans were abnormal in ten of 17 patients preoperatively; six of ten showed improvement postoperatively. Ventilation-perfusion ratios were abnormal in ten of 17 patients, normalizing postoperatively in six of ten. Symmetry of ventilation-perfusion ratio images improved in six out of nine in the latter group. The distribution of regional lung function in pectus excavatum can be evaluated preoperatively to support indications for surgery. Postoperative improvement can be documented by physiological changes produced by the surgical correction.

  15. Biomechanical Implications of Corrective Surgery for FAI: An Evidence-based Review.

    Science.gov (United States)

    Sampson, Joshua D; Safran, Marc R

    2015-12-01

    Femoroacetabular impingement (FAI) has been identified as a potential cause of hip osteoarthritis. The goal of FAI surgery is to relieve pain, and hopefully delay or prevent osteoarthritis of the hip. Several studies have now demonstrated favorable clinical outcomes after arthroscopic and open surgical correction of symptomatic FAI. The concept is restoration of normal hip anatomy may result in improved biomechanical function and kinematics of the hip, which may prevent or delay the progression of osteoarthritis. Although many clinical studies demonstrate restoration of "normal" anatomy, there are few studies evaluating improvement of biomechanics and function. To date, only 5 studies have been published in the English literature that study biomechanics and/or kinematics of the hip both preoperatively and postoperatively. At this point in the understanding of FAI, critical analysis of the literature suggests that FAI surgery can improve several parameters of biomechanical hip function. However, the impact of these improved biomechanics on the natural history and progression of degenerative changes in patients that are treated for symptomatic FAI has not been demonstrated.

  16. Perioperative concerns in pediatric patients undergoing different types of scoliosis correction surgery: A retrospective observational study

    Directory of Open Access Journals (Sweden)

    Anjolie Chhabra

    2013-01-01

    Patients and Methods: After taking parental consent, data were collected retrospectively for 33 patients who underwent 37 procedures (four patients had both anterior and posterior procedures on 2 days of the week mainly from August 2008 to February 2010 at a tertiary care institution. Results: Children undergoing GR surgery were younger (8.1 ± 2.1 years than patients undergoing AR (12.9 ± 1.7 years or posterior fusion (14.2 ± 2.2 years. AR children had a significantly higher Cobb′s angle and more rigid curves. (P = 0.057 Associated congenital abnormalities especially neurological were commoner in the GR children. Surgical duration and blood loss was significantly more for PF (2207.5 ± 1224.13 ml than GR (456 ± 337.5 ml, or AR (642.85 ± 304.72 ml, (P = 0.0002. PF patients needed Intensive care unit (ICU care mainly due to the blood loss and prolonged surgery (35%. AR performed via thoracotomy was associated with the need for mechanical ventilation in 28.6%. The GR patients had major intraoperative hemodynamic events and 20% needed ICU care. Conclusions: Post-operative ventilation may be required in 20-35% patients undergoing procedures for scoliosis correction. Despite GR insertion involving lesser blood loss; younger age, congenital abnormalities, positioning, and surgical manipulation resulted in life threatening events in these patients.

  17. Lumbar Lordosis Minus Thoracic Kyphosis: Remain Constant in Adolescent Idiopathic Scoliosis Patients Before and After Correction Surgery.

    Science.gov (United States)

    Yang, Mingyuan; Yang, Changwei; Chen, Ziqiang; Wei, Xianzhao; Chen, Yuanyuan; Zhao, Jian; Shao, Jie; Zhu, Xiaodong; Li, Ming

    2016-03-01

    A retrospective study. To explore the relationship between the change of lumbar lordosis (LL) and thoracic kyphosis (TK) in AIS patients after correction surgery. TK tends to decrease in Lenke 1 and Lenke 2 AIS patients after correction surgery using pedicle screws, with the compensation of LL decrease. We hypothesize that lumbar lordosis minus thoracic kyphosis (LL-TK) remains constant after correction surgery to achieve the sagittal balance in AIS patients. Medical records of Lenke 1 or Lenke 2 AIS patients who received posterior correction surgery using pedicle screws in our hospital from January 2010 to January 2013 were reviewed. General characters of patients and radiological parameters were evaluated before the surgery and at two years' follow-up. Correlation analysis between TK and LL was conducted. LL-TK and the change of LL and TK were analyzed at preoperation and final follow-up. A total of 76 Lenke 1 and Lenke 2 AIS patients were included. Both TK and LL decreased significantly after correction surgery (P = 0.019 and P = 0.040, respectively). There were significant correlations between TK and LL before and after surgery, respectively (preoperative: r = 0.234, P = 0.042; postoperative: r = 0.310, P = 0.006). Preoperative and postoperative LL-TK was 23.80° and 25.09°, respectively, and no significant difference of LL-TK was observed (P = 0.372). The same tendency was observed in the change of LL and TK, and significant correlation was also found between the change of TK and LL (r = 0.626, P = 0.002). The same change of LL and TK and no significant difference in LL-TK indicated that LL-TK might be an important compensatory mechanism in keeping sagittal balance.

  18. Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction.

    Science.gov (United States)

    Vilaça, João L; Rodrigues, Pedro L; Soares, Tony R; Fonseca, Jaime C; Pinho, António C M; Henriques-Coelho, Tiago; Correia-Pinto, Jorge

    2014-06-01

    Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients' sides. It highlighted that the prosthesis bar should be modeled according to each patient's rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.

  19. EVALUATION OF THE EFFECT OF SUFENTANIL AND LIGNOCAINE COMBINATION IN PATIENTS UNDERGOING PERIANAL SURGERIES UNDER SPINAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Kiran

    2016-04-01

    Full Text Available CONTEXT Spinal anaesthesia with hyperbaric lignocaine has the limitation of relatively shorter duration of action, which means that early analgesic intervention is needed in the postoperative period. Intrathecal opioid administration has a promising role in fulfilling this objective. Sufentanil, the congener of fentanyl is 1000 more times potent than morphine is a newer addition to the armoury of modern day anaesthesiologists. AIMS To compare the efficacy of sufentanil and lignocaine combination with lignocaine alone to reduce postoperative pain in patients undergoing perianal under spinal anaesthesia. SETTINGS AND DESIGN A prospective randomized single blinded study conducted after obtaining written informed consent, 100 patients aged above 18 years belonging to ASA Grade I and II scheduled to undergo perianal surgeries under spinal anaesthesia were enrolled in the study. METHODS AND MATERIAL The study population was divided into two groups of 50 each to receive the following treatments: 5% hyperbaric lignocaine 50 mg and 5% hyperbaric lignocaine 50 mg with sufentanil 10 µg. All the drugs were administered intrathecally. All the patients were explained about the Visual Analog Scale (VAS and standardized perioperative and anaesthetic procedures were followed. STATISTICAL ANALYSIS All data analysis was completed using SPSS software. Data were expressed as mean±SD. Quantitative data was analysed using unpaired ‘t’ test. Side effects were compared by Chi-square test. P <0.05 was considered as statistically significant. RESULTS There was no variation with regard to the onset of sensory and motor blockade between the two groups. Significant increase in duration of complete and effective analgesia was observed in sufentanil group and the time for first dose of analgesic postoperatively was also significantly delayed. Pruritus was the most common side effect noted in sufentanil group. CONCLUSION Sufentanil potentiates lignocaine anaesthesia by

  20. Clinical and neuropsychiatric correlates of lumbar spinal surgery in older adults: results of a pilot study.

    Science.gov (United States)

    Karp, Jordan F; McGovern, Jonathan; Marron, Megan M; Gerszten, Peter; Weiner, Debra K; Okonkwo, David; Kanter, Adam S

    2016-11-01

    To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection.

  1. Resolution of low back symptoms after corrective surgery for dropped-head syndrome: a report of two cases.

    Science.gov (United States)

    Koda, Masao; Furuya, Takeo; Inada, Taigo; Kamiya, Koshiro; Ota, Mitsutoshi; Maki, Satoshi; Ikeda, Osamu; Aramomi, Masaaki; Takahashi, Kazuhisa; Yamazaki, Masashi; Mannoji, Chikato

    2015-10-07

    Cervical deformity can influence global sagittal balance. We report two cases of severe low back pain and lower extremity radicular pain associated with dropped-head syndrome. Symptoms were relieved by cervical corrective surgery. Two Japanese women with dropped head syndrome complained of severe low back pain and lower extremity radicular pain on walking. Radiographs showed marked cervical spine kyphosis and lumbar spine hyperlordosis. After cervicothoracic posterior corrective fusion was performed, cervical kyphosis was corrected and lumbar lordosis decreased, and low back pain and leg pain were relieved in both patients. Cervical deformity can influence global sagittal balance. Marked cervical kyphosis in patients with dropped-head syndrome can induce compensatory thoracolumbar hyperlordosis. Low back symptoms in patients with dropped-head syndrome are attributable to this compensatory lumbar hyperlordosis. Symptoms of lumbar canal stenosis may result from cervical deformity and can be improved with cervical corrective surgery.

  2. Old method, new drugs: comparison of the efficacy of sevoflurane, isoflurane, and desflurane in achieving controlled hypotension in spinal surgery.

    Science.gov (United States)

    Kurt, Filiz; Derbent, Abdurrahim; Demirag, Kubilay; Eris, Oguz; Uyar, Mehmet; Islekel, Sertac

    2005-01-01

    This study compared the efficacy of isoflurane, sevoflurane, and desflurane in achieving hemodynamic stability in spinal procedures using moderate levels of controlled hypotension. After obtaining ethics committee approval and written informed consent, 32 American Surgical Association I-II patients were randomly allocated to receive isoflurane (n=12), sevoflurane (n=10), or desflurane (n=10) in O2-N2O (1:1) for maintenance of anesthesia. The induction of anesthesia, fentanyl dosage, and initial and maintenance volume replacements were standardized. Blood pressure was invasively monitored and maintained within a target systolic blood pressure (SBP) range of 80 to 90 mm Hg during the study. SBP outside this range was recorded. Volatile anesthetic concentration was adjusted according to the same protocol for all 3 agents. SPB control was maintained better with sevoflurane and isoflurane than desflurane; median SBP was outside the target range during 32% (range, 15%-55%) of study time with isoflurane, 26% (12%-42%) with sevoflurane, and 44% (20%-80%) with desflurane. Total blood loss did not differ among the groups. Sevoflurane and isoflurane administered in 2 L/min fresh gas flow were more effective than desflurane in achieving controlled hypotension in spinal surgery.

  3. Minimally invasive spine surgery in spinal infections. An up-date.

    Science.gov (United States)

    Verdú López, Francisco; Vanaclocha Vanaclocha, Vicente; Mayorga-Villa, Juan D

    2016-10-27

    Although spinal infections have always been present recently their incidence has increased, in partly fostered by the advances in medicine (i.e. compromised 10 immunity, chronic diseases, increasingly complex spinal procedures...) and increased life expectancy. Using PubMed for this systematic review, the main spine infections types will be addressed focusing in the minimally invasive surgical techniques that can be used in their treatment. Spontaneous and iatrogenic pyogenic and non-pyogenic spine infections can be treated in many different ways depending on their extension and 15 location as well as on their causative microorganisms. The indications of percutaneous image-guided, endoscopic and microsurgical treatment techniques will be updated. In spine infections minimally invasive surgical techniques show a great potential as to be safe, effective, with low surgical morbidity and fast patients' recovery.

  4. Do we need to establish guidelines for patients with neuromodulation implantable devices, including spinal cord stimulators undergoing nonspinal surgeries?

    Directory of Open Access Journals (Sweden)

    Ramsis F Ghaly

    2016-01-01

    Full Text Available Background: Spinal cord stimulation is currently approved to treat chronic intractable pain of the trunk and limbs. However, such implantable electronic devices are vulnerable to external electrical currents and magnetic fields. Within the hospitals and modern operating rooms (ORs, there is an abundance of electrical devices and other types of equipment that could interfere with such devices. Despite the increasing number of patients with neuromodulation implantable devices, there are no written guidelines available or consensus of cautions for such patients undergoing unrelated surgery. Case Descriptions: A 60-year-old female with a permanent St. Jude′s spinal cord stimulator (SCS presented for open total abdominal hysterectomy. Both the anesthesia and gynecology staffs were aware of the device presence, but were unaware of any precautions regarding intraoperative management. The device was found to be nonmagnetic resonance imaging compatible, and bipolar cautery was used instead of monopolar cautery. A 59-year-old female with a 9-year-old permanent Medtronic SCS, presented for right total hip arthroplasty. The device was switched off prior to entering the OR, bipolar cautery was used, and grounding pads were placed away from her battery site. In each case, the manufacturer′s representative was contacted preoperative. Both surgeries proceeded uneventfully. Conclusions: The Food and Drug Administration safety information manual warns about the use of diathermy, concomitant implanted stimulation devices, lithotripsy, external defibrillation, radiation therapy, ultrasonic scanning, and high-output ultrasound, all of which can lead to permanent implant damage if not turned off prior to undertaking procedures. Lack of uniform guidelines makes intraoperative management, as well as remote anesthesia care of patients with previously implanted SCSs unsafe.

  5. MR imaging of compressive cervical myelopathy after surgery; High signal intensity of the spinal cord on T2 weighted images

    Energy Technology Data Exchange (ETDEWEB)

    Mimura, Fumitoshi; Fujiwara, Kazuhisa; Otake, Shoichiro (Tenri Hospital, Nara (Japan)) (and others)

    1990-06-01

    We reviewed the MR images of 32 patients with cervical myelopathy, showing lesions of high signal intensity in the spinal cord on the sagittal T2 weighted images (T2WI) after surgery: 16 with ossification of posterior longitudinal ligament (OPLL); 9 with spondylosis; 4 with disc herniation and 3 with trauma. All images were obtained on a superconducting 1.5 Tesla system. The lesions were classified into five groups, according to the shape and grade of signal intensity on the sagittal T2WI: (I) oval-shaped lesion of signal intensity less brighter than CSF with blurred margin, (II) longitudinal linear-shaped lesion of signal intensity similar to CSF, (III) spindle-shaped lesion of signal intensity similar to CSF, (IV) round-shaped lesion of signal intensity similar to CSF, and (V) mixed-types lesions which consisted of group I and II. The present study was summarized as follows: Oval-shaped lesions were seen in the cases of disc herniation and spondylosis with relatively short duration of the symptom, presumptively with relatively short duration of the symptom, presumptively indicative of edema. Most cases of OPLL and spondylosis showed linear-shaped lesions, suggesting necrosis and/or cavitations of the central gray matter. One case of spondylosis developed a spindle-shaped lesion, implicating syringomyelia. Round-shaped lesions were seen in the cases of spinal trauma, suggesting postraumatic cyst. In a case of mixed-typed lesion examined pre- and postoperatively, only an oval-shaped lesion decreased in size after surgery. (author).

  6. DEXAMETHASONE PROPHYLAXIS ON INCIDENCES OF POST-OPERATIVE NAUSEA AND VOMITING (PONV IN PATIENTS UNDERGOING GYNECOLOGICAL SURGERIES UNDER SPINAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Chandrashekharappa

    2014-05-01

    Full Text Available BACK GROUND: Nausea and vomiting are the most common distressing symptom in the post-operative period. It can result in delayed hospital discharge and increased hospital cost. The present study was done to assess the effect of dexamethasone prophylaxis on the incidences of nausea and vomiting in post-operative period in patients undergoing gynecological surgeries. MATERIAL AND METHODS: A total number of 66 patients, aged between 20 to 65 years, posted for elective gynecological surgeries under spinal anesthesia were included in the study. Patients were randomized into two groups of 33 patients each, and the study group (group-D received Inj. Dexamethasone 8 mg intravenously as prophylactic antiemetic 1 hour before surgery whereas control group (group-N received normal saline. Post-operatively, the frequency of nausea and vomiting were observed and its influences on postoperative analgesia were also noted. RESULTS: In our study, 4(12.1% patients in group-D and 8(24.2% patients in group-N had nausea and vomiting in the intraoperative period (p value=0.202. 24.2% patients in group-D had vomiting in the postoperative period as compared to 72.7% in group-N and group D patients had significant reduction in incidences of nausea and vomiting in immediate post-operative period compared to group N (p-value 0.016. Accordingly, the mean requirement of rescue antiemetic was less in group- D compared to Group-N. Further, patients in group-D had better VAS scores compared to patients in group-N in post-operative period. CONCLUSION: Use of Dexamethasone prior to subarachnoid block in patients undergoing gynecological surgeries reduces the incidence of nausea and vomiting and the requirement of antiemetic in the postoperative period, and better post-operative analgesia.

  7. Minimally invasive surgery for benign intradural extramedullary spinal meningiomas: experience of a single institution in a cohort of elderly patients and review of the literature

    Directory of Open Access Journals (Sweden)

    Iacoangeli M

    2012-12-01

    Full Text Available Maurizio Iacoangeli, Maurizio Gladi, Alessandro Di Rienzo, Mauro Dobran, Lorenzo Alvaro, Niccolò Nocchi, Lucia Giovanna Maria Di Somma, Roberto Colasanti, Massimo ScerratiDepartment of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, ItalyAbstract: Meningiomas of the spine are the most common benign intradural extramedullary lesions and account for 25%–46% of all spinal cord tumors in adults. The goal of treatment is complete surgical resection while preserving spinal stability. Usually, these lesions occur in the thoracic region and in middle-aged women. Clinical presentation is usually nonspecific and the symptoms could precede the diagnosis by several months to years, especially in older people, in whom associated age-related diseases can mask the tumor for a long time. We report a series of 30 patients, aged 70 years or more, harboring intradural extramedullary spinal meningiomas. No subjects had major contraindications to surgery. A minimally invasive approach (hemilaminectomy and preservation of the outer dural layer was used to remove the tumor, while preserving spinal stability and improving the watertight dural closure. We retrospectively compared the outcomes in these patients with those in a control group subjected to laminectomy or laminotomy with different dural management. In our experience, the minimally invasive approach allows the same chances of complete tumor removal, while providing a better postoperative course than in a control group.Keywords: spinal meningioma, elderly, hemilaminectomy, outer dural layer, inner dural layer, minimally invasive surgery

  8. Timing and prognosis of surgery for spinal epidural abscess: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Conclusion: The vast majority of studies advocated early surgery to achieve better outcomes for treating SEA; this avoids high failure rates (41-42.5% for nonoperative therapy, and limits morbidity/mortality rates.

  9. Physical Therapy and Surgery

    Science.gov (United States)

    Valle-Onate, Rafael; Ward, Michael M.; Kerr, Gail S.

    2012-01-01

    Physical therapy and orthopedic surgery are important components in the treatment of ankylosing spondylitis (AS). Supervised physical therapy is more effective that individual or unsupervised exercise in improving symptoms, but controlled trials suggest than combined inpatient and outpatient therapy provides the greatest improvement. Recommendations for exercise are universal, but the best types and sequence of therapies are not known. Total hip replacement is the surgery most commonly performed for AS, with good long-term implant survival. Heterotopic ossification may occur no more frequently after hip replacement in patients with AS than in patients with other diseases. Corrective spinal surgery is rarely performed and requires specialized centers and experienced surgeons. PMID:22543536

  10. Seasonal Variations in the Risk of Reoperation for Surgical Site Infection Following Elective Spinal Fusion Surgery: A Retrospective Study Using the Japanese Diagnosis Procedure Combination Database.

    Science.gov (United States)

    Ohya, Junichi; Chikuda, Hirotaka; Oichi, Takeshi; Kato, So; Matsui, Hiroki; Horiguchi, Hiromasa; Tanaka, Sakae; Yasunaga, Hideo

    2017-07-15

    A retrospective study of data abstracted from the Diagnosis Procedure Combination (DPC) database, a national representative database in Japan. The aim of this study was to examine seasonal variations in the risk of reoperation for surgical site infection (SSI) following spinal fusion surgery. Although higher rates of infection in the summer than in other seasons were thought to be caused by increasing inexperience of new staff, high temperature, and high humidity, no studies have examined seasonal variations in the risk of SSI following spinal fusion surgery in the country where medical staff rotation timing is not in summer season. In Japan, medical staff rotation starts in April. We retrospectively extracted the data of patients who were admitted between July 2010 and March 2013 from the DPC database. Patients were included if they were aged 20 years or older and underwent elective spinal fusion surgery. The primary outcome was reoperation for SSI during hospitalization. We performed multivariate analysis to clarify the risk factors of primary outcome with adjustment for patient background characteristics. We identified 47,252 eligible patients (23,659 male, 23,593 female). The mean age of the patients was 65.4 years (range, 20-101 yrs). Overall, reoperation for SSI occurred in 0.93% of the patients during hospitalization. The risk of reoperation for SSI was significantly higher in April (vs. February; odds ratio, 1.93; 95% confidence interval, 1.09-3.43, P = 0.03) as well as other known risk factors. In subgroup analysis with stratification for type of hospital, month of surgery was identified as an independent risk factor of reoperation for SSI among cases in an academic hospital, although there was no seasonal variation among those in a nonacademic hospital. This study showed that month of surgery is a risk factor of reoperation for SSI following elective spinal fusion surgery, nevertheless, in the country where medical staff rotation timing is not in

  11. Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Karhade, Aditya V; Vasudeva, Viren S; Dasenbrock, Hormuzdiyar H; Lu, Yi; Gormley, William B; Groff, Michael W; Chi, John H; Smith, Timothy R

    2016-08-01

    OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011-2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12-23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8-20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4-5 designation. Major complications occurred in 14.4% of patients: the

  12. Surgery

    Science.gov (United States)

    ... days or even weeks after the surgical procedure. Spinal anesthesia and epidural anesthesia are specific types of regional ... childbirth. Headaches occasionally develop in the days after spinal anesthesia but usually can be treated effectively. General anesthesia ...

  13. Repair of diaphragmatic hernia following spinal surgery by laparoscopic mesh application: a case report and review of the literature.

    Science.gov (United States)

    Bini, Roberto; Fontana, Diego; Longo, Alessandro; Manconi, Paolo; Leli, Renzo

    2014-01-01

    We describe the laparoscopic management of diaphragmatic hernia (DH) caused by vertebral pedicle screw displacement. A 58-year-old woman underwent surgery for scoliosis and underwent posterior pedicle screw fixation. In the first postoperative (PO)day, she developed mild dyspnea. An anteroposterior chest radiograph revealed bilateral pleural effusion, which was more pronounced on the left side. A thoracoabdominal computed tomography (CT) scan, performed in the second PO day, revealed a solid mass in the pleural cavity that was associated with screw displacement, which had also entered into the peritoneal cavity without apparent other lesion of hollow and solid viscous. In the third PO day, after the screw was removed, explorative laparoscopy was carried out. We observed herniation of the omentum through a small diaphragmatic tear. Once the absence of visceral injury was confirmed, we reduced the omentum into the abdomen. Then, we repaired the hernia by applying a dual layer polypropylene mesh over the defect with a 3-cm overlap. The remainder of the postoperative period was uneventful. Iatrogenic DH due to a pedicle screw displacement has never been described before. In cases of pleural effusion following spinal surgery, rapid assessment and treatment are crucial. We conclude that a laparoscopic approach to iatrogenic DH could be feasible and effective in a hemodynamically stable patient with negative CT findings because it enables the completion of the diagnostic cascade and the repair of the tear, providing excellent visualization of the abdominal viscera and diaphragmatic tears.

  14. Incidental durotomy during spinal surgery: a multivariate analysis for risk factors.

    Science.gov (United States)

    Du, Jerry Y; Aichmair, Alexander; Kueper, Janina; Lam, Cyrena; Nguyen, Joseph T; Cammisa, Frank P; Lebl, Darren R

    2014-10-15

    Multivariate analysis. The purpose of this study was to investigate risk factors for incidental durotomy (ID) in modern spine surgery techniques. ID, a relatively common complication of spine surgery, has been associated with postoperative complications such as durocutaneous fistulas, pseudomeningoceles, and arachnoiditis. Revision surgery may be necessary if the dural tear is not recognized and repaired during the initial procedure. ID was prospectively documented in patients who underwent spine surgery at a single institution during a 2-year period (n=4822). Patients with ID (n=182) from lumbar or thoracolumbar cases were matched 1:1 to a control cohort without ID. Demographic, diagnostic, and surgical procedure data were retrospectively collected and analyzed. Multivariate analysis identified revision spine surgery (adjusted odds ratio [aOR]: 4.78, 95% confidence interval [CI]: 2.84-8.06, P<0.01), laminectomy (aOR: 3.82, 95% CI: 2.02-7.22, P<0.01), and older age (aOR: 1.03, 95% CI: 1.01-1.04, P<0.01) as independent risk factors for ID. Fusion (aOR: 0.59, 95% CI: 0.35-0.99, P=0.04), foraminectomy, (aOR: 0.42, 95% CI: 0.25-0.69, P<0.01), and lateral approach (aOR: 0.29, 95% CI: 0.14-0.61, P<0.01) were independent protective factors. Prior spine surgery, laminectomy, and older age were significant independent risk factors for ID. The recently developed lateral approach to interbody fusion was identified as a significant protective factor for ID, along with fusion and foraminectomy. These findings may help guide future surgical decisions regarding ID and aid in the patient informed-consent process. 3.

  15. Early Outcomes of Minimally Invasive Anterior Longitudinal Ligament Release for Correction of Sagittal Imbalance in Patients with Adult Spinal Deformity

    Directory of Open Access Journals (Sweden)

    Armen R. Deukmedjian

    2012-01-01

    Full Text Available The object of this study was to evaluate a novel surgical technique in the treatment of adult degenerative scoliosis and present our early experience with the minimally invasive lateral approach for anterior longitudinal ligament release to provide lumbar lordosis and examine its impact on sagittal balance. Methods. All patients with adult spinal deformity (ASD treated with the minimally invasive lateral retroperitoneal transpsoas interbody fusion (MIS LIF for release of the anterior longitudinal ligament were examined. Patient demographics, clinical data, spinopelvic parameters, and outcome measures were recorded. Results. Seven patients underwent release of the anterior longitudinal ligament (ALR to improve sagittal imbalance. All cases were split into anterior and posterior stages, with mean estimated blood loss of 125 cc and 530 cc, respectively. Average hospital stay was 8.3 days, and mean follow-up time was 9.1 months. Comparing pre- and postoperative 36′′ standing X-rays, the authors discovered a mean increase in global lumbar lordosis of 24 degrees, increase in segmental lumbar lordosis of 17 degrees per level of ALL released, decrease in pelvic tilt of 7 degrees, and decrease in sagittal vertical axis of 4.9 cm. At the last followup, there was a mean improvement in VAS and ODI scores of 26.2% and 18.3%. Conclusions. In the authors’ early experience, release of the anterior longitudinal ligament using the minimally invasive lateral retroperitoneal transpsoas approach may be a feasible alternative in correcting sagittal deformity.

  16. Operative costs, reasons for operative waste, and vendor credit replacement in spinal surgery.

    Science.gov (United States)

    Epstein, Nancy E; Roberts, Rita; Collins, John

    2015-01-01

    In 2012, Epstein et al. documented that educating spinal surgeons reduced the cost of operative waste (explanted devices: placed but removed prior to closure) occurring during anterior cervical diskectomy/fusion from 20% to 5.8%.[5] This prompted the development of a two-pronged spine surgeon-education program (2012-2014) aimed at decreasing operative costs for waste, and reducing the nine reasons for operative waste. The spine surgeon-education program involved posting the data for operative costs of waste and the nine reasons for operative waste over the neurosurgery/orthopedic scrub sinks every quarter. These data were compared for 2012 (latter 10 months), 2013 (12 months), and 2014 (first 9 months) (e.g. data were normalized). Savings from a 2013 Vendor Credit Replacement program were also calculated. From 2012 to 2013 and 2014, spinal operative costs for waste were, respectively reduced by 64.7% and 61% for orthopedics, and 49.4% and 45.2% for neurosurgery. Although reduced by the program, the major reason for operative waste for all 3 years remained surgeon-related factors (e.g. 159.6, to 67, and 96, respectively). Alternatively, the eight other reasons for operative waste were reduced from 68.4 (2012) to 12 (2013) and finally to zero by 2014. Additionally, the Vendor Replacement program for 2013 netted $78,564. The spine surgeon-education program reduced the costs/reasons for operative waste for 2012 to lower levels by 2013 and 2014. Although the major cost/reasons for operative waste were attributed to surgeon-related factors, these declined while the other eight reasons for operative waste were reduced to zero by 2014.

  17. Operative costs, reasons for operative waste, and vendor credit replacement in spinal surgery

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: In 2012, Epstein et al. documented that educating spinal surgeons reduced the cost of operative waste (explanted devices: placed but removed prior to closure occurring during anterior cervical diskectomy/fusion from 20% to 5.8%. [5] This prompted the development of a two-pronged spine surgeon-education program (2012-2014 aimed at decreasing operative costs for waste, and reducing the nine reasons for operative waste. Methods: The spine surgeon-education program involved posting the data for operative costs of waste and the nine reasons for operative waste over the neurosurgery/orthopedic scrub sinks every quarter. These data were compared for 2012 (latter 10 months, 2013 (12 months, and 2014 (first 9 months (e.g. data were normalized. Savings from a 2013 Vendor Credit Replacement program were also calculated. Results: From 2012 to 2013 and 2014, spinal operative costs for waste were, respectively reduced by 64.7% and 61% for orthopedics, and 49.4% and 45.2% for neurosurgery. Although reduced by the program, the major reason for operative waste for all 3 years remained surgeon-related factors (e.g. 159.6, to 67, and 96, respectively. Alternatively, the eight other reasons for operative waste were reduced from 68.4 (2012 to 12 (2013 and finally to zero by 2014. Additionally, the Vendor Replacement program for 2013 netted $78,564. Conclusions: The spine surgeon-education program reduced the costs/reasons for operative waste for 2012 to lower levels by 2013 and 2014. Although the major cost/reasons for operative waste were attributed to surgeon-related factors, these declined while the other eight reasons for operative waste were reduced to zero by 2014.

  18. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery.

    Science.gov (United States)

    Shen, Yang; Drum, Melinda; Roth, Steven

    2009-11-01

    Perioperative visual loss (POVL) accompanying nonocular surgery is a rare and potentially devastating complication but its frequency in commonly performed inpatient surgery is not well defined. We used the Nationwide Inpatient Sample to estimate the rate of POVL in the United States among the eight most common nonocular surgeries. More than 5.6 million patients in the Nationwide Inpatient Sample who underwent principal procedures of knee arthroplasty, cholecystectomy, hip/femur surgical treatment, spinal fusion, appendectomy, colorectal resection, laminectomy without fusion, coronary artery bypass grafting, and cardiac valve procedures from 1996 to 2005 were included. Rates of POVL, defined as any discharge with an International Classification of Diseases, Ninth Revision, Clinical Modification code of ischemic optic neuropathy (ION), cortical blindness (CB), or retinal vascular occlusion (RVO), were estimated. Potential risk factors were assessed by univariate and multivariable analyses. Cardiac and spinal fusion surgery had the highest rates of POVL. The national estimate in cardiac surgery was 8.64/10,000 and 3.09/10,000 in spinal fusion. By contrast, POVL after appendectomy was 0.12/10,000. Those undergoing cardiac surgery, spinal fusion, and orthopedic surgery had a significantly increased risk of developing ION, RVO, or CB. Patients younger than 18 yr had the highest risk for POVL, because of higher risk for CB, whereas those older than 50 yr were at greater risk of developing ION and RVO. Other significant positive predictors for some diagnoses of POVL were male gender, Charlson comorbidity index, anemia, and blood transfusion. There was no increased risk associated with hospital surgical volume. During the 10 yr from 1996 to 2005, there was an overall decrease in POVL in the procedures we studied. The results confirm the clinical suspicion that the risk of POVL is higher in cardiac and spine fusion surgery and show for the first time a higher risk of this

  19. Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery.

    Science.gov (United States)

    Smith, Justin S; Klineberg, Eric; Lafage, Virginie; Shaffrey, Christopher I; Schwab, Frank; Lafage, Renaud; Hostin, Richard; Mundis, Gregory M; Errico, Thomas J; Kim, Han Jo; Protopsaltis, Themistocles S; Hamilton, D Kojo; Scheer, Justin K; Soroceanu, Alex; Kelly, Michael P; Line, Breton; Gupta, Munish; Deviren, Vedat; Hart, Robert; Burton, Douglas C; Bess, Shay; Ames, Christopher P

    2016-07-01

    OBJECTIVE Although multiple reports have documented significant benefit from surgical treatment of adult spinal deformity (ASD), these procedures can have high complication rates. Previously reported complications rates associated with ASD surgery are limited by retrospective design, single-surgeon or single-center cohorts, lack of rigorous data on complications, and/or limited follow-up. Accurate definition of complications associated with ASD surgery is important and may serve as a resource for patient counseling and efforts to improve the safety of patient care. The authors conducted a study to prospectively assess the rates of complications associated with ASD surgery with a minimum 2-year follow-up based on a multicenter study design that incorporated standardized data-collection forms, on-site study coordinators, and regular auditing of data to help ensure complete and accurate reporting of complications. In addition, they report age stratification of complication rates and provide a general assessment of factors that may be associated with the occurrence of complications. METHODS As part of a prospective, multicenter ASD database, standardized forms were used to collect data on surgery-related complications. On-site coordinators and central auditing helped ensure complete capture of complication data. Inclusion criteria were age older than 18 years, ASD, and plan for operative treatment. Complications were classified as perioperative (within 6 weeks of surgery) or delayed (between 6 weeks after surgery and time of last follow-up), and as minor or major. The primary focus for analyses was on patients who reached a minimum follow-up of 2 years. RESULTS Of 346 patients who met the inclusion criteria, 291 (84%) had a minimum 2-year follow-up (mean 2.1 years); their mean age was 56.2 years. The vast majority (99%) had treatment including a posterior procedure, 25% had an anterior procedure, and 19% had a 3-column osteotomy. At least 1 revision was required in 82

  20. Analysis on Surgery Treatment of 10 Cases of Spinal Cord Injury%10例脊髓损伤的手术处理分析

    Institute of Scientific and Technical Information of China (English)

    刘志刚

    2014-01-01

    Objective Clinical effect of surgery of spinal cord injury is to be investigated. Methods The data of clinical surgery of 10 cases of patients with spinal cord injury were selected for analysis. Results There are 6 cases in which the function of the nerve is recovered completely. There are 3 cases which have recovered to Grade D can basical y take care of themselves. In addition, there is 1 case with increasing the lower limb myo-tensity. The pathology is positive with muscle strength of Grade II~IV. Conclusion The stability of the spine should be restored and kept in order to avoid another injury of spinal cord. With complete decompression, the spinal cord pressure wil be discarded.%目的:探讨脊髓损伤外科手术方法的临床效果。方法对10例脊髓损伤患者的临床手术资料进行分析。结果6个神经功能完全恢复,3例恢复D级,生活基本自理,1例双下肢肌张力增加,病理征阳性,肌力II~IV级。结论恢复并保持脊柱的稳定性,防止脊髓再损伤,充分减压,解除脊髓压迫。

  1. Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Ai-Min Wu

    Full Text Available BACKGROUND: Dynamic interspinous spacers, such as X-stop, Coflex, DIAM, and Aperius, are widely used for the treatment of lumbar spinal stenosis. However, controversy remains as to whether dynamic interspinous spacer use is superior to traditional decompressive surgery. METHODS: Medline, Embase, Cochrane Library, and the Cochrane Controlled Trials Register were searched during August 2013. A track search was performed on February 27, 2014. Study was included in this review if it was: (1 a randomized controlled trial (RCT or non-randomized prospective comparison study, (2 comparing the clinical outcomes for interspinous spacer use versus traditional decompressive surgery, (3 in a minimum of 30 patients, (4 with a follow-up duration of at least 12 months. RESULTS: Two RCTs and three non-randomized prospective studies were included, with 204 patients in the interspinous spacer (IS group and 217 patients in the traditional decompressive surgery (TDS group. Pooled analysis showed no significant difference between the IS and TDS groups for low back pain (WMD: 1.2; 95% CI: -10.12, 12.53; P = 0.03; I2 = 66%, leg pain (WMD: 7.12; 95% CI: -3.88, 18.12; P = 0.02; I2 = 70%, ODI (WMD: 6.88; 95% CI: -14.92, 28.68; P = 0.03; I2 = 79%, RDQ (WMD: -1.30, 95% CI: -3.07, 0.47; P = 0.00; I2 = 0%, or complications (RR: 1.39; 95% CI: 0.61, 3.14; P = 0.23; I2 = 28%. The TDS group had a significantly lower incidence of reoperation (RR: 3.34; 95% CI: 1.77, 6.31; P = 0.60; I2 = 0%. CONCLUSION: Although patients may obtain some benefits from interspinous spacers implanted through a minimally invasive technique, interspinous spacer use is associated with a higher incidence of reoperation and higher cost. The indications, risks, and benefits of using an interspinous process device should be carefully considered before surgery.

  2. Amount of Torque and Duration of Stretching Affects Correction of Knee Contracture in a Rat Model of Spinal Cord Injury

    National Research Council Canada - National Science Library

    Moriyama, Hideki; Tobimatsu, Yoshiko; Ozawa, Junya; Kito, Nobuhiro; Tanaka, Ryo

    2013-01-01

    ... impressions.Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short...

  3. A comparison of thoracic spinal anesthesia with low-dose isobaric and low-dose hyperbaric bupivacaine for orthopedic surgery: A randomized controlled trial

    Science.gov (United States)

    Imbelloni, Luiz Eduardo; Gouveia, Marildo A.

    2014-01-01

    Background: The thoracic spinal anesthesia was first described in 1909 and recently revised for various surgical procedures. This is a prospective study aims to evaluate the parameters of the thoracic spinal anesthesia (latency, motor block and paresthesia), the incidence of cardiovascular changes and complications comparing low doses of isobaric and hyperbaric bupivacaine. Materials and Methods: A total of 200 orthopedic patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T9-T10, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with 0.5% bupivacaine isobaric or hyperbaric. Patients remained in cephalad or head down position 10-20° for 10 minutes. We evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia, bradycardia, hypotension, anesthesia success and neurological complications. Results: All patients developed spinal and there was no failure. The solution did not affect the onset of the blockade. The duration of motor block was greater than the sensitive with isobaric. The duration of sensory block was greater than the motor block with hyperbaric solution. The incidence of paresthesia was 4%, with no difference between the needles. The incidence of hypotension was 12.5% with no difference between the solutions. There was no neurological damage in all patients. Conclusion: The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery PMID:25886099

  4. Correction.

    Science.gov (United States)

    2016-04-01

    Sukcharanjit S, Tan AS, Loo AV, Chan XL, Wang CY. The effect of a forced-air warming blanket on patients’ end-tidal and transcutaneous carbon dioxide partial pressures during eye surgery under local anaesthesia: a single-blind, randomised controlled trial. Anaesthesia 2015; 70: 1390–4. In the article [1] by Sukcharanjit et al., data in the ‘Systolic blood pressure; mmHg’ row in Table 1 is listed incorrectly. It should be: 158.0 (14.3) in the Forced air warmer column and 160.9 (15.6) in the Heated Overblanket column.

  5. Comparison of harmonic blade versus traditional approach in canine patients undergoing spinal decompressive surgery for naturally occurring thoracolumbar disk extrusion

    Science.gov (United States)

    Hettlich, Bianca F.; Cook, Laurie; London, Cheryl; Fosgate, Geoffrey T.

    2017-01-01

    Objectives To assess feasibility of the harmonic Osteovue blade (HOB) for use in the soft tissue approach for dogs undergoing hemilaminectomy and to compare outcomes between dogs undergoing HOB or traditional approach (TRAD). Methods A prospective randomized clinical trial was performed using 20 client-owned dogs with thoracolumbar intervertebral disk extrusion requiring hemilaminectomy. Dogs were randomly assigned to HOB or TRAD. Neurologic function and pain scores were assessed pre-operatively. Intraoperative blood loss and surgical approach time as well as postoperative pain and wound healing scores were recorded. Additionally, neurologic recovery and owner perceived quality of life were recorded at day 10 and 30 postoperative. Results There was no significant difference in sex distribution, weight, age, preoperative neurological grade and pain score, and perioperative outcome measures between groups. Intraoperative total blood loss was minimal for HOB and TRAD (median: 0 ml (range 0–9) and 2.2 ml (range 0–6.8), respectively; p = 0.165) and approach times were similar (median: 7 min (range 5–12) and 8 min (range 5–13), respectively; p = 0.315). While changes in wound healing scores were similar, changes in postoperative pain scores and neurological function were significantly improved in the HOB compared to the TRAD group. Postoperative complications in the HOB group consisted of automutilation of part of the incision and development of a small soft, non-painful subcutaneous swelling in 1 dog each. Conclusions The HOB is a safe and effective tool for the soft tissue approach for routine spinal surgery in dogs and is associated with decreased pain and increased neurological function post-surgery. PMID:28253289

  6. Patient are satisfied one year after decompression surgery for lumbar spinal stenosis

    DEFF Research Database (Denmark)

    Tendal Paulsen, Rune; Bouknaitir, Jamal Bech; Fruensgaard, Søren

    2016-01-01

    INTRODUCTION: Lumbar spinal stenosis (LSS) is a clinical syndrome of buttock or lower extremity pain, which may occur with or without back pain. The syndrome is associated with diminished space available for the neural and vascular elements in the lumbar spine. LSS is typically seen in elderly...... without fusion. Data were obtained from the DaneSpine register and collected pre- and post-operatively after a minimum interval of one year. The outcome measures were Oswestry Disability Index (ODI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS), 36-Short Form Mental Component Summary...... (MCS), 36-Short Form Physical Component Summary (PCS) and self-reported walking distance. RESULTS: Of 3,420 cases enrolled, 2,591 (75%) had complete data after a minimum interval of one year. The mean ODI scores were 39.8 and improved to 24. The mean EQ-5D score was 0.40 and improved to 0.66. The mean...

  7. Design and calibration of a six-axis MEMS sensor array for use in scoliosis correction surgery

    Science.gov (United States)

    Benfield, David; Yue, Shichao; Lou, Edmond; Moussa, Walied A.

    2014-08-01

    A six-axis sensor array has been developed to quantify the 3D force and moment loads applied in scoliosis correction surgery. Initially this device was developed to be applied during scoliosis correction surgery and augmented onto existing surgical instrumentation, however, use as a general load sensor is also feasible. The development has included the design, microfabrication, deployment and calibration of a sensor array. The sensor array consists of four membrane devices, each containing piezoresistive sensing elements, generating a total of 16 differential voltage outputs. The calibration procedure has made use of a custom built load application frame, which allows quantified forces and moments to be applied and compared to the outputs from the sensor array. Linear or non-linear calibration equations are generated to convert the voltage outputs from the sensor array back into 3D force and moment information for display or analysis.

  8. Vertebral column decancellation: a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis.

    Science.gov (United States)

    Zhang, X; Zhang, Z; Wang, J; Lu, M; Hu, W; Wang, Y; Wang, Y

    2016-05-01

    correction mechanism is that it achieved a satisfactory correction by controlled anterior column opening and posterior column closing, avoiding the occurrence of sagittal translation. Cite this article: Bone Joint J 2016;98-B:672-8. ©2016 The British Editorial Society of Bone & Joint Surgery.

  9. Resolution of low back symptoms after corrective surgery for dropped-head syndrome: a report of two cases

    OpenAIRE

    Koda, Masao; Furuya, Takeo; Inada, Taigo; Kamiya, Koshiro; Ota, Mitsutoshi; MAKI, Satoshi; Ikeda, Osamu; Aramomi, Masaaki; Takahashi, Kazuhisa; Yamazaki, Masashi; Mannoji, Chikato

    2015-01-01

    Background Cervical deformity can influence global sagittal balance. We report two cases of severe low back pain and lower extremity radicular pain associated with dropped-head syndrome. Symptoms were relieved by cervical corrective surgery. Case presentation Two Japanese women with dropped head syndrome complained of severe low back pain and lower extremity radicular pain on walking. Radiographs showed marked cervical spine kyphosis and lumbar spine hyperlordosis. After cervicothoracic poste...

  10. Depression Subscale of the Hospital Anxiety and Depression Scale applied preoperatively in spinal surgery

    Directory of Open Access Journals (Sweden)

    Asdrubal Falavigna

    2012-05-01

    Full Text Available OBJECTIVE: To evaluate the accuracy of the Depression Subscale of Hospital Anxiety and Depression Scale (HADS-D in spine surgery, comparing it to Beck Depression Inventory (BDI. METHODS: In a cross-sectional study, the HADS-D and the BDI were applied to patients undergoing spine surgery for lumbar (n=139 or cervical spondylosis (n=17. Spearman correlation tests for HADS-D and BDI were applied. The internal consistency of HADS-D was estimated by Cronbach's alpha coefficient. RESULTS: According to the BDI, the prevalence of depression was of 28.8% (n=45. The Spearman r coefficient between HADS-D and BDI was 0.714 (p10, there was a sensitivity of 71.1%, specificity of 95.4%, and positive likelihood-ratio of 15.78. CONCLUSIONS: HADS-D showed a strong correlation with BDI and good reliability. HADS-D is a good alternative for screening depression and assessing its severity.

  11. Correction

    CERN Document Server

    2002-01-01

    Tile Calorimeter modules stored at CERN. The larger modules belong to the Barrel, whereas the smaller ones are for the two Extended Barrels. (The article was about the completion of the 64 modules for one of the latter.) The photo on the first page of the Bulletin n°26/2002, from 24 July 2002, illustrating the article «The ATLAS Tile Calorimeter gets into shape» was published with a wrong caption. We would like to apologise for this mistake and so publish it again with the correct caption.

  12. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    Science.gov (United States)

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2017-02-24

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  13. Low dose lignocaine + butorphanol vs. low dose bupivacaine for spinal anaesthesia in day care urological surgeries: a prospective randomized control trial.

    Science.gov (United States)

    Khant, Shahil Rameshbhai; Chaudhari, Rajeev; Kore, Rishikesh Arun; Bhagwat, Shirish; Jakhalekar, Ranjan Purushottam

    2017-06-01

    A local anaesthetic with fast onset, short and reliable duration of anaesthesia may be preferable for day care urological surgeries. Low dose lignocaine is believed to act faster and to have a shorter duration of action than low dose bupivacaine. Use of lignocaine for spinal anesthesia is discouraged now a days because of rare reports of transient neurological symptoms. The purpose of this study was to compare effectiveness and safety of low dose of lignocaine + butorphanol against low dose of bupivacaine for day care urological surgeries. A prospective randomized control trial was conducted between December 2012 to November 2015. After taking ethical committe approval and patient consent, total 990 patients were randomized in two groups. Group A received 0.5 mL of 5% lignocaine (25 mg) + 0.3 mL butorphanol (0.3 mg) and group B received 1 mL of 0.5% bupivacaine (5 mg) for spinal anesthesia. Spinal anesthesia was given at the L3-L4 interspace with the patient in the sitting or lateral position. The criteria for evaluation were time till onset of sensory and motor block, duration of sensory and motor block, time till ambulation, time till fit for discharge and any complications. Both the groups were comparable in terms of age, male to female ratio, American Society of Anesthesiologists (ASA) grade and duration surgery. Group A and Group B were statistically different in terms of mean time till onset of sensory block (120±22 sec and 274±36 sec), onset of motor block (228±34 sec and 372±41 sec), duration of sensory block (100±21 min and 230±28 min), duration of motor block (60±15 min and 152±23 min), time till ambulation (138±24 min and 292±48 min), time till fit for discharge (256±35 min and 428±46 min) respectively (Spinal anaesthesia is an effective as well as a safe modality to anaesthetize the patient for day care urological procedures. This study shows lignocaine + butorphanol is preferable over bupivacaine for spinal anesthesia for day care

  14. Vital Signs Changes in Post-Operative Corrective Surgery for Cyanotic and Noncyanotic Congenital Heart Diseases

    Directory of Open Access Journals (Sweden)

    H Amoozegar

    2008-07-01

    Full Text Available Background: Post open cardiac surgery is associated with rises in fever, blood pressure and heart rate. The objective of the present study was to determine the changes in temperature, blood pressure and heart rate in first week after open cardiac surgery of non-complicated cyanotic and noncyanotic congenital heart diseases.Patients and Methods: Temperature, blood pressure and heart rate were obtained from 100 patients with different congenital heart disease after open cardiac surgery. The patients divided in two groups, 40 cyanotic CHD and 60 noncyanotic CHD.Result: Half of patients had fever in first day after surgery. Cyanotic patients became afebrile earlier than noncyanotic group. Cyanotic patients had higher heart rate and lower blood pressure than noncyanotic group.Conclusion: The study suggests that post open heart surgery body temperature, blood pressure and heart rate are different in patients with cyanotic and non cyanotic congenital heart diseases.

  15. High order aberration and straylight evaluation after cataract surgery with implantation of an aspheric,aberration correcting monofocal intraocular lens

    Institute of Scientific and Technical Information of China (English)

    Florian; T; A; Kretz; Tamer; Tandogan; Ramin; Khoramnia; Gerd; U; Auffarth

    2015-01-01

    ·AIM: To evaluate the quality of vision in respect to high order aberrations and straylight perception after implantation of an aspheric, aberration correcting,monofocal intraocular lens(IOL).·METHODS: Twenty-one patients(34 eyes) aged 50 to83 y underwent cataract surgery with implantation of an aspheric, aberration correcting IOL(Tecnis ZCB00,Abbott Medical Optics). Three months after surgery they were examined for uncorrected(UDVA) and corrected distance visual acuity(CDVA), contrast sensitivity(CS)under photopic and mesopic conditions with and without glare source, ocular high order aberrations(HOA, Zywave II) and retinal straylight(C-Quant).· RESULTS: Postoperatively, patients achieved a postoperative CDVA of 0.0 log MAR or better in 97.1% of eyes. Mean values of high order abberations were +0.02±0.27(primary coma components) and-0.04 ±0.16(spherical aberration term). Straylight values of the C-Quant were 1.35±0.44 log which is within normal range of age matched phakic patients. The CS measurements under mesopic and photopic conditions in combination with and without glare did not show any statistical significance in the patient group observed(P ≥0.28).· CONCLUSION: The implantation of an aspherical aberration correcting monofocal IOL after cataractsurgery resulted in very low residual higher order aberration(HOA) and normal straylight.

  16. Application of 3D rapid prototyping technology in posterior corrective surgery for Lenke 1 adolescent idiopathic scoliosis patients.

    Science.gov (United States)

    Yang, Mingyuan; Li, Chao; Li, Yanming; Zhao, Yingchuan; Wei, Xianzhao; Zhang, Guoyou; Fan, Jianping; Ni, Haijian; Chen, Ziqiang; Bai, Yushu; Li, Ming

    2015-02-01

    A retrospective study to evaluate the effectiveness of 3-dimensional rapid prototyping (3DRP) technology in corrective surgery for Lenke 1 adolescent idiopathic scoliosis (AIS) patients. 3DRP technology has been widely used in medical field; however, no study has been performed on the effectiveness of 3DRP technology in corrective surgery for Lenke 1 AIS patients. Lenke 1 AIS patients who were preparing to undergo posterior corrective surgery from a single center between January 2010 and January 2012 were included in this analysis. Patients were divided into 2 groups. In group A, 3-dimensional (3D) printing technology was used to create subject-specific spine models in the preoperative planning process. Group B underwent posterior corrective surgery as usual (by free hand without image guidance). Perioperative and postoperative clinical outcomes were compared between 2 groups, including operation time, perioperative blood loss, transfusion volume, postoperative hemoglobin (Hb), postoperative complications, and length of hospital stay. Radiological outcomes were also compared, including the assessment of screw placement, postoperative Cobb angle, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis. Subgroup was also performed according to the preoperative Cobb angle: mean Cobb angle 50°. Besides, economic evaluation was also compared between 2 groups. A total of 126 patients were included in this study (group A, 50 and group B, 76). Group A had significantly shorter operation time, significantly less blood loss and transfusion volume, and higher postoperative Hb (all, P 0.05). There was also no significant difference in misplacement of screws in total populations (16.90% vs 18.82%, P = 0.305), whereas a low misplacement rate of pedicle screws was observed in patients whose mean Cobb angle was >50° (9.15% vs 13.03%, P = 0.02). Besides, using 3DRP increased the economic burden of patients (157,000 ± 9948.85 Ren Min Bi

  17. Multi-stage 3D-2D registration for correction of anatomical deformation in image-guided spine surgery

    Science.gov (United States)

    Ketcha, M. D.; De Silva, T.; Uneri, A.; Jacobson, M. W.; Goerres, J.; Kleinszig, G.; Vogt, S.; Wolinsky, J.-P.; Siewerdsen, J. H.

    2017-06-01

    A multi-stage image-based 3D-2D registration method is presented that maps annotations in a 3D image (e.g. point labels annotating individual vertebrae in preoperative CT) to an intraoperative radiograph in which the patient has undergone non-rigid anatomical deformation due to changes in patient positioning or due to the intervention itself. The proposed method (termed msLevelCheck) extends a previous rigid registration solution (LevelCheck) to provide an accurate mapping of vertebral labels in the presence of spinal deformation. The method employs a multi-stage series of rigid 3D-2D registrations performed on sets of automatically determined and increasingly localized sub-images, with the final stage achieving a rigid mapping for each label to yield a locally rigid yet globally deformable solution. The method was evaluated first in a phantom study in which a CT image of the spine was acquired followed by a series of 7 mobile radiographs with increasing degree of deformation applied. Second, the method was validated using a clinical data set of patients exhibiting strong spinal deformation during thoracolumbar spine surgery. Registration accuracy was assessed using projection distance error (PDE) and failure rate (PDE  >  20 mm—i.e. label registered outside vertebra). The msLevelCheck method was able to register all vertebrae accurately for all cases of deformation in the phantom study, improving the maximum PDE of the rigid method from 22.4 mm to 3.9 mm. The clinical study demonstrated the feasibility of the approach in real patient data by accurately registering all vertebral labels in each case, eliminating all instances of failure encountered in the conventional rigid method. The multi-stage approach demonstrated accurate mapping of vertebral labels in the presence of strong spinal deformation. The msLevelCheck method maintains other advantageous aspects of the original LevelCheck method (e.g. compatibility with standard clinical workflow, large

  18. Correction

    CERN Multimedia

    2002-01-01

    The photo on the second page of the Bulletin n°48/2002, from 25 November 2002, illustrating the article «Spanish Visit to CERN» was published with a wrong caption. We would like to apologise for this mistake and so publish it again with the correct caption.   The Spanish delegation, accompanied by Spanish scientists at CERN, also visited the LHC superconducting magnet test hall (photo). From left to right: Felix Rodriguez Mateos of CERN LHC Division, Josep Piqué i Camps, Spanish Minister of Science and Technology, César Dopazo, Director-General of CIEMAT (Spanish Research Centre for Energy, Environment and Technology), Juan Antonio Rubio, ETT Division Leader at CERN, Manuel Aguilar-Benitez, Spanish Delegate to Council, Manuel Delfino, IT Division Leader at CERN, and Gonzalo León, Secretary-General of Scientific Policy to the Minister.

  19. Correction

    Directory of Open Access Journals (Sweden)

    2012-01-01

    Full Text Available Regarding Gorelik, G., & Shackelford, T.K. (2011. Human sexual conflict from molecules to culture. Evolutionary Psychology, 9, 564–587: The authors wish to correct an omission in citation to the existing literature. In the final paragraph on p. 570, we neglected to cite Burch and Gallup (2006 [Burch, R. L., & Gallup, G. G., Jr. (2006. The psychobiology of human semen. In S. M. Platek & T. K. Shackelford (Eds., Female infidelity and paternal uncertainty (pp. 141–172. New York: Cambridge University Press.]. Burch and Gallup (2006 reviewed the relevant literature on FSH and LH discussed in this paragraph, and should have been cited accordingly. In addition, Burch and Gallup (2006 should have been cited as the originators of the hypothesis regarding the role of FSH and LH in the semen of rapists. The authors apologize for this oversight.

  20. Correction

    Directory of Open Access Journals (Sweden)

    2014-01-01

    Full Text Available Regarding Tagler, M. J., and Jeffers, H. M. (2013. Sex differences in attitudes toward partner infidelity. Evolutionary Psychology, 11, 821–832: The authors wish to correct values in the originally published manuscript. Specifically, incorrect 95% confidence intervals around the Cohen's d values were reported on page 826 of the manuscript where we reported the within-sex simple effects for the significant Participant Sex × Infidelity Type interaction (first paragraph, and for attitudes toward partner infidelity (second paragraph. Corrected values are presented in bold below. The authors would like to thank Dr. Bernard Beins at Ithaca College for bringing these errors to our attention. Men rated sexual infidelity significantly more distressing (M = 4.69, SD = 0.74 than they rated emotional infidelity (M = 4.32, SD = 0.92, F(1, 322 = 23.96, p < .001, d = 0.44, 95% CI [0.23, 0.65], but there was little difference between women's ratings of sexual (M = 4.80, SD = 0.48 and emotional infidelity (M = 4.76, SD = 0.57, F(1, 322 = 0.48, p = .29, d = 0.08, 95% CI [−0.10, 0.26]. As expected, men rated sexual infidelity (M = 1.44, SD = 0.70 more negatively than they rated emotional infidelity (M = 2.66, SD = 1.37, F(1, 322 = 120.00, p < .001, d = 1.12, 95% CI [0.85, 1.39]. Although women also rated sexual infidelity (M = 1.40, SD = 0.62 more negatively than they rated emotional infidelity (M = 2.09, SD = 1.10, this difference was not as large and thus in the evolutionary theory supportive direction, F(1, 322 = 72.03, p < .001, d = 0.77, 95% CI [0.60, 0.94].

  1. Prediction of Deformity Correction by Pedicle Screw Instrumentation in Thoracolumbar Scoliosis Surgery

    Science.gov (United States)

    Kiriyama, Yoshimori; Yamazaki, Nobutoshi; Nagura, Takeo; Matsumoto, Morio; Chiba, Kazuhiro; Toyama, Yoshiaki

    In segmental pedicle screw instrumentation, the relationship between the combinations of pedicle screw placements and the degree of deformity correction was investigated with a three-dimensional rigid body and spring model. The virtual thoracolumbar scoliosis (Cobb’s angle of 47 deg.) was corrected using six different combinations of pedicle-screw placements. As a result, better correction in the axial rotation was obtained with the pedicle screws placed at or close to the apical vertebra than with the screws placed close to the end vertebrae, while the correction in the frontal plane was better with the screws close to the end vertebrae than with those close to the apical vertebra. Additionally, two screws placed in the convex side above and below the apical vertebra provided better correction than two screws placed in the concave side. Effective deformity corrections of scoliosis were obtained with the proper combinations of pedicle screw placements.

  2. Transpedicular endoscopic surgery for lumbar spinal synovial cyst-report of two cases.

    Science.gov (United States)

    Krzok, Guntram; Telfeian, Albert E; Wagner, Ralf; Iprenburg, Menno

    2016-12-01

    Lumbar facet cysts are a benign, degenerative, and fairly uncommon cause for lumbar radiculopathy. The standard surgical treatment for lumbar facet cysts often requires a laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for transpedicular endoscopic access to the pathology that obviates the need to violate the lamina or facet. Two patient cases are described where the lumbar 4-5 facet cysts arise medial to the pedicle. Percutaneous access to the cysts was established by drilling through the adjacent pedicle creating a 7-mm corridor to establish access for the endoscopic tubular retractor and the working channel endoscope. Straight and bendable forceps were used to remove the cysts under direct visualization. Following surgery, the patients' symptoms showed immediate regression with complete relief of one patient's foot drop by 6 months. Transpedicular endoscopic access is described as novel minimally invasive surgical option in the awake patient for lumbar facet cysts adjacent to the Lumbar 4 or 5 pedicle.

  3. Correction.

    Science.gov (United States)

    2015-10-01

    In the article by Quintavalle et al (Quintavalle C, Anselmi CV, De Micco F, Roscigno G, Visconti G, Golia B, Focaccio A, Ricciardelli B, Perna E, Papa L, Donnarumma E, Condorelli G, Briguori C. Neutrophil gelatinase–associated lipocalin and contrast-induced acute kidney injury. Circ Cardiovasc Interv. 2015;8:e002673. DOI: 10.1161/CIRCINTERVENTIONS.115.002673.), which published online September 2, 2015, and appears in the September 2015 issue of the journal, a correction was needed. On page 1, the institutional affiliation for Elvira Donnarumma, PhD, “SDN Foundation,” has been changed to read, “IRCCS SDN, Naples, Italy.” The institutional affiliation for Laura Papa, PhD, “Institute for Endocrinology and Experimental Oncology, National Research Council, Naples, Italy,” has been changed to read, “Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy” and “Humanitas Research Hospital, Rozzano, Italy.” The authors regret this error.

  4. Comparison of spinal block after intrathecal clonidine–bupivacaine, buprenorphine–bupivacaine and bupivacaine alone in lower limb surgeries

    Science.gov (United States)

    Arora, Major Vishal; Khan, Mohammad Zafeer; Choubey, Major Sanjay; Rasheed, Mohammad Asim; Sarkar, Arindam

    2016-01-01

    Context: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. The α2-adrenergic agonist clonidine and potent opioid buprenorphine have the ability to potentiate the effects of local anesthetics. Aims: The purpose of this prospective, double-blind study was to compare onset, duration of sensory and motor block, effect on hemodynamics, level of sedation, duration of postoperative analgesia, and any adverse effects of clonidine and buprenorphine. Settings and Design: Seventy-five American Society of Anesthesiologists Class I and II patients undergoing lower limb surgery under spinal anesthesia were randomly allocated into three Groups A, B, and C. Subjects and Methods: Control Group A received injection bupivacaine 0.5% (heavy) 2.5 ml + saline 0.5 ml whereas Group B received injection bupivacaine 0.5% (heavy) 2.5 ml + injection buprenorphine 50 μg and Group C received injection bupivacaine 0.5% (heavy) 2.5 ml + preservative free injection clonidine 50 μg intrathecally. Statistical Analysis Used: Unpaired Student's t-test and Z-test were used for comparing data. Results: Statistically highly significant differences in mean time of sensory regression to L1, mean time to attain the Bromage Score of 1, and mean time of first rescue analgesic request were observed between the three groups. The patients did not suffer any serious side effects. Conclusion: Administration of buprenorphine and clonidine intrathecally does potentiate the duration of analgesia, sensory and motor block, with buprenorphine having a long-lasting effect. PMID:27746532

  5. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery.

    Science.gov (United States)

    Molliqaj, Granit; Schatlo, Bawarjan; Alaid, Awad; Solomiichuk, Volodymyr; Rohde, Veit; Schaller, Karl; Tessitore, Enrico

    2017-05-01

    OBJECTIVE The quest to improve the safety and accuracy and decrease the invasiveness of pedicle screw placement in spine surgery has led to a markedly increased interest in robotic technology. The SpineAssist from Mazor is one of the most widely distributed robotic systems. The aim of this study was to compare the accuracy of robot-guided and conventional freehand fluoroscopy-guided pedicle screw placement in thoracolumbar surgery. METHODS This study is a retrospective series of 169 patients (83 women [49%]) who underwent placement of pedicle screw instrumentation from 2007 to 2015 in 2 reference centers. Pathological entities included degenerative disorders, tumors, and traumatic cases. In the robot-assisted cohort (98 patients, 439 screws), pedicle screws were inserted with robotic assistance. In the freehand fluoroscopy-guided cohort (71 patients, 441 screws), screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. Patients treated before 2009 were included in the fluoroscopy cohort, whereas those treated since mid-2009 (when the robot was acquired) were included in the robot cohort. Since then, the decision to operate using robotic assistance or conventional freehand technique has been based on surgeon preference and logistics. The accuracy of screw placement was assessed based on the Gertzbein-Robbins scale by a neuroradiologist blinded to treatment group. The radiological slice with the largest visible deviation from the pedicle was chosen for grading. A pedicle breach of 2 mm or less was deemed acceptable (Grades A and B) while deviations greater than 2 mm (Grades C, D, and E) were classified as misplacements. RESULTS In the robot-assisted cohort, a perfect trajectory (Grade A) was observed for 366 screws (83.4%). The remaining screws were Grades B (n = 44 [10%]), C (n = 15 [3.4%]), D (n = 8 [1.8%]), and E (n = 6 [1.4%]). In the fluoroscopy-guided group, a completely intrapedicular course graded as A was found in 76% (n = 335). The

  6. Pneumomediastinum, Subcutaneous Emphysema, and Tracheal Tear in the Early Postoperative Period of Spinal Surgery in a Paraplegic Achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    Sinan Kahraman

    2013-01-01

    Full Text Available Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia. Spinal manifestations include thoracolumbar kyphosis, foramen magnum, and spinal stenosis. Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal. The deficits are typically progressive, presenting as an insidious onset of paresthesia, followed by the inability to walk and then by urinary incontinence. Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone. Surgical treatment consists of posterior instrumentation, fusion with total wide laminectomy at stenosis levels, and anterior interbody support. Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal. Pedicle lengths are significantly shorter, and 20–25 mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles. Tracheal injury due to inappropriate pedicle screw length is a rare complication. We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period.

  7. A comparative study of Sterofundin and Ringer lactate based infusion protocol in scoliosis correction surgery

    Science.gov (United States)

    Sharma, Ashima; Yadav, Monu; Kumar, B. Rajesh; Lakshman, P. Sai; Iyenger, Raju; Ramchandran, Gopinath

    2016-01-01

    Background: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. We prospectively studied the influence of Sterofundin (SF) and Ringer lactate (RL) on acid–base changes, hemodynamics, and readiness for extubation during scoliosis surgery. Subjects and Methods: Thirty consecutive children posted for scoliosis surgery were randomized to receive either RL (n = 15) or SF (n = 15) as intraoperative fluid at 10 mg/kg/h. Fluid boluses were added according to the study fluid algorithm. Arterial blood was sampled and analyzed at hourly intervals during surgery. Red blood cell transfusion was guided by hematocrit below 27. Patients were followed for 24 h postoperatively in the Intensive Care Unit. Results: There was no statistically significant difference in the volume of infused fluid (2400 ± 512 ml in Group RL and 2200 ± 640 ml in Group SF. There were no significant changes in pH of patients infused with SF. Statistically, significant higher lactate levels were seen in RL-infused group. The strong ion difference was decreased in both groups, but it normalized earlier with SF. Conclusions: SF-infused patients had nonremarkable changes in acid–base physiology in scoliosis surgery. PMID:27746547

  8. [Computer-assisted surgery (CAS)-guided correction arthrodesis of the ankle and subtalar joint with retrograde nail fixation].

    Science.gov (United States)

    Richter, M

    2011-04-01

    Restoration of a stable and plantigrade foot in deformities of the ankle and/or hindfoot and concomitant degenerative changes at the ankle and subtalar joint. Deformities of the ankle and/or hindfoot and concomitant degenerative changes at the ankle and subtalar joint. Active local infection or relevant arterial insufficiency. Prone position and posterolateral approach to ankle and subtalar joint. Placement of dynamic reference bases (DRB) in the tibia and through a stab incision in the talus or calcaneus. Two-dimensional (2D) image acquisition for navigation. Definition of axes of the tibia, calcaneus, and hindfoot, and of extent of correction. Exposition of ankle and subtalar joint and removal of remaining cartilage. Computer-assisted surgery (CAS)-guided correction and transfixation of the corrected position with 2.5 mm K-wires. Three-dimensional (3D) image acquisition for analysis of the accuracy of the correction and planning of the drilling for the retrograde nail. CAS-guided drilling insertion of the nail. Insertion of locking screws in the calcaneus, talus and tibia. 3D image acquisition for analysis of the accuracy of the correction implant position. Partial weight bearing (15 kg) in an orthosis (Vacuped) for 6 weeks, followed by full weight bearing in a stable standard shoe. From 1 September 2006 to 31 August 2008, 14 correction arthrodeses were performed. The accuracy was assessed by intraoperative 3D imaging. All achieved angles/translations were within a maximum deviation of 2°/mm when compared to the planned correction. Complications that were associated with CAS were not observed. In all 14 cases completing follow-up, timely fusion was registered.

  9. Development of a MEMS-based sensor array to characterise in situ loads during scoliosis correction surgery.

    Science.gov (United States)

    Benfield, D; Lou, E; Moussa, W

    2008-08-01

    Finite element analysis was implemented in three stages to design a piezoresistive, micro-electro-mechanical systems sensor array consisting of four-terminal sensors placed on deformable silicon diaphragms. This sensor array was used to retrofit the Contrel-Dubousset instrumentation in order to capture forces and moments applied by surgeons in real time during scoliosis correction surgery. Outputs from the sensor array have been designed to be compatible with a low-power wireless data transmission system that is currently being developed with a collaborating team in the biomedical industry. The designed sensor array is capable of resolving forces of up to 1000 N and moments of up to 4000 N mm in three dimensions during surgery. A process flow to produce the first prototyped version of this micro sensor with known performance characteristics is presented and tested. Acceptable correlation was found between the performance of the manufactured prototypes, numerical simulation and similar documented devices.

  10. Evaluation the Results of Harington Rod Instrumentation in Correction of Schuermann Kyphosis Surgery

    Directory of Open Access Journals (Sweden)

    S.A.R. Basam Pur

    2007-10-01

    Full Text Available Introduction & Objective: Before using multi hook segmental fixation in schuerman kyphosis (SK surgery, instrumentation by harington rod (H.R was common. Materials & Methods: In this study we evaluated the complication and pre and post surgical kyphosis in 26 SK patients who had anterior release and anterior fusion and then halofemoral traction and finally posterior fusion and instrumentation by Harington compression rod, in Shafa Yahyaian Hospital from 1976 till 2001. All of their documents were available in hospital archive and had minimum acceptable follow up.Results: No major complication was noted. One infection and one Harington rod fracture was noted, which they cured by appropriate treatment. Mean degree of thoracic kyphosis was 94 and after surgery it was 43.Conclusion: It seems that most prominent failure was overcorrection after surgery, so sometimes it reached to below 35 degree.

  11. The perioperative dialogue--a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia.

    Science.gov (United States)

    Pulkkinen, Maria; Junttila, Kristiina; Lindwall, Lillemor

    2016-03-01

    The aim of the study was to describe how patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia experienced to be a part of the perioperative dialogue as an ideal model of caring. A qualitative approach was chosen as a method. Nineteen patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia participated. These patients and their nurse anaesthetists had three perioperative dialogues in the pre-, intra- and postoperative phase of care. Data were collected by means of conversational interviews by four voluntary nurse anaesthetists who wrote the dialogues from each perioperative phase. The text from the collected data was analysed by qualitative, latent content analysis. The findings of the analysis show three identified themes: Suffering while waiting for surgery (preoperative dialogue), Continuity creates togetherness (intraoperative dialogue) and Uniqueness - the patient has been seen (postoperative dialogue). The findings show evidence that the perioperative dialogue is an ideal model of caring and serves the patients' desires of individual and dignified care. The patients have a deep appreciation when there is time to develop a caring encounter with his or her own nurse. When a caring encounter has been established, the patient is involved in his or her own care. This model of caring offers the perioperative nurses a new way of caring and arouses reflections about their main task caring for the suffering patient. The continuity created by the perioperative dialogue probably has an influence on both patient satisfaction and patient safety.

  12. Potential triaging of referrals for lumbar spinal surgery consultation: a comparison of referral accuracy from pain specialists, findings from advanced imaging and a 3-item questionnaire.

    Science.gov (United States)

    Simon, David; Coyle, Matt; Dagenais, Simon; O'Neil, Joseph; Wai, Eugene K

    2009-12-01

    Waiting times to see a spinal surgeon are among the highest in Canada. However, most patients who are referred would not benefit from surgical care. Effective triaging of surgical candidates may reduce morbidity related to prolonged waiting times and optimize use of limited resources. We administered a questionnaire consisting of 3 items identifying leg-dominant or back-dominant pain among 119 consecutive patients who presented at a community spinal pain centre or a spinal surgical unit for assessment of an elective lumbar problem. We analyzed the questionnaire under 2 different scenarios: 1 hypothesized to be more sensitive and 1 hypothesized to be more specific. For the "sensitive" scenario of clearly back-dominant pain, the sensitivity of the questionnaire was 100% in identifying appropriate surgical candidates. For the "specific" scenario of leg-dominant pain, the questionnaire had a sensitivity of 83% and specificity of 73% in identifying appropriate surgical candidates, which was significantly superior to findings on computed tomography or magnetic resonance imaging (i.e., presence of neurocompressive lesions). When comparing the accuracy of the questionnaire in identifying appropriate surgical candidates to that of an assessment performed by a pain specialist at an acute spinal pain clinic, we found no statistically significant differences between the 2 methods. Use of the questionnaire when triaging patients may decrease the number of unnecessary referrals to spine surgeons. Adopting such a method of triaging could reduce waiting times for appropriate surgical candidates and potentially improve the outcomes of any resulting spinal surgery performed in a timely fashion.

  13. Fast diffusion tensor imaging and tractography of the whole cervical spinal cord using point spread function corrected echo planar imaging

    DEFF Research Database (Denmark)

    Lundell, Hans Magnus Henrik; Barthelemy, Dorothy; Biering-Sørensen, Fin

    2013-01-01

    Diffusion tensor imaging has been used in a number of spinal cord studies, but severe distortions caused by susceptibility induced field inhomogeneities limit its applicability to investigate small volumes within acceptable acquisition times. A way to evaluate image distortions is to map the poin...... artifacts or in high-field imaging settings where off-resonance effects are pronounced. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc....

  14. Effects of preoperative β-blocker on blood loss and blood transfusion during spinal surgeries with sodium nitroprusside-controlled hypotension

    Directory of Open Access Journals (Sweden)

    Yasser Mohamed Amr

    2012-01-01

    Full Text Available Background: The present study sought to determine whether premedication with oral β-blocker before hypotensive anesthesia with sodium nitroprusside could improve the quality of surgical field, decrease the blood loss, and decrease the need for homologous blood transfusion and duration of surgery. Methods: Eighty patients scheduled for spinal fixation surgery were included in a prospective, randomized, double-blinded study. Patients were classified into two groups: Group I received oral atenolol 50 mg twice one day before surgery; and Group II received placebo tablets identical in appearance to atenolol tablets for the same period and interval. All patients in both the groups received intraoperative sodium nitroprusside (SNP as a hypotensive agent. Hemodynamic variables, amount of sodium nitroprusside used, quality of surgical field, and the amount of homologous blood transfusion and blood loss were compared between groups. Results: Heart rate and amount of SNP used were significantly less (P<0.0001 in the atenolol group, but no significant difference was found in intraoperative mean arterial blood pressure (MABP between the two groups. The time of surgeries was significantly shorter in Group I than in Group II (185±15.21 vs 225±12.61 min, P<0.0001. The quality of surgical field was better in Group I than in Group II in all times of measurements, P<0.0001. The amount of blood loss and the amount of packed red blood cells transfused were significantly less in Group I than in Group II, P<0.0001. No clinically significant complications were observed in either group. Conclusion: Premedication with oral atenolol 50 mg twice/day for one day before hypotensive anesthesia with SNP during spinal surgeries seems to be clinically safe and effective to reduce heart rate, amount of SNP used, amount of blood loss, and amount of blood transfused with better quality of surgical field.

  15. The possible meaning of fractional anisotropy measurement of the cervical spinal cord in correct diagnosis of amyotrophic lateral sclerosis.

    Science.gov (United States)

    Budrewicz, Slawomir; Szewczyk, Pawel; Bladowska, Joanna; Podemski, Ryszard; Koziorowska-Gawron, Ewa; Ejma, Maria; Słotwiński, Krzysztof; Koszewicz, Magdalena

    2016-03-01

    Diagnosis of amyotrophic lateral sclerosis (ALS) is based on clinical criteria and electrophysiological tests (electromyography, and transcranial magnetic stimulation). In the search for ALS biomarkers, the role of imaging procedures is currently emphasized, especially modern MR techniques. MR procedures were performed on 15 ALS patients and a sex- and age-matched control group. The MR examinations were performed with a 1.5-T MR unit, and the protocol consisted of sagittal T1-weighed images, sagittal and axial T2-weighed images, and sagittal T2-weighed FAT SAT images followed by an axial diffusion tensor imaging (DTI) sequence of the cervical spinal cord. FA values in individual segments of the cervical spinal cord were decreased in the ALS group in comparison with the control group. After comparing FA values for anterior, posterior, and lateral corticospinal columns, the greatest difference was observed between the C2 and C5 segments. Spinal cord assessment with the use of FA measurements allows for confirmation of the motor pathways lesion in ALS patients. The method, together with clinical criteria, could be helpful in ALS diagnosis, assessment of clinical course, or even the effects of new drugs. The results also confirmed the theory of the generalized character of ALS.

  16. Physiotherapy Commenced Within the First Four Weeks Post-Spinal Surgery Is Safe and Effective: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Snowdon, Megan; Peiris, Casey L

    2016-02-01

    To determine whether physiotherapy commenced within the first 4 weeks post-spinal surgery is safe and effective. Electronic databases CINAHL, MEDLINE, AMED, PubMed, Embase, and PEDro were searched from the earliest date possible through May 2015. An additional trial was identified through reference list scanning. Controlled trials evaluating comprehensive physiotherapy rehabilitation commenced within 4 weeks postoperatively compared with a control group receiving no physiotherapy, standard postoperative care, rest, less active physiotherapy, or sham physiotherapy after spinal surgery of a musculoskeletal etiology. Two reviewers independently applied inclusion and exclusion criteria, with disagreements discussed until consensus could be reached. Searching identified 3162 potentially relevant articles, of which 4 trials with 250 participants met the inclusion criteria. Data were extracted using a predefined data extraction form. Methodological quality of trials was assessed independently by 2 reviewers using the Downs and Black checklist. Pooled analyses were performed using a random-effects model with inverse variance methods to calculate risk differences and 95% confidence intervals (CIs) (dichotomous outcomes), and standardized mean differences (SMDs) and 95% CIs (continuous outcomes). When compared with no or sham physiotherapy, early comprehensive physiotherapy did not increase the risk of adverse events (risk difference, -.01; 95% CI, -.07 to .05; I(2)=0%). In addition, there is moderate-quality evidence demonstrating a reduction in pain by a moderate and significant amount at 12 weeks (SMD=-.38; 95% CI, -.66 to -.10; I(2)=0%) and at 12+ months (SMD=-.30; 95% CI, -.59 to -.02; I(2)=0%). Early comprehensive physiotherapy commenced within the first 4 weeks post-spinal surgery does not increase the potential for an adverse event and leads to a moderate, statistically significant reduction in pain when compared with a control group. Copyright © 2016 American

  17. Toric Intraocular Lens vs. Peripheral Corneal Relaxing Inci-sions to Correct Astigmatism in Eyes Undergoing Cataract Surgery

    Institute of Scientific and Technical Information of China (English)

    Zhiping Liu; Xiangyin Sha; Xuanwei Liang; Zhonghao Wang; Jingbo Liu; Danping Huang

    2014-01-01

    Purpose:.To compare toric intraocular lens implantation (Toric-IOL).with peripheral corneal relaxing incisions (PCRIs) for astigmatism correction in patients undergoing cataract surgery. Methods: 54 patients (54 eyes) with more than 0.75 diopter (D).of preexisting corneal astigmatism were classified as group A (0.75-1.50D) or group B (1.75-2.50D). The patients were randomized to undergo Toric-IOL or PCRIs in the steep axis with spherical IOL implantation..LogMAR uncorrected visual acuity (LogMAR UCVA), LogMAR best corrected vi sual acuity.(LogMAR BCVA),.error of vector (|EV|), surgery induced refraction correction. (|SIRC|),.and correction rates (CR) were measured 1 month and 6 months postoperatively. Results: At 6 months postoperatively, all 54 eyes had Log-MAR BCVA≤0.2. Patients who underwent PCRIs and Toric-IOL with LogMAR BCVA≤0.1 showed no significant differ-ences in group A (P=1.00) or in group B (P=0.59). Group A showed no significant differences in LogMAR UCVA (P=0.70), |EV| (P=0.13), |SIRC| (P=0.71), and CR (P=0.56) in patients underwent PCRIs and Toric-IOL. However, group B showed significant differences in LogMAR UCVA (P Conclusion:.The efficacy and stability of Toric-IOL and PCRIs were equal in low astigmatic patients..Toric-IOL achieved an enhanced effect over PCRIs in higher astigmatic patients. PCRIs had the more refractive regression than Toric-IOL in 6 months.

  18. Estimation of the Ideal Lumbar Lordosis to Be Restored From Spinal Fusion Surgery: A Predictive Formula for Chinese Population.

    Science.gov (United States)

    Xu, Leilei; Qin, Xiaodong; Zhang, Wen; Qiao, Jun; Liu, Zhen; Zhu, Zezhang; Qiu, Yong; Qian, Bang-ping

    2015-07-01

    A prospective, cross-sectional study. To determine the independent variables associated with lumbar lordosis (LL) and to establish the predictive formula of ideal LL in Chinese population. Several formulas have been established in Caucasians to estimate the ideal LL to be restored for lumbar fusion surgery. However, there is still a lack of knowledge concerning the establishment of such predictive formula in Chinese population. A total of 296 asymptomatic Chinese adults were prospectively recruited. The relationships between LL and variables including pelvic incidence (PI), age, sex, and body mass index were investigated to determine the independent factors that could be used to establish the predictive formula. For the validation of the current formula, other 4 reported predictive formulas were included. The absolute value of the gap between the actual LL and the ideal LL yielded by these formulas was calculated and then compared between the 4 reported formulas and the current one to determine its reliability in predicting the ideal LL. The logistic regression analysis showed that there were significant associations of LL with PI and age (R = 0.508, P < 0.001 for PI; R = 0.088, P = 0.03 for age). The formula was, therefore, established as follows: LL = 0.508 × PI - 0.088 × Age + 28.6. When applying our formula to these subjects, the gap between the predicted ideal LL and the actual LL was averaged 3.9 ± 2.1°, which was significantly lower than that of the other 4 formulas. The calculation formula derived in this study can provide a more accurate prediction of the LL for the Chinese population, which could be used as a tool for decision making to restore the LL in lumbar corrective surgery. 3.

  19. Erbium:YAG laser as a method of deepithelization in corrective and reductive breast surgery.

    Science.gov (United States)

    Trelles, Mario A; Pardo, Lourdes; Chamorro, Juan José; Bonanad, Enrique; Allones, Inés; Buil, Carmen; Luna, Ricardo

    2005-08-01

    Deepithelization of the breast in breast ptosis surgery is important, being associated with risks which could affect the clinical outcome. The role of Er:YAG laser deepithelization was investigated. A total of 12 bilateral mammoplasties were performed, randomly assigned to 2 groups, one of experienced and one of less-experienced surgeons. Results were compared between the 2 groups of surgeons for scalpel deepithelization on one breast and the Er:YAG laser on the contralateral breast. No complications; less edema, pain, and erythema; and quicker wound healing were observed in the laser-deepithelized breasts, with a shorter operation time even for the less-experienced surgeons. The authors do not suggest that the Er:YAG laser should replace the scalpel in the hands of the expert surgeon for breast deepithelization in breast ptosis surgery, but the results of the study suggest that Er:YAG laser ablation is a safe, precise, effective and complication-free method.

  20. Computer-assisted orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct facial asymmetry and maxillary defects secondary to maxillectomy in childhood.

    Science.gov (United States)

    Zhang, Lei; Sun, Hao; Yu, Hong-bo; Yuan, Hao; Shen, Guo-fang; Wang, Xu-dong

    2013-05-01

    Maxillectomy in childhood not only causes composite primary defects but also secondary malformation of the middle and lower face. In the case presented, we introduced computer-assisted planning and simulation of orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction to correct complex craniofacial deformities. Virtual orthognathic surgery and maxillary reconstruction surgery were undertaken preoperatively. LeFort I osteotomy, with bilateral sagittal split ramus osteotomy and lower border ostectomy, was performed to correct malocclusion and facial asymmetry. Maxillary reconstruction was accomplished using a fibular osteomyocutaneous flap. The patient recovered uneventfully with an adequate aesthetic appearance on 3D computed tomography. Our experience indicates that orthognathic surgery combined with fibular osteomyocutaneous flap reconstruction can used to correct complex facial asymmetry and maxillary defects secondary to maxillectomy. Computer-assisted simulation enables precise execution of the reconstruction. It shortens the free flap ischemia time and reduces the risks associated with microsurgery.

  1. Trypan blue selective staining using whole blood for internal limiting membrane peeling during macular hole corrective surgery.

    Science.gov (United States)

    Lai, Chi-Chun; Chuang, Lan-Hsin; Wang, Nan-Kai; Yeung, Ling; Chen, Yen-Po; Hwang, Yih-Shiou; Chen, Kuan-Jen; Wu, Wei-Chi

    2009-01-01

    To prevent trypan blue (TB) retention and its potential toxicity by selectively staining the internal limiting membrane (ILM) with the aid of whole blood. Twenty-four consecutive patients with macular holes who underwent TB-assisted ILM peeling were enrolled. In the surgeries, autologous whole blood was applied to cover the macular hole, and only the area selectively used for TB staining was exposed. Trypan blue solution (0.75 mg/mL, after being diluted with 5% glucose) was used to stain the exposed macular area in the fluid-filled vitreous cavity. The stained ILM was then completely removed. Twenty-four macular holes were studied. The ILMs were selectively stained by trypan blue and then removed completely. No visible dye remained on the retina after peeling. The macular holes were closed in 22 eyes (92%) after a single surgery. The mean best-corrected visual acuity improved from 20/140 to 20/62 after surgery. In addition, no fundus changes were observed during the follow-up period. Selective staining of ILM during TB-assisted membrane peeling could be achieved with whole blood as the adjuvant. Complete removal of stained membranes can prevent TB retention and may further reduce toxicity on retinal pigment epithelium and retina.

  2. Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections.

    Science.gov (United States)

    Kim, Han Jo; Bridwell, Keith H; Lenke, Lawrence G; Park, Moon Soo; Song, Kwang Sup; Piyaskulkaew, Chaiwat; Chuntarapas, Tapanut

    2014-04-20

    Case control study. To evaluate risk factors in patients in 3 groups: those without proximal junctional kyphosis (PJK) (N), with PJK but not requiring revision (P), and then those with PJK requiring revision surgery (S). It is becoming clear that some patients maintain stable PJK angles, whereas others progress and develop severe PJK necessitating revision surgery. A total of 206 patients at a single institution from 2002 to 2007 with adult scoliosis with 2-year minimum follow-up (average 3.5 yr) were analyzed. Inclusion criteria were age more than 18 years and primary fusions greater than 5 levels from any thoracic upper instrumented vertebra to any lower instrumented vertebrae. Revisions were excluded. Radiographical assessment included Cobb measurements in the coronal/sagittal plane and measurements of the PJK angle at postoperative time points: 1 to 2 months, 2 years, and final follow-up. PJK was defined as an angle greater than 10°. The prevalence of PJK was 34%. The average age in N was 49.9 vs. 51.3 years in P and 60.1 years in S. Sex, body mass index, and smoking status were not significantly different between groups. Fusions extending to the pelvis were 74%, 85%, and 91% of the cases in groups N, P, and S. Instrumentation type was significantly different between groups N and S, with a higher number of upper instrumented vertebra hooks in group N. Radiographical parameters demonstrated a higher postoperative lumbar lordosis and a larger sagittal balance change, with surgery in those with PJK requiring revision surgery. Scoliosis Research Society postoperative pain scores were inferior in group N vs. P and S, and Oswestry Disability Index scores were similar between all groups. Patients with PJK requiring revision were older, had higher postoperative lumbar lordosis, and larger sagittal balance corrections than patients without PJK. Based on these data, it seems as though older patients with large corrections in their lumbar lordosis and sagittal balance

  3. Anesthetic management of a child with corrected transposition of great vessels undergoing non-cardiac surgery.

    Science.gov (United States)

    Mathew, Shaji; Umesh, Goneppanavar; Arun Kumar, Handigodu Duggappa; Srinivasan, Nataraj Madagondapalli

    2013-04-01

    We describe the successful anesthetic management of a 14-year-old child, a corrected case of transposition of great vessels in childhood and presently with residual atrial septal defect, peripheral cyanosis, and neurological deficit of lower limb presented for tendoachillis lengthening.

  4. Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study

    Directory of Open Access Journals (Sweden)

    Endres Stefan

    2011-11-01

    Full Text Available Abstract Background Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery. Methods This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments. Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed. Results The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39. The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the platelet concentration Allogenic blood transfusion (two red cell units was needed for eight patients

  5. Toric Intraocular Lenses in the Correction of Astigmatism During Cataract Surgery

    DEFF Research Database (Denmark)

    Kessel, Line; Andresen, Jens; Tendal, Britta

    2016-01-01

    TOPIC: We performed a systematic review and meta-analysis to evaluate the benefit and harms associated with implantation of toric intraocular lenses (IOLs) during cataract surgery. Outcomes were postoperative uncorrected distance visual acuity (UCDVA) and distance spectacle independence. Harms were...... literature search in the Embase, PubMed, and CENTRAL databases within the Cochrane Library. We included randomized clinical trials (RCTs) if they compared toric with non-toric IOL implantation (± relaxing incision) in patients with regular corneal astigmatism and age-related cataracts. We assessed the risk...

  6. Correction of camptocormia using a cruciform anterior spinal hyperextension brace and back extensor strengthening exercise in a patient with Parkinson disease.

    Science.gov (United States)

    Ye, Byung Kook; Kim, Hyoung-Seop; Kim, Yong Wook

    2015-02-01

    Parkinson disease, one of the most common neurodegenerative diseases, is characterized by cardinal motor features including bradykinesia, rigidity, resting tremor, postural instability, freezing gait, and fatigue. Of these, postural instability in the form of hyperflexion of the thoracolumbar spine upon standing and walking that disappears on recumbent positioning is called camptocormia. Many different trials have been conducted on the treatment of camptocormia, including physiotherapy, corsets, medications, and deep brain stimulation. However, there is insufficient evidence as to which treatment modality is the most valid in terms of effectiveness, cost, safety, and patient satisfaction. In this study, we present a patient whose symptom of camptocormia was effectively resolved using a cruciform anterior spinal hyperextension (CASH) brace and back extensor strengthening exercise which was modified through follow-ups based on a short-term outpatient setting for proper application with minimal discomfort. The patient was satisfied with the amount of correction provided by the brace and exercise.

  7. Conventional Spinal Anaesthesia

    African Journals Online (AJOL)

    patients scheduled for clcctive unilateral lower limb surgery. ... the conventional group were turned supine immediately after injection. Blood pressure, heart rate, respiratory rate and oxygen .... Characteristic Type of spinal anaesthcsia P-value.

  8. Spinal Headaches

    Science.gov (United States)

    ... who undergo a spinal tap (lumbar puncture) or spinal anesthesia. Both procedures require a puncture of the tough ... fluid is withdrawn from your spinal canal. During spinal anesthesia, medication is injected into your spinal canal to ...

  9. Corrective surgery of external sexual organs in female pseudo hermaphrodite dog

    Directory of Open Access Journals (Sweden)

    Prokić Branislav

    2011-01-01

    Full Text Available Hermaphroditism is a congenital anomaly characterized by the presentation of sexual characteristics of both sexes in one individual. Hermaphrodites can occur in every mammal species. Real and pseudo hermaphrodites can be distinguished. Both ovaries and testes (ovotestes are presented in real hermaphrodites, while the conformation of the individual does not correspond to any sex in particular. Pseudo hermaphrodites are more frequent. Male pseudo hermaphrodites have testes and female external genital characteristics, while female pseudo hermaphrodites have ovaries and rudimentary external genitals reassembling to masculine ones. Corrective surgical removal of a rudimental penis in a female pseudo hermaphrodite dog is presented in the paper.

  10. Uterus preserving vaginal surgery versus vaginal hysterectomy for correction of female pelvic organ prolapse.

    Science.gov (United States)

    Iliev, Vasil N; Andonova, Irena T

    2014-01-01

    The objective of this study is to evaluate uterus preserving vaginal procedure of cervical amputation with uterosacral ligament plication (modified Manchester operation) and compare it to vaginal hysterectomy regard recurrence rate, duration of surgery, blood loses, intra and post-operative complications, duration of hospital stay. Consecutive women with pelvic organ prolapse who underwent either vaginal hyste-rectomy or a modified Manchester procedure were included. Assessments were made preoperatively and at 1-year follow-up, including physical examination with pelvic organ prolapse quantification standardized questionnaires. 66 patients were included in the study with a one year follow-up. We found no significant difference in: recurrence of POP and reintervention (recurrence with required treatment n (%): 3(10) vs. 5(15), p=0.28) and hospital stay (mean±SD days: 5±2 vs. 7±2, p=0.97). Significant less blood loses (250±210 ml. vs. 360±230 ml.) and shorter operation time (67±20 min. vs 102±22 min.) in modified Manchester group, but significant more urinary retention (cases: 8 vs 6) in modified Manchester group. The overall functional outcome was acceptable for both procedures. We found an excellent performance of both procedures regarding recurrences and intra and post-operative complications. A high degree of acceptance-satisfaction shows the modified Manchester operation and is good option for the treatment of uterine prolapse in younger women who wish to keep their uterus and in all cases of genital prolapse with elongation of uterine cervix (when there is not other uterine pathology). Shorter operation time and lower blood lose are another factors for stronger recommendation of the modified Manchester operation for patients with concomitant diseases and/or older age patients with elevated risk from anesthesia and/or surgery.

  11. Posterior and Anterior Spinal Fusion for the Management of Deformities in Patients with Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    Masashi Sato

    2013-01-01

    Full Text Available Introduction. Spinal scoliosis and kyphosis in elderly people sometimes cause severe low back pain. Surgical methods such as osteotomy are useful for correcting the deformity. However, complications during and after surgery are associated with the osteotomy procedure. In particular, it is difficult to manage deformity correction surgery for patients with Parkinson's disease. Here, we present two cases of combined anterior and posterior surgery for deformity in patients with adult scoliosis and kyphosis due to Parkinson's disease. Case Presentation. Two 70-year-old women had spinal scoliosis and kyphosis due to Parkinson's disease. They had severe low back pain, and conservative treatment was not effective for the pain. Surgery was planned to correct the deformity in both patients. We performed combined posterior and anterior correction surgery. At first, posterior fusions were performed from T4 to the ilium using pedicle screws. Next, cages and autograft from the iliac crest were used in anterior lumbar surgery. The patients became symptom free after surgery. Bony fusion was observed 12 months after surgery. Conclusions. Combined posterior and anterior fusion surgery is effective for patients who show scoliosis and kyphosis deformity, and symptomatic low back pain due to Parkinson's disease.

  12. [Corrective surgery of thoracic anomalies in Poland syndrome. General review of 20 patients].

    Science.gov (United States)

    Glicenstein, J

    2001-12-01

    Breast and thoracic anomalies in Poland's syndrome, whether associated or not with hypoplasia of the upper limb, have no functional impairment. They present an important cosmetic disgrace. Several methods for correction were proposed: muscular transfer with or without implants. Each one has its advantages and drawbacks. We operated 20 adolescents and adults with this deformity: 13 females and 7 males. If the inferior bundle of the pectoralis major was always absent, other muscular anomalies such as aplasia of the latissimus dorsi may complicate the corrective procedure. The choice of the treatment depends upon the importance of the muscular and sometimes associated costal aplasia, in the young girl, the breast development and in both sexes the position of the nipple. The latissimus dorsi transfer may be considered as the most adapted technique for the pestoralis major replacement. The results are often disappointing due to the secondary muscular atrophy. A composite implant with a part for breast reconstruction and another to fill the subclavicular gap gives satisfactory results but it has the hazards of implants.

  13. Simple prediction method of lumbar lordosis for planning of lumbar corrective surgery: radiological analysis in a Korean population.

    Science.gov (United States)

    Lee, Chong Suh; Chung, Sung Soo; Park, Se Jun; Kim, Dong Min; Shin, Seong Kee

    2014-01-01

    This study aimed at deriving a lordosis predictive equation using the pelvic incidence and to establish a simple prediction method of lumbar lordosis for planning lumbar corrective surgery in Asians. Eighty-six asymptomatic volunteers were enrolled in the study. The maximal lumbar lordosis (MLL), lower lumbar lordosis (LLL), pelvic incidence (PI), and sacral slope (SS) were measured. The correlations between the parameters were analyzed using Pearson correlation analysis. Predictive equations of lumbar lordosis through simple regression analysis of the parameters and simple predictive values of lumbar lordosis using PI were derived. The PI strongly correlated with the SS (r = 0.78), and a strong correlation was found between the SS and LLL (r = 0.89), and between the SS and MLL (r = 0.83). Based on these correlations, the predictive equations of lumbar lordosis were found (SS = 0.80 + 0.74 PI (r = 0.78, R (2) = 0.61), LLL = 5.20 + 0.87 SS (r = 0.89, R (2) = 0.80), MLL = 17.41 + 0.96 SS (r = 0.83, R (2) = 0.68). When PI was between 30° to 35°, 40° to 50° and 55° to 60°, the equations predicted that MLL would be PI + 10°, PI + 5° and PI, and LLL would be PI - 5°, PI - 10° and PI - 15°, respectively. This simple calculation method can provide a more appropriate and simpler prediction of lumbar lordosis for Asian populations. The prediction of lumbar lordosis should be used as a reference for surgeons planning to restore the lumbar lordosis in lumbar corrective surgery.

  14. 美洛昔康针剂用于脊柱外科围手术期镇痛初步观察%A preliminary evaluation of the perioperafive analgesic effect of intramuscular meloxicam administration on patients undergoing spinal surgery

    Institute of Scientific and Technical Information of China (English)

    冯丰; 李宁; 戎利民

    2011-01-01

    目的 观察美洛昔康肌肉注射和口服两种不同给药方式用于脊柱外科围手术期的镇痛效果及安全性.方法 118例接受脊柱手术患者中腰椎融合37例,显微内镜腰椎间盘髓核摘除(MED)60例,脊柱肿瘤切除重建14例,脊柱后凸畸形截骨矫形7例.所有患者随机分为两组:美洛昔康针剂给药组(A组)58例,术前1天15 mg IM,术后第1~7天15 mg IM QD;美洛昔康口服给药组(B组)60例,术前1天15 mg PO,术后第1~7天15 mg PO QD.两组术后均不限制使用静脉止痛泵、肌注或口服阿片类药物.观察两组术后疼痛视觉模拟评分(VAS)、阿片类药物用量、相关并发症以及术后1个月患者综合满意度.结果 术后第1、2、3、7天两组患者VAS评分比较的差异,有统计学意义(P<0.05);术后阿片类药物累计使用率,A组为15.52%,B组为60%(P<0.05);两组均未观察到面部浮肿、血压异常升高等心血管不良反应,B组7例出现恶心或呕吐等胃肠道不良反应;术后1个月综合满意度,A组为87.5%,B组为80.8%(P<0.05).结论 脊柱手术患者围手术期使用美洛昔康针剂能有效缓解术后疼痛,减少术后阿片类止痛药的使用和不良反应,提高患者对手术的综合满意度.%Objective To evaluate the perioperative analgesic effect and safety of intramuscular and oral meloxicam adrmmistrauon on patients underwent spinal surgery. Methods One hundred and eighteen patients underwent spinal surgery,including 37 cases of lumbar interbody fusion, 60 of microendoscopic discectomy (MED), 14 of tumor resection and 7 of spinal correction, were randomly divded into two groups. For the 58 patients in group A, 15 mg meloxicam was administrated intramuscularly once a day from the day before surgery to the 7th day postoperatively, while in group B the 60 patients orally took 15 mg meloxicam once a day for the same period of time as group A. All patients, if needed, unrestrictedly received intravenous analgesic pump

  15. Amount of torque and duration of stretching affects correction of knee contracture in a rat model of spinal cord injury.

    Science.gov (United States)

    Moriyama, Hideki; Tobimatsu, Yoshiko; Ozawa, Junya; Kito, Nobuhiro; Tanaka, Ryo

    2013-11-01

    Joint contractures are a common complication of many neurologic conditions, and stretching often is advocated to prevent and treat these contractures. However, the magnitude and duration of the stretching done in practice usually are guided by subjective clinical impressions. Using an established T8 spinal cord injury rat model of knee contracture, we sought to determine what combination of static or intermittent stretching, varied by magnitude (high or low) and duration (long or short), leads to the best (1) improvement in the limitation in ROM; (2) restoration of the muscular and articular factors leading to contractures; and (3) prevention and treatment of contracture-associated histologic alterations of joint capsule and articular cartilage. Using a rat animal model, the spinal cord was transected completely at the level of T8. The rats were randomly assigned to seven treatment groups (n = 4 per group), which were composed of static or intermittent stretching in combination with different amounts of applied torque magnitude and duration. We assessed the effect of stretching by measuring the ROM and evaluating the histologic alteration of the capsule and cartilage. Contractures improved in all treated groups except for the low-torque and short-duration static stretching conditions. High-torque stretching was effective against shortening of the synovial membrane and adhesions in the posterosuperior regions. Collagen Type II and VEGF in the cartilage were increased by stretching. High-torque and long-duration static stretching led to greater restoration of ROM than the other torque and duration treatment groups. Stretching was more effective in improving articular components of contractures compared with the muscular components. Stretching in this rat model prevented shortening and adhesion of the joint capsule, and affected biochemical composition, but did not change morphologic features of the cartilage. This animal study tends to support the ideas that static

  16. Correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism by combined orthognathic surgery and guiding templates and splints fabricated by rapid prototyping technique.

    Science.gov (United States)

    Ying, B; Ye, N; Jiang, Y; Liu, Y; Hu, J; Zhu, S

    2015-11-01

    The facial asymmetry associated with vertical maxillary excess and mandibular prognathism is one of the more complicated types in the field of oral and maxillofacial surgery. The purpose of this study was to investigate the efficacy of combined orthognathic surgeries, together with guiding templates and splints fabricated by rapid prototyping technique, for the correction of facial asymmetry. Fourteen patients with facial asymmetry associated with vertical maxillary excess and mandibular prognathism were included. A maxillary Le Fort I osteotomy, a sagittal split ramus osteotomy on the shorter side of the face, and an intraoral vertical ramus osteotomy on the longer side of the face were performed with the aid of guiding templates and splints fabricated by rapid prototyping technique. Parameters reflecting maxillary canting, ramal inclination, mandibular deviation, and chin inclination were measured before surgery, 7 days after surgery, and 1 year after surgery, and compared. Significant differences in these parameters were found between the two sides preoperatively, whereas no differences were observed postoperatively. Facial asymmetry was corrected in all patients with satisfactory outcomes. In conclusion, combined orthognathic surgery and guiding templates and splints can offer improvements in accuracy, complexity, and duration over traditional procedures for the correction of facial asymmetry associated with vertical maxillary excess and mandibular prognathism.

  17. Correction of quantification errors in pelvic and spinal lesions caused by ignoring higher photon attenuation of bone in [{sup 18}F]NaF PET/MR

    Energy Technology Data Exchange (ETDEWEB)

    Schramm, Georg, E-mail: georg.schramm@kuleuven.be; Maus, Jens; Hofheinz, Frank; Petr, Jan; Lougovski, Alexandr [Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden 01328 (Germany); Beuthien-Baumann, Bettina; Oehme, Liane [Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden 01307 (Germany); Platzek, Ivan [Department of Radiology, University Hospital Carl Gustav Carus, Dresden 01307 (Germany); Hoff, Jörg van den [Helmholtz-Zentrum Dresden-Rossendorf, Institute for Radiopharmaceutical Cancer Research, Dresden 01328 (Germany); Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden 01307 (Germany)

    2015-11-15

    Purpose: MR-based attenuation correction (MRAC) in routine clinical whole-body positron emission tomography and magnetic resonance imaging (PET/MRI) is based on tissue type segmentation. Due to lack of MR signal in cortical bone and the varying signal of spongeous bone, standard whole-body segmentation-based MRAC ignores the higher attenuation of bone compared to the one of soft tissue (MRAC{sub nobone}). The authors aim to quantify and reduce the bias introduced by MRAC{sub nobone} in the standard uptake value (SUV) of spinal and pelvic lesions in 20 PET/MRI examinations with [{sup 18}F]NaF. Methods: The authors reconstructed 20 PET/MR [{sup 18}F]NaF patient data sets acquired with a Philips Ingenuity TF PET/MRI. The PET raw data were reconstructed with two different attenuation images. First, the authors used the vendor-provided MRAC algorithm that ignores the higher attenuation of bone to reconstruct PET{sub nobone}. Second, the authors used a threshold-based algorithm developed in their group to automatically segment bone structures in the [{sup 18}F]NaF PET images. Subsequently, an attenuation coefficient of 0.11 cm{sup −1} was assigned to the segmented bone regions in the MRI-based attenuation image (MRAC{sub bone}) which was used to reconstruct PET{sub bone}. The automatic bone segmentation algorithm was validated in six PET/CT [{sup 18}F]NaF examinations. Relative SUV{sub mean} and SUV{sub max} differences between PET{sub bone} and PET{sub nobone} of 8 pelvic and 41 spinal lesions, and of other regions such as lung, liver, and bladder, were calculated. By varying the assigned bone attenuation coefficient from 0.11 to 0.13 cm{sup −1}, the authors investigated its influence on the reconstructed SUVs of the lesions. Results: The comparison of [{sup 18}F]NaF-based and CT-based bone segmentation in the six PET/CT patients showed a Dice similarity of 0.7 with a true positive rate of 0.72 and a false discovery rate of 0.33. The [{sup 18}F]NaF-based bone

  18. Antidepressant treatment with MAO-inhibitors during general and regional anesthesia: a review and case report of spinal anesthesia for lower extremity surgery without discontinuation of tranylcypromine.

    Science.gov (United States)

    Krings-Ernst, Ilana; Ulrich, Sven; Adli, Mazda

    2013-10-01

    Monoamine oxidase-(MAO)-inhibitors are a treatment of last resort in treatment resistant depression, which is regarded as a condition of increased psychiatric risk. General and regional anesthesia for elective surgery during use of long-term MAO-inhibitors remains a matter of debate because of an increased risk of drug interactions and decreased sympathetic stability. A series of case reports and new comparative studies reveal the safety of anesthesia/analgesia in non-cardiac surgery without discontinuation of the MAO-inhibitor if best effort is made for maintenance of sympathetic homeostasis and if known drug interactions are avoided. Very few reports with severe adverse incidents have been noted. Severe cardiovascular morbidity, a contraindication of MAO-inhibitors, probably contributed to peri- and postoperative complications. According to new studies, the risk of pharmacokinetic drug interactions is lower for tranylcypromine than for phenelzine. In the present case, a 66-year-old psychiatric patient on permanent treatment with 20 mg/day tranylcypromine was admitted for forefoot surgery. Anesthetic premedication consisted of 7.5 mg oral midazolam. Intravenous midazolam (0.5 mg) was dispensed for intraoperative sedation. After local anesthesia of the puncture site with 30 mg isobar prilocaine, spinal anesthesia was achieved by a single shot of 13.5 mg hyperbar bupivacaine (0.5%) intrathecally. Postoperative regional and general analgesia were accomplished by a peripheral nerve block with 50 mg isobar bupivacaine as well as oral etoricoxib and oxycodone. No peri- or postoperative complications were encountered. It is concluded that general or regional anesthesia for noncardiac surgery without discontinuation of MAO-inhibitor treatment may be a safe intervention after careful evaluation of an individual's perioperative and psychiatric risk. The increased psychiatric risk in patients treated with MAO-inhibitors outweighs the increased, however manageable

  19. The efficacy and cost-effectiveness of cell saver use in instrumented posterior correction and fusion surgery for scoliosis in school-aged children and adolescents.

    Science.gov (United States)

    Miao, Yu-Liang; Ma, Hua-Song; Guo, Wen-Zhi; Wu, Ji-Gong; Liu, Yan; Shi, Wen-Zhu; Wang, Xiao-Ping; Mi, Wei-Dong; Fang, Wei-Wu

    2014-01-01

    Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Compared to the control group, the cell saver group had significantly fewer intraoperative allogeneic RBC transfusions (P = 0.012). However, when the combined postoperative and total perioperative periods were evaluated for the use of allogeneic RBC transfusion, no significant differences were observed between the two groups (P = 0.813 and P = 0.101, respectively). With regard to the total cost of perioperative transfusion of all blood products (RBC and plasma), costs for the control group were slightly lower than those of the cell saver group, but this variance did not reach statistical significance (P = 0.095). The use of the cell saver in posterior spinal instrumentation and fusion surgery in school-aged children and adolescents was able to decrease the amount of intraoperative allogeneic RBC transfusion but failed to decrease total perioperative allogeneic RBC transfusion. Moreover, the use of the cell saver

  20. The effects of different doses of intrathecal meperidine on the incidence and severity of shivering during lower extremity orthopedic surgery under spinal anesthesia: A randomized, placebo-controlled, double blind-clinical trial

    Directory of Open Access Journals (Sweden)

    Azim Honarmand

    2015-01-01

    Conclusions: Using higher dosage of intrathecal meperidine (0.3 mg/kg was more effective than using lower dosage of meperidine (0.1 mg/kg and 0.2 mg/kg in reducing the incidence and severity of shivering during spinal anesthesia in lower extremity orthopedic surgeries.

  1. 双侧钉棒梯次紧凑闭合脊髓短缩联合植入物内固定矫正僵硬性脊柱角状后凸%Bilateral pedicle screw and echelon tight closure spinal cord technique combined with implant fixations for correcting stiff spinal angular kyphosis

    Institute of Scientific and Technical Information of China (English)

    马华松; 李龙; 伍佳剑; 张敬; 郑蕊; 辛莘; 王晓平; 谭荣; 陈志明; 陆明; 袁伟; 徐启明; 任冬云; 麻巍

    2014-01-01

    是脊柱功能和术后矫形效果的有效保障。%BACKGROUND:The treatment difficulties of thoracolumbar angular kyphosis surgery are:low correction rate, hard to rebuild sagittal plane, easily induce neurological complications, postoperative loss of balance, high incidence of pseudarthrosis and postoperative loss of correction degree. OBJECTIVE:To explore the safety and efficacy of modified posterior vertebral column resection osteotomy and bilateral pedicle screw combined with echelon tight closure spinal cord technique and implant fixation for severe spinal angular kyphosis. METHODS:A total of 87 severe spinal angular kyphosis patients, 36 males and 51 females, who were treated in the Department of Orthopedics, the 306 Hospital of Chinese PLA from January 2006 to December 2013, were enrol ed in this study. They underwent posterior vertebral column resection, bilateral pedicle screw combined with echelon tight closure spinal cord, and implant fixation. Kyphosis, spinal sagittal imbalance, offset rate towards trunk side, operation time and intraoperative blood loss were observed before and after treatment. RESULTS AND CONCLUSION:The preoperative average kyphosis was 90.1° (31°-138°). The postoperative average kyphosis was 27.9° (15°-57°). The improvement rate was 76%. The improvement rate of trunk sagittal offset was 76%. Intraoperative blood loss was 800-3 000 mL, and average blood loss was 2 300 mL. The operation time was 5-7 hours, averagely 5.9 hours. Before treatment, two patients affected neurologic symptoms in double lower extremity, and their Frankel classification was grade C and became grade E after treatment. Al patients were fol owed up for 9-57 months. Bony fusion was achieved in al patients. No complications of spinal cord injury appeared, and no orthopedic angle missing occurred. These results indicate that during posterior vertebral column resection for treating severe angular stiffness of the thoracic kyphosis, blood vessels could be

  2. Chitin Oligosaccharide (COS) Reduces Antibiotics Dose and Prevents Antibiotics-Caused Side Effects in Adolescent Idiopathic Scoliosis (AIS) Patients with Spinal Fusion Surgery.

    Science.gov (United States)

    Qu, Yang; Xu, Jinyu; Zhou, Haohan; Dong, Rongpeng; Kang, Mingyang; Zhao, Jianwu

    2017-03-14

    Antibiotics are always considered for surgical site infection (SSI) in adolescent idiopathic scoliosis (AIS) surgery. However, the use of antibiotics often causes the antibiotic resistance of pathogens and side effects. Thus, it is necessary to explore natural products as drug candidates. Chitin Oligosaccharide (COS) has anti-inflammation and anti-bacteria functions. The effects of COS on surgical infection in AIS surgery were investigated. A total of 312 AIS patients were evenly and randomly assigned into control group (CG, each patient took one-gram alternative Azithromycin/Erythromycin/Cloxacillin/Aztreonam/Ceftazidime or combined daily), experiment group (EG, each patient took 20 mg COS and half-dose antibiotics daily), and placebo group (PG, each patient took 20 mg placebo and half-dose antibiotics daily). The average follow-up was one month, and infection severity and side effects were analyzed. The effects of COS on isolated pathogens were analyzed. SSI rates were 2%, 3% and 8% for spine wounds and 1%, 2% and 7% for iliac wound in CG, EG and PG (p antibiotics (p antibiotics dose and antibiotics-caused side effects in AIS patients with spinal fusion surgery by improving antioxidant and anti-inflammatory activities. COS should be developed as potential adjuvant for antibiotics therapies.

  3. Ultrasound guided pectoral nerve blockade versus thoracic spinal blockade for conservative breast surgery in cancer breast: A randomized controlled trial

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    Hala M.S. ELdeen

    2016-01-01

    Conclusion: In conclusion, both Pecs and TSB provide effective intraoperative anesthesia and prolonged postoperative pain relief after breast surgery, but the Pecs block is technically simple and easy to learn with few contraindications, provides hemodynamic stability, and has a low complication rate and it is therefore a safe and effective technique in performing intraoperative anesthesia and controlling postoperative pain after unilateral conservative breast surgery.

  4. Effects of modified bridging exercises on static postural control of a poststroke hemiplegic patient who had received surgery for lumbar spinal stenosis: a case report.

    Science.gov (United States)

    Kim, Young-Dong

    2015-04-01

    [Purpose] This study investigated the efficacy on postural control of a bridging exercise in order to suggest a pertinent procedure for the bridging exercise. [Subject] One poststroke hemiplegic patient who had received surgery for lumbar spinal stenosis participated in this study [Methods] A reverse ABAB single-case experimental design was used. To assess postural control, foot pressure and the stability limit test were evalulated once a week a total of 4 times during the intervention period. [Results] Noticeable improvement in the distribution of foot pressure and increased stability limit were shown after performing the bridging exercise supervised by a physical therapist. [Conclusion] Bridging exercise on a plinth is effective at balancing body weight-bearing and resulted in the patient putting her weight on both feet evenly and in both the anterior and posterior directions.

  5. Novel biodegradable α-TCP/poly(amino acid) composite artificial lamina following spinal surgery for prevention of intraspinal scar adhesion.

    Science.gov (United States)

    Ran, Bo; Song, Yue-Ming; Liu, Hao; Liu, Li-Min; Gong, Quan; Li, Tao; Zeng, Jian-Cheng; Yuan, Hai-Feng

    2011-12-01

    Biodegradable copolymer α-TCP/poly(amino acid) composite artificial lamina was prepared and used in goat cervical vertebra resection repair. Cervical 4 was removed by laminectomy, and a vertebra defect of 27 × 9 mm was made. α-TCP/poly(amino acid) composite artificial lamina was inserted in the test group. The efficiency of the copolymer during repair and reconstruction of the goats' vertebra was tested by using X-ray, CT scanning, and histological and biomechanical measurements. In the 24 weeks following the operation, the artificial lamina refrained from shifting, and no dural adhesion pressure was observed. In contrast, the control group suffered from infiltration of soft tissue in the spinal canal, dural pressure and α-TCP/poly(amino acid) degradation. In conclusion, α-TCP/poly(amino acid) composite artificial lamina can significantly prevent scar tissue from infiltrating the spinal canal.

  6. Implications of the center of rotation concept for the reconstruction of anterior column lordosis and axial preloads in spinal deformity surgery.

    Science.gov (United States)

    Koller, Heiko; Mayer, Michael; Zenner, Juliane; Resch, Herbert; Niederberger, Alfred; Fierlbeck, Johann; Hitzl, Wolfgang; Acosta, Frank L

    2012-07-01

    In thoracolumbar deformity surgery, anterior-only approaches are used for reconstruction of anterior column failures. It is generally advised that vertebral body replacements (VBRs) should be preloaded by compression. However, little is known regarding the impact of different techniques for generation of preloads and which surgical principle is best for restoration of lordosis. Therefore, the authors analyzed the effect of different surgical techniques to restore spinal alignment and lordosis as well as the ability to generate axial preloads on VBRs in anterior column reconstructions. The authors performed a laboratory study using 7 fresh-frozen specimens (from T-3 to S-1) to assess the ability for lordosis reconstruction of 5 techniques and their potential for increasing preloads on a modified distractable VBR in a 1-level thoracolumbar corpectomy. The testing protocol was as follows: 1) Radiographs of specimens were obtained. 2) A 1-level corpectomy was performed. 3) In alternating order, lordosis was applied using 1 of the 5 techniques. Then, preloads during insertion and after relaxation using the modified distractable VBR were assessed using a miniature load-cell incorporated in the modified distractable VBR. The modified distractable VBR was inserted into the corpectomy defect after lordosis was applied using 1) a lamina spreader; 2) the modified distractable VBR only; 3) the ArcoFix System (an angular stable plate system enabling in situ reduction); 4) a lordosizer (a customized instrument enabling reduction while replicating the intervertebral center of rotation [COR] according to the COR method); and 5) a lordosizer and top-loading screws ([LZ+TLS], distraction with the lordosizer applied on a 5.5-mm rod linked to 2 top-loading pedicle screws inserted laterally into the vertebra). Changes in the regional kyphosis angle were assessed radiographically using the Cobb method. The bone mineral density of specimens was 0.72 ± 22.6 g/cm(2). The maximum regional

  7. Corrective surgery for canine patellar luxation in 75 cases (107 limbs: landmark for block recession

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    Mitsuhiro Isaka

    2014-05-01

    Full Text Available Canine medial patellar luxation (MPL is a very common orthopedic disease in small animals. Because the pathophysiology of this disease involves various pathways, the surgical techniques and results vary according to the veterinarian. Further, the landmark for block recession is not completely clear. We retrospectively evaluated 75 dogs (107 limbs with MPL in whom our landmark for block recession was used from July 2008 to May 2013. Information regarding the breed, age, sex, body weight, body condition score (BCS, lateral vs bilateral, pre-operative grading, surgical techniques, removal of implants, concomitance with anterior cruciate ligament (ACL rupture, re-luxation, re-operation, and rehabilitation was obtained from the medical records. The breeds were as follows: Chihuahua (n=23, Pomeranian (n=12, Yorkshire Terrier (n=9, and so on. The study group consisted of 33 males (castrated n=13 and 42 females (spayed n=21. The median age was 53.3±35.9 months (32-146 months; 13 cases were less than 12 months of age (17.3%. The pre-surgical BCSs were as follows: 1 (n=0, 2 (n=20, 3 (n=24, 4 (n=24 and 5 (n=7. The body weight was 4.51±3.48 kg (1.34-23.0 kg; 71 cases (94.7% were less than 10 kg. The MPL grades (each limb were G1 (n=1, G2 (n=18, G3 (n=78, and G4 (n=10; 32 cases were bilateral and 43 cases were unilateral (right n=27; left n=16. The specific surgical procedure (distal femoral osteotomy was 3 stifles in Chihuahuas. Concurrent with ACL rupture was 16/107 stifles (15.0% corrected with the over-the-top method or the extracapsular method in Papillons (5/6, Chihuahuas (5/23, and so on. The occurrences of re-luxation and re-operation were 3 out of 107 stifles (2.8% and 0%, respectively. In this retrospective study, we present a potentially good surgical landmark for block recession of MPL in dogs.

  8. Postoperative epidural analgesia for patients undergoing pectus excavatum corrective surgery: a 10-year retrospective analysis

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    Siddiqui A

    2016-05-01

    Full Text Available Asad Siddiqui,1 Andrew Tse,2 James E Paul,3 Peter Fitzgerald,4 Bernice Teh,51Department of Anesthesia, University of Toronto, Toronto, 2Department of Anesthesia, University of Ottawa, Ottawa, 3Department of Anesthesia, 4Department of Surgery, McMaster University, Hamilton, Ontario, Canada; 5Canterbury Anesthetic Services, Victoria, Australia Introduction: Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children's hospital, in patients undergoing the Nuss procedure. Methods: Seventy-two pediatric patients were identified as having been treated with one of three epidural regimens for postoperative pain management following the Nuss procedure: Group A (n=12 received 0.125% bupivacaine and 5 µg/mL fentanyl, Group B (n=21 received 0.125% bupivacaine and 10 µg/mL hydromorphone, and Group C (n=39 received 0.1% ropivacaine and 20 µg/mL hydromorphone. Our primary outcome was maximal daily pain scores (numerical rating scale 0–10, with an analytical focus on postoperative day 1 scores. The primary outcome was analyzed using linear regression. The secondary outcomes included the length of stay, side-effect profiles as reflected by the number of treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or

  9. Effects of ozone applied by spinal endoscopy in patients with chronic pain related to failed back surgery syndrome: a pilot study

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    Magalhães FNO

    2013-11-01

    Full Text Available Francisco Nêuton de Oliveira Magalhães, Sandra Correia Soares, Jaqueline Melo Torres, Arthur Ungaretti, Mariana Fillipi Cacciacarro, Manoel Jacobsen Teixeira, Erich Talamoni FonoffPain Center and Division of Functional Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, BrazilIntroduction: In the last two decades, ozone has emerged as a treatment for low back pain, applied by means of minimally invasive techniques. Objective: The aim of this study is to assess the effect and safety of ozone therapy applied in the epidural space for chronic pain related to failed back surgery syndrome.Methods: The investigators studied 13 sequential patients of both sexes, between 18 and 70 years old, with persistent chronic pain (more than six months in the lumbar region and in the lower limbs related to failed back surgery syndrome (FBSS. Pain was classified as neuropathic and non-neuropathic regarding the topography (lumbar and lower limb, based on the DN4 questionnaire. The patients received the ozone gas in the lumbar epidural space via spinal-sacral endoscopy. Clinical evaluation was performed before, immediately after (24 hours, and 1, 3, and 6 months after intervention with visual analog scale and Oswestry Disability Index (ODI.Results: Overall, the patients had 43.7% reduction of lumbar pain, 60.9% reduction in leg pain in six months followed by 44.0% of improvement in ODI. The reduction of pain and in the disability index was markedly greater in patients with non-neuropathic predominant pain, 95.2%, 80.6%, and 75.3% improvement in lumbar, leg pain, and ODI respectively, while neuropathic predominant pain patients experienced only 12.5%, 42.4%, and 20.9% improvement, also respectively. No neurological or infectious complications were observed acutely or during the follow-up. The present data suggests that epidural ozone might be a therapeutic option for persistent low back pain, especially in non

  10. Fístula esofágica después de cirugía espinal Esophageal fistula after spinal surgery

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    Nélida Ramos Díaz

    2011-12-01

    Full Text Available En los últimos años, debido al auge que ha tenido la cirugía espinal por vía cervical anterior, se ha observado un incremento en los traumatismos esofágicos después de estos procederes. Existen 2 escenarios clínicos diferentes: la lesión directa transoperatoria, y la presentación tardía por mecanismos de tracción fricción causado por el material de osteosíntesis empleado. A partir del paciente descrito, se exponen las conductas a seguir para cada caso, y se destacan las singularidades del tratamiento quirúrgico, con rafia esofágica y reforzamiento de la sutura con colgajos musculares. El objetivo inicial de la intervención, que es la estabilización espinal, tampoco debe ser descuidado. Se concluye que, por la presentación tardía de lesiones después de cirugía espinal, se necesita de un seguimiento cuidadoso a largo plazo para la detección y tratamiento precoz de estas complicaciones, además de la necesidad del concurso de varias especialidades para la solución exitosa de estas contingencias.In past years, due to the boom of spinal surgery by an anterior cervical route, there has been an increment of esophageal traumata after these procedures. There are two different clinical scenarios: the transoperative direct injury and the late presentation by friction traction mechanisms caused by the osteosynthesis used. From the described patient the behaviors to be followed for each case are exposed emphasizing the peculiarities of surgical treatment using esophageal raphe and reinforcement of suture with tissue flaps. The intervention's initial objective, the spinal stabilization, must to take into account. We conclude that due to late presentation of the injuries after spinal surgery, it is necessary to be long-term careful for a early detection and treatment of these complications in addition to the need of the involvement of some specialties to achieve a successful solution of these eventualities.

  11. Are eponyms used correctly or not? A literature review with a focus on shoulder and elbow surgery.

    Science.gov (United States)

    Somford, Matthijs Paul; Nieuwe Weme, Rebecca A; van Dijk, Cornelis Niek; IJpma, Frank Fa; Eygendaal, Denise

    2016-10-01

    Eponymous terms are used frequently in daily patient care and scientific literature. They remind us of our predecessors in surgery. It is debatable whether eponymous terms are reliable in case of information transfer. The aim of our study was to investigate whether the original meaning of eponymous terms in shoulder and elbow surgery has been preserved in its use in contemporary literature. To evaluate whether eponymous terms were used correctly, we analysed the use of frequently encountered eponymous terms from January to December 2014. By means of a PubMed search, articles with eponymous terms were identified and analysed for the way an eponymous term was used, and we compared it with the original description. The original description was traced back to the index publication. The use of the eponymous term was scored as similar, divergent or undefined. In the search for eponymous terms, we included those eponymous terms that were used more than 10 times in the English, German and Dutch literature of 2014. 6 eponymous terms were eligible for analysis: Bankart lesion, Bristow-Latarjet procedure, Essex-Lopresti injury of the forearm, Galeazzi fracture, Hill-Sachs lesion and Monteggia fracture. We analysed 96 articles with the listed eponymous terms, of which 27 (28%) were scored divergent, 32 (33%) undefined and 37 (39%) similar. Bristow-Latarjet scored lowest, with 0% descriptions similar to the original, meaning that all articles had an undefined or divergent eponym, and Essex-Lopresti scored highest with 82% similarity. Eponymous terms in shoulder and elbow trauma and surgery are used inadequately and inconsistently. The use of eponymous terms probably cannot be avoided, but since the majority of eponymous terms are not used properly and understanding of its meaning and content varies from surgeon to surgeon, we should be keen on explaining the meaning of eponymous terms when using them. Published by the BMJ Publishing Group Limited. For permission to use (where

  12. Hip fracture surgery

    Science.gov (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis - hip ... You may receive general anesthesia for this surgery. This means you ... spinal anesthesia . With this kind of anesthesia, medicine is ...

  13. [F-18]2-fluoro-2-deoxyglucose (FDG) positron emission tomography after limb salvage surgery: post-surgical appearance, attenuation correction and local complications

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    Gelfand, Michael J.; Sharp, Susan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Nuclear Medicine Division, Cincinnati, OH (United States)

    2015-08-15

    Metal endoprostheses and internal fixation devices cause significant artifacts on CT after limb salvage surgery; positron emission tomography (PET) images should be evaluated for artifacts. (1) To describe [F-18]2-fluoro-2-deoxyglucose (FDG) PET uptake patterns after limb salvage surgery. (2) To determine whether metal endoprostheses and fixation hardware cause significant artifacts on CT attenuation-corrected PET that interfere with diagnostic use of PET/CT after limb salvage surgery. We reviewed 92 studies from 18 patients ages 5-21 years. Diagnoses were osteogenic sarcoma in 14, Ewing sarcoma in 3, and malignant peripheral nerve sheath tumor originating in bone in 1. Nine patients had distal femur/knee endoprostheses, five had lower-extremity bone allografts secured by large metal plates and four had upper-extremity limb salvage procedures. Maximum standardized uptake value was calculated at lower-extremity soft-tissue-endoprosthesis interfaces. In 15 patients with PET/CT imaging, the first PET/CT scan after limb salvage surgery was reviewed for metal artifacts on CT images and for artifacts at locations on PET corresponding to the CT metal artifacts. Increased FDG uptake was consistently present at soft-tissue interfaces with endoprostheses, allografts and internal fixation devices, with little or no FDG uptake at cemented endoprosthesis-bone interfaces. Maximum standardized uptake value at margins of femur/knee endoprostheses ranged from 1.4 to 5.7. In four patients with distal femur/knee endoprostheses, minimal artifact was noted on attenuation-corrected PET images, but image interpretation was not affected. In the other 11 patients who had CT attenuation correction, we detected no artifacts caused by the attenuation correction. CT attenuation correction did not cause artifacts that affected interpretation of attenuation-corrected PET images. (orig.)

  14. Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75 mg) for hip fracture repair surgery in the elderly. A randomized, double blinded study.

    Science.gov (United States)

    Errando, C L; Peiró, C M; Gimeno, A; Soriano, J L

    2014-11-01

    Single shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia. In a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5mg hyperbaric bupivacaine 5mg/ml (control group), and B0.25 group 3.75mg hyperbaric bupivacaine 2.5mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administration were registered, along with rescue anesthesia needs, the feasibility of surgery, its duration, and regression time of sensory anesthesia to T12. After exclusions, 61 patients were included in the final analysis. Arterial hypotension incidence was lower in the B0.25 group (at the 5, 10, and 15min determinations), and a lower amount of vasopressor drugs was needed (mean accumulated ephedrine dose 1.6mg vs. 8.7mg in the B0.5 group, p<0.002). Sensory block regression time to T12 was shorter in the B0.25 group, mean 78.6±23.6 (95% CI 51.7-110.2)min vs. 125.5±37.9 (95% CI 101.7-169.4)min in the B0.5 group, p=0.033. All but one patient in the B0.25 group were operated on under the anesthetic procedure first intended. No rescue anesthesia was needed. Lowering bupivacaine dose for single shot spinal anesthesia for hip fracture repair surgery in elderly patients was effective in decreasing the occurrence of arterial hypotension and vasopressor use, while intraoperative quality remained. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Radiofrequency bipolar hemostatic sealer reduces blood loss, transfusion requirements, and cost for patients undergoing multilevel spinal fusion surgery: a case control study.

    Science.gov (United States)

    Frank, Steven M; Wasey, Jack O; Dwyer, Ian M; Gokaslan, Ziya L; Ness, Paul M; Kebaish, Khaled M

    2014-07-05

    A relatively new method of electrocautery, the radiofrequency bipolar hemostatic sealer (RBHS), uses saline-cooled delivery of energy, which seals blood vessels rather than burning them. We assessed the benefits of RBHS as a blood conservation strategy in adult patients undergoing multilevel spinal fusion surgery. In a retrospective cohort study, we compared blood utilization in 36 patients undergoing multilevel spinal fusion surgery with RBHS (Aquamantys, Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 38) matched for variables related to blood loss. Transfusion-related costs were calculated by two methods. Patient characteristics in the two groups were similar. Intraoperatively, blood loss was 55% less in the RBHS group than in the control group (810 ± 530 vs. 1,800 ± 1,600 mL; p = 0.002), and over the entire hospital stay, red cell utilization was 51% less (2.4 ± 3.4 vs. 4.9 ± 4.5 units/patient; p = 0.01) and plasma use was 56% less (1.1 ± 2.4 vs. 2.5 ± 3.4 units/patient; p = 0.03) in the RBHS group. Platelet use was 0.1 ± 0.5 and 0.3 ± 0.6 units/patient in the RBHS and control groups, respectively (p = 0.07). The perioperative decrease in hemoglobin was less in the RBHS group than in the control group (-2.0 ± 2.2 vs. -3.2 ± 2.1 g/dL; p = 0.04), and hemoglobin at discharge was higher in the RBHS group (10.5 ± 1.4 vs. 9.7 ± 0.9 g/dL; p = 0.01). The estimated transfusion-related cost savings were $745/case by acquisition cost and approximately 3- to 5-fold this amount by activity-based cost. The use of RBHS in patients undergoing multilevel spine fusion surgery can conserve blood, promote higher hemoglobin levels, and reduce transfusion-related costs.

  16. Corrective Jaw Surgery

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  17. Corrective Jaw Surgery

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  19. Corrective Jaw Surgery

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    Full Text Available ... are extensively trained to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Click here ... are extensively trained to appropriately administer local anesthesia, all forms of sedation and general anesthesia. Click here ...

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    Full Text Available ... and gums to improve function, appearance and oral health. Click here to find out more. Dental Implant ... and gums to improve function, appearance and oral health. Click here to find out more. Dental Implant ...

  1. Corrective Jaw Surgery

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    Full Text Available ... teeth or become infected. It can also invite bacteria that lead to gum disease. Click here to ... teeth or become infected. It can also invite bacteria that lead to gum disease. Click here to ...

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    Full Text Available ... not uncommon. Individuals with a TMJ disorder may experience a variety of symptoms, such as earaches, headaches ... not uncommon. Individuals with a TMJ disorder may experience a variety of symptoms, such as earaches, headaches ...

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  8. Corrective Jaw Surgery

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    Full Text Available ... Oral Pathology Obstructive Sleep Apnea TMJ and Facial Pain Treatment of Facial Injury Wisdom Teeth Management Procedures Administration of Anesthesia Administration of Anesthesia ...

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    Full Text Available ... education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and ... education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and ...

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  12. Corrective Jaw Surgery

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    Full Text Available ... Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth or become infected. It can also ... Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth or become infected. It can also ...

  13. Corrective Jaw Surgery

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    Full Text Available ... more. Treatment of Facial Injury Treatment of Facial Injury Facial trauma injuries include fractures of the upper ... more. Treatment of Facial Injury Treatment of Facial Injury Facial trauma injuries include fractures of the upper ...

  14. Corrective Jaw Surgery

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    Full Text Available ... skin, muscle, bone and cartilage finely attune the oral and maxillofacial surgeon to the need for harmony between facial appearance and function. As ... skin, muscle, bone and cartilage finely attune the oral and maxillofacial surgeon to the need for harmony between facial appearance and function. As ...

  15. Corrective Jaw Surgery

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  16. Corrective Jaw Surgery

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  17. Corrective Jaw Surgery

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    Full Text Available ... a Surgeon What We Do Administration of Anesthesia Administration of Anesthesia Oral and maxillofacial surgeons are extensively ... Injury Wisdom Teeth Management Procedures Administration of Anesthesia Administration of Anesthesia Oral and maxillofacial surgeons are extensively ...

  18. Corrective Jaw Surgery

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    Full Text Available ... Extensive education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral ... Extensive education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral ...

  19. Corrective Jaw Surgery

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    Full Text Available ... Extensive education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral ... Extensive education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral ...

  20. Corrective Jaw Surgery

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    Full Text Available ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ... to find out more. Obstructive Sleep Apnea Obstructive Sleep Apnea Obstructive sleep apnea (OSA) is a serious ...

  1. Corrective Jaw Surgery

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  2. Corrective Jaw Surgery

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  3. Corrective Jaw Surgery

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    Full Text Available ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth ... find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring teeth ...

  4. Corrective Jaw Surgery

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  5. Corrective Jaw Surgery

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  6. Corrective Jaw Surgery

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  7. Corrective Jaw Surgery

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  8. Corrective Jaw Surgery

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    Full Text Available ... more. Treatment of Facial Injury Treatment of Facial Injury Facial trauma injuries include fractures of the upper ... more. Treatment of Facial Injury Treatment of Facial Injury Facial trauma injuries include fractures of the upper ...

  9. Corrective Jaw Surgery

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  10. Applications in spinal imbalance.

    Science.gov (United States)

    Husson, J-L; Mallet, J-F; Parent, H; Cavagna, R; Vital, J-M; Blamoutier, A; Violas, P

    2010-05-04

    The pelvis may be seen as a single vertebra, between the spine and the femurs. The anatomy of this pelvic vertebra has changed with the evolution of species, notably with the transition to bipedalism, with the consequent appearance of lumbar lordosis. The lumbosacral angle, almost non-existent in other mammals, is at its greatest in humans. Pelvic and spinal radiological parameters reflect the sagittal balance of the spine in bipedal humanity. Applications in the management of spinal imbalance are numerous. Arthrogenic or degenerative kyphosis is the stereotypic example of spinal aging. Postoperative flat back following spine surgery is hard to prevent. Scoliosis surgery in adults should now take greater account of the patient's individual sagittal balance, by analyzing the pelvic and spinal parameters. The extent of arthrodeses performed during adolescence to manage idiopathic scoliosis may also induce problems of balance in adulthood if these elements are not taken into account. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  11. The utility of erythrocyte sedimentation rate values and white blood cell counts after spinal deformity surgery in the early (≤3 months) post-operative period.

    Science.gov (United States)

    Kuhn, Margaret G; Lenke, Lawrence G; Bridwell, Keith H; O'Donnell, June C; Luhmann, Scott J

    2012-03-01

    The erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count are frequently obtained in the work-up of post-operative fever. However, their diagnostic utility depends upon comparison with normative peri-operative trends which have not yet been described. The purpose of this study is to define a range of erythrocyte sedimentation rates and white blood cell counts following spinal instrumentation and fusion in non-infected patients. Seventy-five patients underwent spinal instrumentation and fusion. The erythrocyte sedimentation rate and white blood cell count were recorded pre-operatively, at 3 and 7 days post-operatively, and at 1 and 3 months post-operatively. Both erythrocyte sedimentation rate and white blood cell count trends demonstrated an early peak, followed by a gradual return to normal. Peak erythrocyte sedimentation rates occurred within the first week post-operatively in 98% of patients. Peak white blood cell counts occurred with the first week in 85% of patients. In the absence of infection, the erythrocyte sedimentation rate was abnormally elevated in 78% of patients at 1 month and in 53% of patients at 3 months post-operatively. The white blood cell count was abnormally elevated in only 6% of patients at 1 month post-operatively. Longer surgical time was associated with elevated white cell count at 1 week post-operatively. The fusion of more vertebral levels had a negative relationship with elevated erythrocyte sedimentation rate at 1 week post-operatively. The anterior surgical approach was associated with significantly lower erythrocyte sedimentation rate at 1 month post-operatively and with lower white cell count at 1 week post-operatively. In non-infected spinal fusion surgeries, erythrocyte sedimentation rates are in the abnormal range in 78% of patients at 1 month and in 53% of patients at 3 months post-operatively, suggesting that the erythrocyte sedimentation rate is of limited diagnostic value in the early post

  12. Spinal Cord Monitoring Data in Pediatric Spinal Deformity Patients With Spinal Cord Pathology.

    Science.gov (United States)

    Aleem, Alexander W; Thuet, Earl D; Padberg, Anne M; Wallendorf, Michael; Luhmann, Scott J

    2015-01-01

    Retrospective. The purpose of this study is to review the efficacy of monitoring data and outcomes in pediatric patients with spinal cord pathology. The incidence of spinal cord pathology in pediatric patients with scoliosis has been reported between 3% and 20%. Previous studies demonstrated that intraoperative spinal cord monitoring (IOM) during scoliosis surgery can be reliable despite underlying pathology. A single-center retrospective review of 119 spinal surgery procedures in 82 patients with spinal cord pathology was performed. Diagnoses included Arnold-Chiari malformation, syringomyelia, myelomeningocele, spinal cord tumor, tethered cord, and diastematomyelia. Baseline neurologic function and history of prior neurosurgical intervention were identified. Outcome measures included ability to obtain reliable monitoring data during surgery and presence of postoperative neurologic deficits. Results were compared for 82 patients with adolescent idiopathic scoliosis (AIS). Usable IOM data were obtained in 82% of cases (97/119). Twenty-two cases (18%) had no lower extremity data. Patients with Arnold-Chiari malformation or syringomyelia pathologies, in isolation or together, had a significantly higher rate of reliable data compared to other pathologies (p < .0001). Among study group cases with usable data, there were 1 false negative (1%) and 4 true positive (4%) outcomes. There were no permanent neurologic deficits. The spinal cord pathology group demonstrated 80% sensitivity and 92% specificity. Spinal cord monitoring is a valuable tool in pediatric patients with spinal cord pathology undergoing spinal deformity surgeries. When obtained, data allow to detect changes in spinal cord function. Patients with a diagnosis of Arnold-Chiari or syringomyelia have monitoring data similar to those patients with AIS. Patients with other spinal cord pathologies have less reliable data, and surgeons should have a lower threshold for performing wake-up tests to assess spinal cord

  13. The evaluation of effects two different doses of hydrocortisone on the intensity of perioperative shivering in elective surgery under spinal anesthesia: A double-blind randomized controlled trial study

    Directory of Open Access Journals (Sweden)

    Mohammadreza Safavi

    2016-01-01

    Full Text Available Background: Post- and intra-operative shivering is one of the most complications of spinal anesthesia so recommend a suitable drug with at least complications for prevention and control of postoperative shivering. This current study aimed to compare the preventive effect of hydrocortisone on intra- and post-operative shivering in patients undergoing surgery with spinal anesthesia. Materials and Methods: In a clinical trial study, ninety patients who candidate for surgery with spinal anesthesia were selected and randomly divided into three groups. The first and second groups were received 1 mg/kg and 2 mg/kg hydrocortisone, respectively, and the third group was received normal saline, and postoperative shivering was compared between the three groups. Results: The investigation of the incidence of inter- and post-operative shivering in patients in the three groups revealed that within the study period, 31 patients suffered from shivering among which 9, 5, and 17 cases were in 1 mg/kg hydrocortisone group, 2 mg/kg hydrocortisone group, and placebo group, respectively, and according to the Chi-square test, the difference among the three groups was significant (P = 0.004. Conclusion: According to the obtained results, the overall conclusion of the study is that using hydrocortisone at least with the dose of 1 mg/kg as a preventive drug reduced the incidence of intra- and post-operative shivering with spinal anesthesia.

  14. Refractive corneal surgery - discharge

    Science.gov (United States)

    Nearsightedness surgery - discharge; Refractive surgery - discharge; LASIK - discharge; PRK - discharge ... You had refractive corneal surgery to help improve your vision. This surgery uses a laser to reshape your cornea. It corrects mild-to-moderate nearsightedness, ...

  15. Intrafraction Prostate Translations and Rotations During Hypofractionated Robotic Radiation Surgery: Dosimetric Impact of Correction Strategies and Margins

    Energy Technology Data Exchange (ETDEWEB)

    Water, Steven van de, E-mail: s.vandewater@erasmusmc.nl [Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam (Netherlands); Valli, Lorella [Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam (Netherlands); Alma Mater Studiorum, Department of Physics and Astronomy, Bologna University, Bologna (Italy); Aluwini, Shafak [Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam (Netherlands); Lanconelli, Nico [Alma Mater Studiorum, Department of Physics and Astronomy, Bologna University, Bologna (Italy); Heijmen, Ben; Hoogeman, Mischa [Erasmus MC Cancer Institute, Department of Radiation Oncology, Rotterdam (Netherlands)

    2014-04-01

    Purpose: To investigate the dosimetric impact of intrafraction prostate motion and the effect of robot correction strategies for hypofractionated CyberKnife treatments with a simultaneously integrated boost. Methods and Materials: A total of 548 real-time prostate motion tracks from 17 patients were available for dosimetric simulations of CyberKnife treatments, in which various correction strategies were included. Fixed time intervals between imaging/correction (15, 60, 180, and 360 seconds) were simulated, as well as adaptive timing (ie, the time interval reduced from 60 to 15 seconds in case prostate motion exceeded 3 mm or 2° in consecutive images). The simulated extent of robot corrections was also varied: no corrections, translational corrections only, and translational corrections combined with rotational corrections up to 5°, 10°, and perfect rotational correction. The correction strategies were evaluated for treatment plans with a 0-mm or 3-mm margin around the clinical target volume (CTV). We recorded CTV coverage (V{sub 100%}) and dose-volume parameters of the peripheral zone (boost), rectum, bladder, and urethra. Results: Planned dose parameters were increasingly preserved with larger extents of robot corrections. A time interval between corrections of 60 to 180 seconds provided optimal preservation of CTV coverage. To achieve 98% CTV coverage in 98% of the treatments, translational and rotational corrections up to 10° were required for the 0-mm margin plans, whereas translational and rotational corrections up to 5° were required for the 3-mm margin plans. Rectum and bladder were spared considerably better in the 0-mm margin plans. Adaptive timing did not improve delivered dose. Conclusions: Intrafraction prostate motion substantially affected the delivered dose but was compensated for effectively by robot corrections using a time interval of 60 to 180 seconds. A 0-mm margin required larger extents of additional rotational corrections than a 3

  16. Spinal tuberculosis: A review

    Science.gov (United States)

    Garg, Ravindra Kumar; Somvanshi, Dilip Singh

    2011-01-01

    Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a ‘cold’ abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good. PMID:22118251

  17. Registration of 2D C-Arm and 3D CT Images for a C-Arm Image-Assisted Navigation System for Spinal Surgery

    Directory of Open Access Journals (Sweden)

    Chih-Ju Chang

    2015-01-01

    Full Text Available C-Arm image-assisted surgical navigation system has been broadly applied to spinal surgery. However, accurate path planning on the C-Arm AP-view image is difficult. This research studies 2D-3D image registration methods to obtain the optimum transformation matrix between C-Arm and CT image frames. Through the transformation matrix, the surgical path planned on preoperative CT images can be transformed and displayed on the C-Arm images for surgical guidance. The positions of surgical instruments will also be displayed on both CT and C-Arm in the real time. Five similarity measure methods of 2D-3D image registration including Normalized Cross-Correlation, Gradient Correlation, Pattern Intensity, Gradient Difference Correlation, and Mutual Information combined with three optimization methods including Powell’s method, Downhill simplex algorithm, and genetic algorithm are applied to evaluate their performance in converge range, efficiency, and accuracy. Experimental results show that the combination of Normalized Cross-Correlation measure method with Downhill simplex algorithm obtains maximum correlation and similarity in C-Arm and Digital Reconstructed Radiograph (DRR images. Spine saw bones are used in the experiment to evaluate 2D-3D image registration accuracy. The average error in displacement is 0.22 mm. The success rate is approximately 90% and average registration time takes 16 seconds.

  18. Cervical spinal meningioma mimicking intramedullary spinal tumor.

    Science.gov (United States)

    Senturk, Senem; Guzel, Aslan; Guzel, Ebru; Bayrak, Aylin Hasanefendioğlu; Sav, Aydin

    2009-01-01

    Case report. To report a very unusual spinal meningioma, mimicking an intramedullary spinal tumor. Spinal meningiomas, usually associated with signs and symptoms of cord or nerve root compression, are generally encountered in women aged over 40. Radiologic diagnosis is often established by their intradural extramedullary location on magnetic resonance images. A 60-year-old woman had a 6-month history of progressive weakness in her upper extremities, difficulty in walking, and cervical pain radiating through both arms. Neurologic examination revealed motor strength deficiency in all her extremities, with extensor reflexes, clonus, and bilateral hyper-reflexiveness. A sensory deficit was present all over her body. Magnetic resonance images revealed that the spinal cord appeared expanded with an ill-defined, homogeneously contrast-enhanced, lobulated, eccentric mass at the C1-C3 level. The patient was operated with a preliminary diagnosis of an intramedullary tumor. At surgery, the mass was found to be extramedullary, and gross total resection was performed. Histopathological examination revealed a meningioma characterized by the presence of fibrous and meningothelial components. The patient was able to ambulate with a cane, and extremity strength and sensation improved 2 months after surgery. Spinal meningiomas can mimic intramedullary tumors, and should be considered in differential diagnosis of intradural tumors with atypical appearance.

  19. Subcutaneous C Shape Muscular Flap for Correcting the Depression of Alar Base in Affected Side in Patients With Unilateral Complete Cleft Lip/Palate During Primary Surgery.

    Science.gov (United States)

    Wu, Dandan; Wang, Guomin; Ouyang, Ningjuan; Lin, Yuhen; Chen, Yang; Dai, Jiewen

    2017-06-01

    The depression of alar base in affected side in patients with unilateral complete cleft lip/palate (CL/P) is one of common clinical features. In this study, the authors try to explore the effect of subcutaneous C shape muscular flap for correcting the depression of alar base in affected side in patients with unilateral complete CL/P during primary surgery. A total of 30 patients with unilateral complete CL/P who received primary correction of the lip nose deformity were included in this study. The C flap was used to drop and lengthen the height of upper lip in unaffected side, and the subcutaneous muscular flap was dissected from the C flap and positioned at the alar base in the affected side of upper lip to correct the depression. Then the surgical effect was evaluated based on clinical examination during follow-up. Alar base symmetry was obtained in 26 patients of this case series, and 4 patients showed slight improvement in alar base symmetry. No major complications such as flap necrosis, infection, or hypertrophic scars were observed during surgery and follow-up. No additional incisions and operative time were necessary. The subcutaneous C shape muscular flap described in this article could offer enough muscular support and markedly correct the depression of nostril and alar base in affected side in primary lip nose repair with no additional incisions and operative time for patients with unilateral complete CL/P.

  20. Ogilvie′s syndrome following posterior spinal arthrodesis for scoliosis

    Directory of Open Access Journals (Sweden)

    Athanasios I Tsirikos

    2013-01-01

    Full Text Available We report Ogilvie′s syndrome following posterior spinal arthrodesis on a patient with thoracic and lumbar scoliosis associated with intraspinal anomalies. Postoperative paralytic ileus can commonly complicate scoliosis surgery. Ogilvie′s syndrome as a cause of abdominal distension and pain has not been reported following spinal deformity correction and can mimic post-surgical ileus. 12 year old female patient with double thoracic and lumbar scoliosis associated with Arnold-Chiari 1 malformation and syringomyelia. The patient underwent posterior spinal fusion from T 4 to L 3 with segmental pedicle screw instrumentation and autogenous iliac crest grafting. She developed abdominal distension and pain postoperatively and this deteriorated despite conservative management. Repeat ultrasounds and abdominal computer tomography scans ruled out mechanical obstruction. The clinical presentation and blood parameters excluded toxic megacolon and cecal volvulus. As the symptoms persisted, a laparotomy was performed on postoperative day 16, which demonstrated ragged tears of the colon and cecum. A right hemi-colectomy followed by ileocecal anastomosis was required. The pathological examination of surgical specimens excluded inflammatory bowel disease and vascular abnormalities. The patient made a good recovery following bowel surgery and at latest followup 3.2 years later she had no abdominal complaints and an excellent scoliosis correction. Ogilvie′s syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after scoliosis correction. Early diagnosis and instigation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

  1. Comparison of best versus worst clinical outcomes for adult spinal deformity surgery: a retrospective review of a prospectively collected, multicenter database with 2-year follow-up.

    Science.gov (United States)

    Smith, Justin S; Shaffrey, Christopher I; Lafage, Virginie; Schwab, Frank; Scheer, Justin K; Protopsaltis, Themistocles; Klineberg, Eric; Gupta, Munish; Hostin, Richard; Fu, Kai-Ming G; Mundis, Gregory M; Kim, Han Jo; Deviren, Vedat; Soroceanu, Alex; Hart, Robert A; Burton, Douglas C; Bess, Shay; Ames, Christopher P

    2015-09-01

    Although recent studies suggest that average clinical outcomes are improved following surgery for selected adult spinal deformity (ASD) patients, these outcomes span a broad range. Few studies have specifically addressed factors that may predict favorable clinical outcomes. The objective of this study was to compare patients with ASD with best versus worst clinical outcomes following surgical treatment to identify distinguishing factors that may prove useful for patient counseling and optimization of clinical outcomes. This is a retrospective review of a prospectively collected, multicenter, database of consecutively enrolled patients with ASD who were treated operatively. Inclusion criteria were age > 18 years and ASD. For patients with a minimum of 2-year follow-up, those with best versus worst outcomes were compared separately based on Scoliosis Research Society-22 (SRS-22) and Oswestry Disability Index (ODI) scores. Only patients with a baseline SRS-22 ≤ 3.5 or ODI ≥ 30 were included to minimize ceiling/floor effects. Best and worst outcomes were defined for SRS-22 (≥ 4.5 and ≤ 2.5, respectively) and ODI (≤ 15 and ≥ 50, respectively). Of 257 patients who met the inclusion criteria, 227 (88%) had complete baseline and 2-year follow-up SRS-22 and ODI outcomes scores and radiographic imaging and were analyzed in the present study. Of these 227 patients, 187 had baseline SRS-22 scores ≤ 3.5, and 162 had baseline ODI scores ≥ 30. Forthe SRS-22, best and worst outcomes criteria were met at follow-up for 25 and 27 patients, respectively. For the ODI, best and worst outcomes criteria were met at follow-up for 43 and 51 patients, respectively. With respect to the SRS-22, compared with best outcome patients, those with worst outcomes had higher baseline SRS-22 scores (p best-fit multivariate model for SRS-22 included baseline SRS-22 (p = 0.033), baseline depression (p = 0.012), and complications (p = 0.030). With respect to the ODI, compared with best

  2. Intrathecal dexmedetomidine as adjuvant for spinal anaesthesia for perianal ambulatory surgeries: A randomised double-blind controlled study

    Directory of Open Access Journals (Sweden)

    S S Nethra

    2015-01-01

    Full Text Available Background and Aim: The newer trend in regional anaesthesia for ambulatory anorectal surgeries advocate use of lower dose of local anaesthetic, providing segmental block with adjuvants such as opioids and α2 agonists to prolong analgesia. The current study investigated effects of addition of 5 μg of dexmedetomidine to 6 mg of hyperbaric bupivacaine on duration of analgesia, sensory and motor block characteristics for perianal ambulatory surgeries. Methods: This study is a prospective randomised controlled double blind study. Forty adult patients between 18 and 55 years of age were divided into 2 groups. Group D received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml with injection dexmedetomidine 5 μg in 0.5 ml of normal saline and Group N received intrathecal 0.5% hyperbaric bupivacaine 6 mg (1.2 ml with 0.5 ml of normal saline. The parameters assessed were time to regression of sensory blockade, motor blockade, ambulation, time to void, first administration of analgesic. Statistical analysis was done using appropriate tests. Results: Time for regression of sensory level and time for first administration of analgesic were prolonged in Group D (430.05 ± 89.13 min, 459.8 ± 100.9 min, respectively in comparison to Group N (301.10 ± 94.86 min, 321.85 ± 95.08 min, respectively. However, the duration of motor blockade, time to ambulation, and time to void were also significantly prolonged in Group D (323.05 ± 54.58 min, 329.55 ± 54.06 min, 422.30 ± 87.59 min than in Group N (220.10 ± 63.61 min, 221.60 ± 63.84 min, 328.45 ± 113.38 min. Conclusion: Intrathecal dexmedetomidine 5 μg added to intrathecal bupivacaine 6 mg as adjuvant may not be suitable for ambulatory perianal surgeries due to prolongation of motor blockade.

  3. [Postoperative findings in the spinal column].

    Science.gov (United States)

    Lieb, J M; Ulmer, S; Kelm, J; Shariat, K; Stippich, C; Ahlhelm, F J

    2011-09-01

    Postoperative imaging after spinal surgery is usually performed to document the correct positioning of implants or to rule out complications if patients still suffer from pain after surgery. Depending on the question various imaging modalities can be used all of which have benefits and limitations. Conventional X-ray is used for the documentation of the correct positioning of spinal implants, stability (olisthesis) and during follow-up to rule out fractures or instability of the implants, whereas soft tissue changes cannot be completely assessed. Besides these indications, imaging is usually performed because of ongoing symptoms (pain for the most part) of the patients. Soft tissue changes including persistent or recurrent herniated disc tissue, hematoma or infection can best be depicted using magnetic resonance imaging (MRI) which should be performed within the immediate postoperative period to be able to distinguish physiological development of scar tissue from inflammatory changes in the area of the surgical approach. Often imaging alone cannot differentiate between these and imaging can therefore only be considered as an adjunct. Computed tomography is the modality of choice for the evaluation of bony structures and an adjunct of new therapies such as image-guided application of cement for kyphoplasty or vertebroplasty.

  4. The effect of impregnated autogenous epidural adipose tissue with bupivacaine, methylprednisolone acetate or normal saline on postoperative radicular and low back pain in lumbar disc surgery under spinal anesthesia; A randomized clinical trial study FNx01

    Directory of Open Access Journals (Sweden)

    Saeid Abrishamkar

    2011-01-01

    Full Text Available Background: Low Back Pain (LBP and radicular leg pain (RLP after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT with bupivacaine or methylprednisolone acetate on reduction of late postoperative pain after spinal anesthesia. Methods: This study was performed on lumbar disc herniation surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group 1, methylprednisolone acetate (group2 and normal saline (control group. The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS. Results: Of 66 patients, 53% were female and 47% male. The average (SE LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively. Conclusions: According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery.

  5. The effect of impregnated autogenous epidural adipose tissue with bupivacaine, methylprednisolone acetate or normal saline on postoperative radicular and low back pain in lumbar disc surgery under spinal anesthesia; A randomized clinical trial study*

    Science.gov (United States)

    Abrishamkar, Saeid; Rafiei, Ahmad Reza; Sabouri, Masih; Moradi, Siamak; Tabesh, Homayoun; Rahmani, Payman; Hekmatnia, Ali; Torkashvand, Mostafa; Eshraghi, Noorolah; Baghershahi, Ghasem

    2011-01-01

    BACKGROUND: Low Back Pain (LBP) and radicular leg pain (RLP) after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT) with bupivacaine or methylprednisolone acetate on reduction of late postoperative pain after spinal anesthesia. METHODS: This study was performed on lumbar disc herniation surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group 1), methylprednisolone acetate (group2) and normal saline (control group). The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS). RESULTS: Of 66 patients, 53% were female and 47% male. The average (SE) LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively. CONCLUSIONS: According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery. PMID:22091284

  6. The effect of administering ketoprofen on the physiology and behavior of dairy cows following surgery to correct a left displaced abomasum.

    Science.gov (United States)

    Newby, Nathalie C; Pearl, David L; LeBlanc, Stephen J; Leslie, Ken E; von Keyserlingk, Marina A G; Duffield, Todd F

    2013-03-01

    Surgical correction of left displaced abomasum (LDA) is common in lactating dairy cattle. Despite the growing acceptance that abdominal surgery is painful, few cows are administered analgesia following LDA surgery. The objective of this research was to examine the effect of administering a label dose of ketoprofen on physiological and behavioral indicators of pain in dairy cattle. Holstein cows were enrolled in a field study following LDA surgery. Surgery was performed using the standing right flank (RF) approach or the paramedian (PARA) approach. Using a triple-blind randomized trial, each animal was assigned to receive either 3mg of ketoprofen/kg of body weight or saline (the equivalent volume) by intramuscular injection immediately following surgery and 24h postoperatively. Physiological parameters (heart rate, respiration rate, and rumen motility), blood β-hydroxybutyrate (BHBA) levels, and an assessment of cow attitude were measured on the day of surgery, and at 2 follow-up visits (visit 1=3 ± 0.9 d and visit 2=9 ± 1.2 d postsurgery; n=175). Milk production and culling were recorded for all cows enrolled in the study. Producers assessed their cows' attitudes and appetites daily for the first 3 d following surgery. A subset of cows (n=37) were fitted on the day of surgery with a 3-axis accelerometer on the hind leg to assess lying behavior. Continuous and binary outcome data were analyzed using multivariable mixed linear and mixed logistic models, respectively, with cow modeled as a random effect. Ketoprofen did not alter the physiological measures, BHBA levels, or behavioral outcomes measured. Cows subjected to RF surgery had longer lying times [model coefficient β=228.9 min; 95% confidence interval (CI): 122.2 to 335.6] in the first 3 d following surgery, and lower heart rates (β=-9.4 beats/min; 95% CI: -12 to -6.9 beats/min) at the follow-up visits, compared with animals that underwent PARA surgery. Regardless of surgical procedure, BHBA decreased from

  7. "INTRAOPERATIVE SPINAL STIFFNESS MEASUREMENT IN MANAGEMENT OF SPINAL CANAL STENOSIS "

    Directory of Open Access Journals (Sweden)

    M. Karami

    2005-08-01

    Full Text Available In this study to determine whether spine stiffness is predictive of clinical results after lumbar spinal fusion for spinal stenosis, a total of 78 patients were measured intraoperatively with Kocher clamp manual distraction technique to determine motion segment stiffness then spinal fusion was performed for any loose segment. ‎Statistical analysis revealed that stiffness measurement correlate with clinical results of surgery. During a minimum of 2 years follow up after surgery, patients who had loose motion segment before or after decompression and were fused had the same level of satisfaction with surgical results as patients without loose segments and fusion. ‎We concluded that intraoperative spinal stiffness measurement provide a good indicator to spine fusion after lumbar canal stenosis ‎surgery.

  8. Spinal Cord Stimulation

    DEFF Research Database (Denmark)

    Meier, Kaare

    2014-01-01

    pain after failed back surgery syndrome (FBSS)(4), pain due to peripheral nerve injury, stump pain(5), peripheral vascular disease(6) and diabetic neuropathy(7,8); whereas phantom pain(9), postherpetic neuralgia(10), chronic visceral pain(11), and pain after partial spinal cord injury(12) remain more...

  9. Indium-111 labelled white blood cell scintigraphy in cranial and spinal septic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Medina, M.; Lucano, A. [Div. of Neurosurgery, S. Croce e Carle Hospital, Cuneo (Italy); Viglietti, A.L.; Camuzzini, G. [Service of Nuclear Medicine, S. Croce e Carle Hospital, Cuneo (Italy); Gozzoli, L. [Service of Neuroradiology, S. Croce e Carle Hospital, Cuneo (Italy); Ravasi, L.; Lucignani, G. [INB-CNR, Univ. of Milan, H San Raffaele, Milan (Italy)

    2000-10-01

    Cranial and spinal infections are severe events that require timely diagnosis and treatment. Physical and neurological examination, laboratory tests and radiological imaging may be insufficient for assessing cranial and spinal septic lesions. This study aimed to evaluate the accuracy of indium-111 white blood cell (WBC) scan in assessing the presence of leucocytes in intracranial and spinal lesions, and in the diagnosis, management and follow-up of primary, post-traumatic and post-surgical infections. One hundred and twenty-four subjects were included in the study (48 with post-traumatic or post-surgical lesions, 73 with primary cerebral lesions, and 3 with spinal lesions). All patients underwent a diagnostic work-up including planar scans with {sup 111}In-labelled WBCs, at 4 and 24 h post tracer injection. All subjects underwent surgical treatment. Patients who did not recover from the infection as suggested by clinical evolution underwent further treatment (up to three times) and further WBC scans (up to four times). WBC scintigraphy correctly identified all the areas of leucocyte accumulation, as confirmed after surgery. WBC scintigraphy also correctly excluded the presence of leucocytes in all other lesions, as demonstrated at surgery. The results of this study confirm the accuracy of WBC scan for the assessment of patients with cranial and spinal lesions, in whom the demonstration of leucocyte accumulation can ease the diagnosis of infection, and indicate that the method is also accurate for the follow-up and management of neurosurgical patients. (orig.)

  10. The Effects of Spinal, Inhalation, and Total Intravenous Anesthetic Techniques on Ischemia-Reperfusion Injury in Arthroscopic Knee Surgery

    Directory of Open Access Journals (Sweden)

    Müge Koşucu

    2014-01-01

    Full Text Available Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA, ischemia-modified albumin (IMA and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t1, 30 min after tourniquet inflation (t2, immediately before (t3, and 5 min (t4, 15 min (t5, 30 min (t6, 1 h (t7, 2 h (t8, and 6 h (t9 after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t2–t9 and t2–t7. MDA levels in Group T and Group I were significantly lower than those in Group S at t2–t8 and t2–t9. IMA levels in Group T were significantly lower than those in Group S at t2–t7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.

  11. A COMPARATIVE STUDY OF EFFECT OF 0.5% AND 0.75% ISOBARIC ROPIVACAINE IN SPINAL ANAESTHESIA IN PATIENTS UNDERGOING ELECTIVE LOWER LIMB SURGERIES

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    Tridip Jyoti

    2016-04-01

    Full Text Available OBJECTIVES The study was conducted to compare the differences in the onset, duration of action and complications of intrathecal isobaric ropivacaine 0.5% (Group I and intrathecal isobaric ropivacaine 0.75% (Group II in elective lower limb surgeries. METHODS We enrolled 60 patients of ASA (American Society of Anaesthesiologists Grade I-II scheduled for lower limb surgeries under spinal anaesthesia for this prospective randomized control trial. The patients were randomized to receive either 15 mg of 0.5% isobaric ropivacaine or 22.5 mg of 0.75% isobaric ropivacaine intrathecally. The time of onset of sensory and motor block, haemodynamic status, time for regression of sensory level to T10 dermatome, time of first request of analgesics and adverse effects were compared in both the groups. RESULTS The time of onset of sensory and motor block was significantly longer in Group-I than Group-II (P0.05. The onset of analgesia was faster in Group II (2.13±0.50 mins. than Group I (2.6±0.93 mins.. The time for regression of sensory level to T10 dermatome (Group-I 150±28.9 minutes and Group-II 180±32.07 were statistically longer in Group II (P<0.001. The time of first request of analgesics by the patient in Group-I was 197±31.20 minutes and in Group II was 219±31.66 minutes, which was statistically significant (P<0.001. The onset of motor block was quicker (P˂0.05 and the total duration of motor block was longer (P˂0.05 in Group II. No unexpected adverse events were registered. CONCLUSION The subarachnoid injection of glucose-free isobaric ropivacaine 0.5% and 0.75% solutions results in a variable spread of analgesia, accompanied by a good quality of motor block. Ropivacaine 0.75% produces a better quality of analgesia and longer duration of analgesia than the 0.5% solution.

  12. The role of curcumin as an inhibitor of oxidative stress caused by ischaemia re-perfusion injury in tetralogy of Fallot patients undergoing corrective surgery.

    Science.gov (United States)

    Sukardi, Rubiana; Sastroasmoro, Sudigdo; Siregar, Nurjati C; Djer, Mulyadi M; Suyatna, Fransciscus D; Sadikin, Mohammad; Ibrahim, Nurhadi; Rahayuningsih, Sri E; Witarto, Arief B

    2016-03-01

    Cardiopulmonary bypass during tetralogy of Fallot corrective surgery is associated with oxidative stress, and contributes to peri-operative problems. Curcumin has been known as a potent scavenger of reactive oxygen species, which enhances the activity of antioxidants and suppresses phosphorylation of transcription factors involved in inflamation and apoptosis. To evaluate the effects of curcumin as an antioxidant by evaluating the concentrations of malondialdehyde and glutathione, activity of nuclear factor-kappa B, c-Jun N-terminal kinase, caspase-3, and post-operative clinical outcomes. Tetralogy of Fallot patients for corrective surgery were randomised to receive curcumin (45 mg/day) or placebo orally for 14 days before surgery. Malondialdehyde and glutathione concentrations were evaluated during the pre-ischaemia, ischaemia, re-perfusion phases, and 6 hours after aortic clamping-off. Nuclear factor-kappa B, c-Jun N-terminal kinase, and caspase-3, taken from the infundibulum, were assessed during the pre-ischaemia, ischaemia, and re-perfusion phases. Haemodynamic parameters were monitored until day 5 after surgery. In all the observation phases, malondialdehyde and glutathione concentrations were similar between groups. There was no significant difference in nuclear factor-kappa B activity between the groups for three observations; however, in the curcumin group, c-Jun N-terminal kinase significantly decreased from the pre-ischaemia to the re-perfusion phases, and caspase-3 expression was lower in the ischaemia phase. Patients in the curcumin group had lower temperature and better ventricular functions, but no significant differences were found in mechanical ventilation day or length of hospital stay in the two groups. Cardioprotective effects of curcumin may include inhibition of the c-Jun N-terminal kinase pathway and caspase-3 in cardiomyocytes, particularly in the ischaemia phase.

  13. A simple bracing technique to correct kinking of arterial branches to avoid ischemic sequelae during neurovascular surgery

    Directory of Open Access Journals (Sweden)

    Yasushi Motoyama

    2016-01-01

    Conclusion: The insertion of prostheses with fibrin glue into the crotch of a kinked artery for repair is considered a simple and useful method for correcting a kinked artery that avoids ischemic sequelae.

  14. Symptomatic Thromboembolism as an Uncommon Postoperative Complication in Young Patients with Spinal Deformity

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    Farzad Omidi-Kashani

    2014-06-01

    Conclusion: Despite the rarity of thromboembolism after surgery for major spinal deformities in young patients, the possibility still exists, and patients with a positive history of anterior spinal surgery or poor posturing are probably more susceptible.

  15. [Anesthesia for the surgery of delayed postoperative stenosis in the pulmonary suture in children with corrected transposition of the great vessels with Jatene's technique].

    Science.gov (United States)

    Suán, C; Cerro, J; Ojeda, R; García-Perla, J L

    1996-11-01

    Any patient with congenital heart disease is at high risk for anesthesia no matter what surgical procedure is performed. Children undergoing D-transposition of the great arteries using Jatene's technique present stenosis of the pulmonary artery in 10-20% of cases and may require surgery to correct that or some other surgically caused anomally. In either case the children must be managed as patients with heart disease, with special attention to cardiovascular depression and rhythm abnormalities. We report the cases of two children who underwent D-transposition of the great arteries in the neonatal period using Jatene's anatomical technique. They were later anesthetized at ages 5 and 6 years to correct pulmonary suture stenosis. Recovery was good.

  16. Spinal instability in ankylosing spondylitis

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    Badve Siddharth

    2010-01-01

    Full Text Available Background: Unstable spinal lesions in patients with ankylosing spondylitis are common and have a high incidence of associated neurological deficit. The evolution and presentation of these lesions is unclear and the management strategies can be confusing. We present retrospective analysis of the cases of ankylosing spondylitis developing spinal instability either due to spondylodiscitis or fractures for mechanisms of injury, presentations, management strategies and outcome. Materials and Methods: In a retrospective analysis of 16 cases of ankylosing spondylitis, treated surgically for unstable spinal lesions over a period of 12 years (1995-2007; 87.5% (n=14 patients had low energy (no obvious/trivial trauma while 12.5% (n=2 patients sustained high energy trauma. The most common presentation was pain associated with neurological deficit. The surgical indications included neurological deficit, chronic pain due to instability and progressive deformity. All patients were treated surgically with anterior surgery in 18.8% (n=3 patients, posterior in 56.2% (n=9 patients and combined approach in 25% (n=4 patients. Instrumented fusion was carried out in 87.5% (n=14 patients. Average surgical duration was 3.84 (Range 2-7.5 hours, blood loss 765.6 (± 472.5 ml and follow-up 54.5 (Range 18-54 months. The patients were evaluated for pain score, Frankel neurological grading, deformity progression and radiological fusion. One patient died of medical complications a week following surgery. Results: Intra-operative adverse events like dural tears and inadequate deformity correction occurred in 18.7% (n=3 patients (Cases 6, 7 and 8 which could be managed conservatively. There was a significant improvement in the Visual analogue score for pain from a pre-surgical median of 8 to post-surgical median of 2 (P=0.001, while the neurological status improved in 90% (n=9 patients among those with preoperative neurological deficit who could be followed-up (n =10. Frankel

  17. 经后路全脊椎切除术治疗严重僵硬性脊柱畸形的手术策略%Surgical strategy of posterior vertebral column resection to correct severe rigid spinal deformity

    Institute of Scientific and Technical Information of China (English)

    解京明; 王迎松; 施志约; 赵智; 李韬; 张颖; 毕尼

    2015-01-01

    挑战,有赖于有效的围手术期处理、严密的手术策略及紧密协作的团队。%Background: It was considered that the surgical treatment for severe rigid spinal deformity was a restricted zone, which would face huge challenges and risks. Objective:To summarize the surgical strategy of posterior vertebral column resection (PVCR) to correct severe rigid spinal deformity in our center. Methods:A total of 105 consecutive patients undergoing PVCR for severe rigid deformity from October 2004 to December 2013 were reviewed. There were 47 males and 58 females with an average age of 18.9 years (range, 10-45 years). The flexi-bility of major curve of scoliosis was less than 10%in all patients. The major curve of scoliosis was larger than 150° in 12 patients who were treated with skull-femoral traction in supine position for 4 weeks before surgery. Demographic data, med-ical and surgical histories, perioperative and final follow-up radiographic measurements, and prevalence of perioperative complications were reviewed. Results:The mean operating time was (602±132) min and intraoperative blood loss was (4694±1794) ml. The mean major curve of scoliosis was 108.9° ± 25.5° and 36.6° ± 15.7° before and after PVCR, respectively, and the mean kyphosis was 88.8° ± 31.1° and 29.9° ± 14.1° . In the 12 patients with the curve greater than 150° , the mean major curve of scoliosis was 152.5°±14.3°, 141.8°±16.3°, 93.4°±14.0°, 47.2°±7.2° in standing position before surgery, in supine position before traction, at 4 weeks after traction in supine position and in standing position after surgery, respectively; the kyphosis was 109.3° ± 42.3°, 98.9°±40.0°, 67.3°±22.2°, and 32.2°±9.5°, respectively. The major curve of scoliosis and kyphosis after 4-week trac-tion in supine position were significantly improved when compared with before traction (P<0.05). Transient neurological complications occurred in 7 cases and nerve function recovered

  18. A predictive model of suitability for minimally invasive parathyroid surgery in the treatment of primary hyperparathyroidism [corrected].

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2012-05-01

    Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient\\'s suitability for minimally invasive surgery.

  19. Ultrasonography and magnetic resonance imaging evaluation of pediatric spinal anomalies

    Directory of Open Access Journals (Sweden)

    Dhaval Durlabhbhai Dhingani

    2016-01-01

    Full Text Available Context: Spinal dysraphisms are congenital abnormalities of the spine due to imperfect fusion of midline mesenchymal, bony and neural structures. Imaging plays a vital role in their evaluation as significant portion of patients may present with concurrent anomalies that need to be corrected simultaneously to avoid repeat surgeries. Aims: The aims of the study were to evaluate Spinal dysraphisms using USG and MRI and to correlate imaging findings with operative findings in patients undergoing surgery. Settings and Design: Hospital based observational study conducted over a period of year. Materials and Methods: 38 cases of both sexes and below 12 years of age with spinal dysraphism were studied. USG was performed in 29 cases where acoustic window was available for proper evaluation. MRI was performed in all cases. USG findings were compared with MRI findings and operative follow up was taken in 23 cases who underwent operative management. Statistical Analysis Used: Results were analysed using percentage and arithmetic mean. Results: 39.47 % cases were male and 60.53 % cases were female. Neonatal period was the most common presenting age group. Closed spinal dysraphism (63.16% was more common than open (36.84%. 79.31% cases showed full agreement between spinal USG and MRI examinations and 6 out of 20.69% showed partial agreement. On operative correlation, USG findings were confirmatory in 91.30% cases and MRI findings were confirmatory in 100% cases. Conclusions: USG can be used as the initial modality for evaluation of spinal dysraphism as well as for screening of suspected cases. MRI is indicated to confirm abnormal USG findings, which shows all concurrent abnormalities and also provides additional anatomical details relevant to surgical planning.

  20. The use of LiDCO based fluid management in patients undergoing hip fracture surgery under spinal anaesthesia: Neck of femur optimisation therapy - targeted stroke volume (NOTTS: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Moran Chris G

    2011-09-01

    Full Text Available Abstract Background Approximately 70,000 patients/year undergo surgery for repair of a fractured hip in the United Kingdom. This is associated with 30-day mortality of 9% and survivors have a considerable length of acute hospital stay postoperatively (median 26 days. Use of oesophageal Doppler monitoring to guide intra-operative fluid administration in hip fracture repair has previously been associated with a reduction in hospital stay of 4-5 days. Most hip fracture surgery is now performed under spinal anaesthesia. Oesophageal Doppler monitoring may be unreliable in the presence of spinal anaesthesia and most patients would not tolerate the probes. An alternative method of guiding fluid administration (minimally-invasive arterial pulse contour analysis has been shown to reduce length of stay in high-risk surgical patients but has never been studied in hip fracture surgery. Methods Single-centre randomised controlled parallel group trial. Randomisation by website using computer generated concealed tables. Setting: University hospital in UK. Participants: 128 patients with acute primary hip fracture listed for operative repair under spinal anaesthesia and aged > 65 years. Intervention: Stroke volume guided intra-operative fluid management. Continuous measurement of SV recorded by a calibrated cardiac output monitor (LiDCOplus. Maintenance fluid and 250 ml colloid boluses given to achieve sustained 10% increases in stroke volume. Control group: fluid administration at the responsible (blinded anaesthetist's discretion. The intervention terminates at the end of the surgical procedure and post-operative fluid management is at the responsible anaesthetist's discretion. Primary outcome: length of acute hospital stay is determined by a blinded team of clinicians. Secondary outcomes include number of complications and total cost of care. Funding NIHR/RfPB: PB-PG-0407-13073. Trial registration number Trial registration: Current Controlled Trials ISRCTN

  1. Management of unstable spinal fractures with segmental spinal instrumentation (VSP System : Results at 5 year follow up

    Directory of Open Access Journals (Sweden)

    Sen Dipankar

    2005-01-01

    Full Text Available Background: Pedicle screw instrumentation has been widely used for spinal stabilisation following spinal injury with variable results. The controversial points associated with spinal injury are effects of canal compromise and decompression on neurological status. Methods: Thirty four patients of unstable thoraco-lumbar fracture with or without neuro-deficit were treated by decompression and stabilisation with VSP system and followed up for 22 - 39 months (mean 29 months. The results were evaluated by neurological recovery (ASIA score, pain relief, loss of surgical correction and functional rehabilitation (FIM score. Results: We achieved a mean post-operative correction of the kyphotic deformity by 14 degrees and an average gain of 30.2% in the canal diameter by decompression. However no correlation was established between degree of canal compromise before or after the surgery with the final neurological outcome. Conclusion: Although the infrastructure for spinal injury management in developing countries is inadequate in many aspects, we find that it is still possible to achieve results, which are comparable with standard literature by adequate decompression and stabilisation followed by appropriate rehabilitation according to the social and cultural demands of the patients.

  2. Medicolegal cases for spinal epidural hematoma and spinal epidural abscess.

    Science.gov (United States)

    French, Keisha L; Daniels, Eldra W; Ahn, Uri M; Ahn, Nicholas U

    2013-01-01

    Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider. The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control. All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases.

  3. Still living with fistula: an exploratory study of the experience of women with obstetric fistula following corrective surgery in West Pokot, Kenya.

    Science.gov (United States)

    Khisa, Anne M; Nyamongo, Isaac K

    2012-12-01

    Obstetric fistula is a complication of pregnancy that affects women following prolonged obstructed labour. Although there have been achievements in the surgical treatment of obstetric fistula, the long-term emotional, psychological, social and economic experiences of women after surgical repair have received less attention. This paper documents the challenges faced by women following corrective surgery and discusses their needs within the broader context of women's health. We interviewed a small sample of women in West Pokot, Kenya, during a two-month period in 2010, including eight in-depth interviews with fistula survivors and two focus group discussions, one each with fistula survivors and community members. The women reported continuing problems following corrective surgery, including separation and divorce, infertility, stigma, isolation, shame, reduced sense of worth, psychological trauma, misperceptions of others, and unemployment. Programmes focusing on the needs of the women should address their social, economic and psychological needs, and include their husbands, families and the community at large as key actors. Nonetheless, a weak health system, poor infrastructure, lack of focus, few resources and weak political emphasis on women's reproductive health do not currently offer enough support for an already disempowered group. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  4. Nursing Cooperation in Radical Correction Surgery of Breast Cancer%乳腺癌根治术手术室护理配合

    Institute of Scientific and Technical Information of China (English)

    刘洋; 尤艳

    2014-01-01

    ObjectiveThe key points of nursing cooperation method in radical correction surgery of breast cancer are to be explored.Methods The nursing cooperation method data of patients with breast cancer treated by radical correction in this hospital from January of 2013 to March of 2014 are selected for analysis.Results Al of the 30 patients have successful operations without serious complications.Conclusion Nursing cooperation in the surgery should be paid attention to. The considerate and comprehensive nursing care can provide a solid foundation for the smooth completion of the operation.%目的:探讨乳腺癌根治术手术室护理配合方法要点。方法对2013年1月~2014年3月收治的行乳腺癌根治术治疗患者30例临床护理配合方法资料进行分析。结果30例患者均手术获得成功,无严重并发症发生。结论注意手术室护理配合工作,工作中做到护理周到,全面,为手术顺利完成做出保证。

  5. Knee microfracture surgery

    Science.gov (United States)

    Cartilage regeneration - knee ... Three types of anesthesia may be used for knee arthroscopy surgery: Medicine to relax you, and shots of painkillers to numb the knee Spinal (regional) anesthesia General anesthesia (you will be ...

  6. Surgical strategy of one stage surgery of anterior release combined with posterior correction in treatment of severe scoliosis

    Institute of Scientific and Technical Information of China (English)

    LI Ming; LIU Yang; ZHU Xiao-dong; ZHAO Xin-gang; BAI Yu-shu; NI Chun-hong; SHI Zhi-cai; HOU Tie-sheng

    2005-01-01

    Objective: Severe scoliosis refers to scoliosis with serious and stiff curve. It always combins with trunk imbalance in coronal and sagittal contour. Besides complex pathological changes, cardiopulmonary deficits and other concomitant diseases increase treatmental difficulties. So the treatment of severe scoliosis is always a great challenge to spine surgeon.Methods:Thirty-six patients with severe scoliosis received one stage posterior correction followed by anterior release during July 1997 to January 2003, including 9 males and 27 females. Mean age was 17.2 years. Of them, 33 was idiopathic scoliosis and 3 was neurofibromatosis scoliosis( Cobb angle: 85-116 degree); 20 cases were abnormal in sagital plane. Three-dimensional devised instrumentation were applied such as CD, CD-Horizon, TSRH or Isola in posterior procedure followed by anterior release during the same anesthesia. 31 cases of this group received thoracic plasty.Results: The correction in the frontal plane achieved an average of 48.5%. In the sagittal plane, the pathological shape of the spine was reduced and distinctly ameliorated. 80.6% of the patients maintained or achieved balance of sagittal plane. There were no complications of severe neurological deficit, hook displacement, rod broken, and deep infection at follow-up. One case occurred traumatic pleurisy after operation and another appeared pseudarthrosis 2 years later. One case demonstrated imbalance 11 months after operation. One patient was presented loss of correction more than 10 degree at one year follow-up and 5.2 degree in average.Conclusion:The study indicates that the one stage posterior correction combined with anterior release in treatment of severe scoliosis can achieve satisfactory correction. Appropriate choice of cases, preoperational detailed assessment and application of SEP and wake-up test during operation can possibly reduce severe complication. The long-term outcomes still need further observation.

  7. Spinal Cord Stimulation

    DEFF Research Database (Denmark)

    Meier, Kaare

    2014-01-01

    pain after failed back surgery syndrome (FBSS)(4), pain due to peripheral nerve injury, stump pain(5), peripheral vascular disease(6) and diabetic neuropathy(7,8); whereas phantom pain(9), postherpetic neuralgia(10), chronic visceral pain(11), and pain after partial spinal cord injury(12) remain more......Spinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain that is refractory to other treatment. Originally described by Shealy et al. in 1967(1), it is used to treat a range of conditions such as complex regional pain syndrome (CRPS I)(2), angina pectoris(3), radicular...

  8. Spinal injury

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000029.htm Spinal injury To use the sharing features on this page, ... move anyone who you think may have a spinal injury, unless it is absolutely necessary. For example, if ...

  9. Multicolumn spinal cord stimulation for significant low back pain in failed back surgery syndrome: design of a national, multicentre, randomized, controlled health economics trial (ESTIMET Study).

    Science.gov (United States)

    Roulaud, M; Durand-Zaleski, I; Ingrand, P; Serrie, A; Diallo, B; Peruzzi, P; Hieu, P D; Voirin, J; Raoul, S; Page, P; Fontaine, D; Lantéri-Minet, M; Blond, S; Buisset, N; Cuny, E; Cadenne, M; Caire, F; Ranoux, D; Mertens, P; Naous, H; Simon, E; Emery, E; Gadan, B; Regis, J; Sol, J-C; Béraud, G; Debiais, F; Durand, G; Guetarni Ging, F; Prévost, A; Brandet, C; Monlezun, O; Delmotte, A; d'Houtaud, S; Bataille, B; Rigoard, P

    2015-03-01

    Many studies have demonstrated the efficacy of spinal cord stimulation (SCS) for chronic neuropathic radicular pain over recent decades, but despite global favourable outcomes in failed back surgery syndrome (FBSS) with leg pain, the back pain component remains poorly controlled by neurostimulation. Technological and scientific progress has led to the development of new SCS leads, comprising a multicolumn design and a greater number of contacts. The efficacy of multicolumn SCS lead configurations for the treatment of the back pain component of FBSS has recently been suggested by pilot studies. However, a randomized controlled trial must be conducted to confirm the efficacy of new generation multicolumn SCS. Évaluation médico-économique de la STImulation MEdullaire mulTi-colonnes (ESTIMET) is a multicentre, randomized study designed to compare the clinical efficacy and health economics aspects of mono- vs. multicolumn SCS lead programming in FBSS patients with radicular pain and significant back pain. FBSS patients with a radicular pain VAS score≥50mm, associated with a significant back pain component were recruited in 14 centres in France and implanted with multicolumn SCS. Before the lead implantation procedure, they were 1:1 randomized to monocolumn SCS (group 1) or multicolumn SCS (group 2). Programming was performed using only one column for group 1 and full use of the 3 columns for group 2. Outcome assessment was performed at baseline (pre-implantation), and 1, 3, 6 and 12months post-implantation. The primary outcome measure was a reduction of the severity of low back pain (bVAS reduction≥50%) at the 6-month visit. Additional outcome measures were changes in global pain, leg pain, paraesthesia coverage mapping, functional capacities, quality of life, neuropsychological aspects, patient satisfaction and healthcare resource consumption. Trial recruitment started in May 2012. As of September 2013, all 14 study centres have been initiated and 112

  10. 脊髓硬膜外联合麻醉下全髋关节置换手术促进LBP和sCD14的表达%LBP and sCD14 expressions after total hip replacement surgery performed during combined spinal/epidural anesthesia

    Institute of Scientific and Technical Information of China (English)

    张娇

    2013-01-01

    目的 探讨脊髓硬膜外联合麻醉对全髋关节置换手术后患者血清LBP和sCD14表达的影响.方法 选择2011年7月至2012年6月期间接受脊髓硬膜外联合麻醉下全髋关节置换手术的患者7例,采用ELISA检测手术前、手术后1h、手术后1天、手术后3天和手术后6天所有患者血清LBP和sCD14质量浓度,另外检测红细胞比容,并计算LBP和sCD14相对于红细胞比容的校正质量浓度.结果 术前和术后1h患者血清LBP质量浓度和校正质量浓度均无显著差异(P=0.376),术后1、3d和6d血清LBP质量浓度均显著高于手术前,校正质量浓度也均显著高于手术前.术前、术后1h、1、3d和6d患者血清sCD14质量浓度均无显著性差异,而术后1h、术后1、3d和6d患者血清sCD14校正质量浓度均显著高于术前.结论 脊髓硬膜外联合麻醉会促进全髋关节置换手术引起的创伤激起的炎症反应,从而促进LBP和sCD14的表达.%Surgical trauma can provoke host innate immune response, in which pattern recognition receptor (PRR) recognizes the danger signals including the pathogenic lipopolysaccharide (LPS) and peptidoglycan, and then cause a series of inflammatory reactions. Toll like receptor 4 (TLR4) is one of the most conservative PRR recognizing LPS, which needs the involvement of LBP and CD14. This study was designed to investigate the effects of total hip replacement surgery during epidural anesthesia on patients' serum LBP and sCD14 levels. Seven patients, who received total hip replacement operation with spinal epidural anesthesia, were enrolled in the study. ELISA was performed to quantify the serum LBP and sCD14 concentration before surgical operation, and 1 h, 1 day, 3 days and 6 days after operation. To correct for hemodilution, each parameter was adjusted for hematocrit. Results showed that there was no apparent difference of LBP concentration and the corrected concentration between preoperational patients and patients 1 h

  11. Postoperative spinal column; Postoperative Wirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Kaefer, W. [Westpfalzklinikum GmbH, Standort II, Abteilung fuer Wirbelsaeulenchirurgie, Kusel (Germany); Heumueller, I. [Westpfalzklinikum GmbH, Standort II, Institut fuer Radiologie II, Kusel (Germany); Harsch, N.; Kraus, C.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2016-08-15

    As a rule, postoperative imaging is carried out after spinal interventions to document the exact position of the implant material. Imaging is absolutely necessary when new clinical symptoms occur postoperatively. In this case a rebleeding or an incorrect implant position abutting a root or the spinal cord must be proven. In addition to these immediately occurring postoperative clinical symptoms, there are a number of complications that can occur several days, weeks or even months later. These include the failed back surgery syndrome, implant loosening or breakage of the material and relapse of a disc herniation and spondylodiscitis. In addition to knowledge of the original clinical symptoms, it is also important to know the operation details, such as the access route and the material used. In almost all postoperative cases, imaging with contrast medium administration and corresponding correction of artefacts by the implant material, such as the dual energy technique, correction algorithms and the use of special magnetic resonance (MR) sequences are necessary. In order to correctly assess the postoperative imaging, knowledge of the surgical procedure and the previous clinical symptoms are mandatory besides special computed tomography (CT) techniques and MR sequences. (orig.) [German] In der Regel erfolgt bei spinalen Eingriffen eine postoperative Bildgebung, um die exakte Lage des Implantatmaterials zu dokumentieren. Unbedingt notwendig ist die Bildgebung, wenn postoperativ neue klinische Symptome aufgetreten sind. Hier muessen eine Nachblutung bzw. inkorrekte, eine Wurzel oder das Myelon tangierende Implantatlage nachgewiesen werden. Neben diesen direkt postoperativ auftretenden klinischen Symptomen gibt es eine Reihe von Komplikationen, die erst nach mehreren Tagen, Wochen oder sogar nach Monaten auftreten koennen. Hierzu zaehlen das Failed-back-surgery-Syndrom, die Implantatlockerung oder -bruch, aber auch ein Rezidivvorfall und die Spondylodiszitis. Neben der

  12. [Extradural spinal meningioma: case report].

    Science.gov (United States)

    Dagain, A; Dulou, R; Lahutte, M; Dutertre, G; Pouit, B; Delmas, J-M; Camparo, P; Pernot, P

    2009-12-01

    We report a case of purely extradural spinal meningioma and discuss the potential pitfalls in differential diagnosis. Spinal meningiomas account for 20-30% of all spinal neoplasms. Epidural meningiomas are infrequent intraspinal tumors that can be easily confused with malignant neoplasms or spinal schwannomas. A 62-year-old man with a previous history of malignant disease presented with back pain and weakness of the lower limbs. Magnetic resonance imaging revealed a well-enhanced T4 intraspinal lesion. The intraoperative histological examination showed a meningioma (confirmed by postoperative examination). Opening the dura mater confirmed the purely epidural location of the lesion. The postoperative course was uneventful with no recurrence 12 months after surgery. Purely extradural spinal meningiomas can mimic metastatic tumors or schwannomas. Intraoperative histology is mandatory for optimal surgical decision making.

  13. Real time noninvasive assessment of external trunk geometry during surgical correction of adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Mac-Thiong Jean-Marc

    2009-02-01

    Full Text Available Abstract Background The correction of trunk deformity is crucial in scoliosis surgery, especially for the patient's self-image. However, direct visualization of external scoliotic trunk deformity during surgical correction is difficult due to the covering draping sheets. Methods An optoelectronic camera system with 10 passive markers is used to track the trunk geometry of 5 scoliotic patients during corrective surgery. The position of 10 anatomical landmarks and 5 trunk indices computed from the position of the passive markers are compared during and after instrumentation of the spine. Results Internal validation of the accuracy of tracking was evaluated at 0.41 +/- 0.05 mm RMS. Intra operative tracking during surgical maneuvers shows improvement of the shoulder balance during and after correction of the spine. Improvement of the overall patient balance is observed. At last, a minor increase of the spinal length can be noticed. Conclusion Tracking of the external geometry of the trunk during surgical correction is useful to monitor changes occurring under the sterile draping sheets. Moreover, this technique can used be used to reach the optimal configuration on the operating frame before proceeding to surgery. The current tracking technique was able to detect significant changes in trunk geometry caused by posterior instrumentation of the spine despite significant correction of the spinal curvature. It could therefore become relevant for computer-assisted guidance of surgical maneuvers when performing posterior instrumentation of the scoliotic spine, provide important insights during positioning of patients.

  14. Patient Satisfaction After Scoliosis Surgery

    Directory of Open Access Journals (Sweden)

    V. Tari

    2008-02-01

    Full Text Available Background:Patient satisfaction with the cosmetic result of spinal fusion surgery was studied in 40 cases of adolescent idiopathic scoliosis.Neutral or dissatisfied patients were compared with satisfied patients in several physical and psychological characteristics. The aim of the study was to determine whether adolescents generally report satisfaction with the postoperative appearance of their back after the correction of severe curves and whether preoperative medical and/or psychological factors could distinguish between patients who report satisfaction with the cosmetic surgical result from those who report neutrality or dissatisfaction. Previous reports emphasize the need for medical outcome research that evaluates both patient satisfaction and technical success. Patient satisfaction with spinal surgery has largely been evaluated in retrospective studies and most consistently is related to postoperative cosmesis and degree of curve correction. Methods: 40 adolescents with idiopathic scoliosis without any comorbidity who were 10 years of age or older were studied preoperatively by physical and psychological measurements. Results: Of patients undergoing surgical correction of severe curves, 50% reported satisfaction with the cosmetic result. Neutral or dissatisfied patients were more likely to have a King II or King IV curve types and less correction than satisfied patients. Preoperative psychological difficulties (P< 0.05 and unmet expectations regarding postoperative cosmesis (P<0.05 were more common among neutral or dissatisfied patients. Conclusion: Most adolescents with idiopathic scoliosis expressed satisfaction with the cosmetic surgical result. Preoperative physical characteristics, psychological difficulties, and unrealistic expectations regarding postoperative cosmesis are associated with patient neutrality or dissatisfaction.

  15. Hardware complications in scoliosis surgery

    Energy Technology Data Exchange (ETDEWEB)

    Bagchi, Kaushik; Mohaideen, Ahamed [Department of Orthopaedic Surgery and Musculoskeletal Services, Maimonides Medical Center, Brooklyn, NY (United States); Thomson, Jeffrey D. [Connecticut Children' s Medical Center, Department of Orthopaedics, Hartford, CT (United States); Foley, Christopher L. [Department of Radiology, Connecticut Children' s Medical Center, Hartford, Connecticut (United States)

    2002-07-01

    Background: Scoliosis surgery has undergone a dramatic evolution over the past 20 years with the advent of new surgical techniques and sophisticated instrumentation. Surgeons have realized scoliosis is a complex multiplanar deformity that requires thorough knowledge of spinal anatomy and pathophysiology in order to manage patients afflicted by it. Nonoperative modalities such as bracing and casting still play roles in the treatment of scoliosis; however, it is the operative treatment that has revolutionized the treatment of this deformity that affects millions worldwide. As part of the evolution of scoliosis surgery, newer implants have resulted in improved outcomes with respect to deformity correction, reliability of fixation, and paucity of complications. Each technique and implant has its own set of unique complications, and the surgeon must appreciate these when planning surgery. Materials and methods: Various surgical techniques and types of instrumentation typically used in scoliosis surgery are briefly discussed. Though scoliosis surgery is associated with a wide variety of complications, only those that directly involve the hardware are discussed. The current literature is reviewed and several illustrative cases of patients treated for scoliosis at the Connecticut Children's Medical Center and the Newington Children's Hospital in Connecticut are briefly presented. Conclusion: Spine surgeons and radiologists should be familiar with the different types of instrumentation in the treatment of scoliosis. Furthermore, they should recognize the clinical and roentgenographic signs of hardware failure as part of prompt and effective treatment of such complications. (orig.)

  16. Comparative study of the efficacy of transdermal buprenorphine patches and prolonged-release tramadol tablets for postoperative pain control after spinal fusion surgery: a prospective, randomized controlled non-inferiority trial.

    Science.gov (United States)

    Kim, Ho-Joong; Ahn, Hyo Sae; Nam, Yunjin; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S

    2017-07-20

    To compare the efficacy of a transdermal buprenorphine patch (5, 10, 15, and 20 μg/h) with that of oral tramadol (150, 200, 250, and 300 mg) for postoperative pain control after single level spinal fusion surgery. The present study (ClinicalTrials.gov, number NCT02416804) was a prospective, randomized controlled non-inferiority trial designed to determine the efficacy of buprenorphine TDS for alleviating postoperative pain following patient controlled analgesia (PCA) in persons underwent a single level posterior lumbar interbody fusion surgery through 1:1 allocation. The primary outcome was the Visual Analog Pain Scale (VAS) score for postoperative back pain at 7 days after surgery. The non-inferior margin of the VAS was set at δ = 1.5 points. The VAS score (primary outcome) for postoperative back pain at 7 days after surgery in the Buprenorphine group was not inferior compared to the Tramadol group. The overall changes in VAS scores for postoperative pain during follow-up assessments over a 2-week period did not differ between both groups. However, the VAS scores for postoperative pain significantly improved with time after surgery in both groups. The patterns of changes in the VAS scores for postoperative pain during the follow-up period were not significantly different between the both groups. The efficacy of buprenorphine TDS was not inferior to that of oral tramadol medication for alleviating postoperative pain in the subacute period from 72 h after surgery, following PCA administration. In addition, adverse events were similar between both groups.

  17. 小儿法乐氏四联症根治术的体会%Corrective Surgery for Tetralogy of Fallot in Children

    Institute of Scientific and Technical Information of China (English)

    谷兴琳; 戴约; 夏建海; 钱龙宝; 汪敏标; 任振; 丁义林; 王振喜; 马耿

    1988-01-01

    本文报告小儿法乐氏四联症根治术40例,手术死亡2例(5%),38例经随访,症状消失.作者着重对手术指征选择、手术方法及术后监护等进行了讨论.%From Apr. 1983 to Nov. 1986, 40 children with tetralogy of Fallot underwent corrective surgery. Their age ranged from 2. 5 to 12 years, about 45. 5% of them being less than 5 years. All patients had cyanosis and clubbed fingers and toes. Grade Ⅰ-Ⅳ systolic murmur could be heard at the 2nd-4th intercostal space near the left sternal border. Hematocrit ranged from 37. 5% to 75%, hemoglobin 10. 2g-20g%. The ratio of main pulmonary artery to ascending aorta was 0. 25 to 0. 77. An infundibular stenosis was seen in 10 cases, while multiple stenosis of the funnel, pulmonary valve ring, and/or main pulmonary artery in 17 cases. Two patients died of operation, making a mortality rate of 5%. The survived 38 cases were followed-up for 6 months to 4 years. After surgery all patients had no more cyanosis, their heart murmur decreased, and their activity increased. They began to enjoy normal life.

  18. Refractive changes and correction after congenital cataract surgery%先天性白内障术后屈光变化及矫正

    Institute of Scientific and Technical Information of China (English)

    王锐; 张浩润; 黄旭东; 付梦军; 赵静静

    2015-01-01

    对先天性白内障的患儿实施白内障摘除手术已经基本达成共识,但先天性白内障手术后是否植入晶状体、植入晶状体的年龄及植入的人工晶状体度数仍是一个很有争议的问题。本文就先天性白内障患儿术后的屈光变化及残余屈光度的矫正进行综述。%Abstract• For the children with congenital cataract, cataract surgery is the consensus. But after congenital cataract surgery, it is still controversial that whether to implant intraocular lenses, the age of the implantation and the degree of lenses. ln this paper, both refractive changes in the children with congenital cataract and correction on residual refraction postoperatively were summarized.

  19. Surgical correction of kyphosis in patients with camptocormia due to Parkinson's disease: a retrospective evaluation.

    Science.gov (United States)

    Wadia, Pettarusp M; Tan, Gamaliel; Munhoz, Renato P; Fox, Susan H; Lewis, Stephen J; Lang, Anthony E

    2011-04-01

    Camptocormia or 'bent spine syndrome' is a rare manifestation of Parkinson's disease. The postural deformity can be a great source of disability. Camptocormia is typically not responsive to dopaminergic medication. Results with deep brain stimulation to treat camptocormia have been mixed but generally poor. The authors report two cases of camptocormia in Parkinson's disease treated with spinal corrective surgery. Despite prolonged postoperative courses, including a high complication rate and the need for multiple revisions, both patients benefited from the procedures.

  20. Less invasive corrective surgery using oblique lateral interbody fusion (OLIF) including L5-S1 fusion for severe lumbar kyphoscoliosis due to L4 compression fracture in a patient with Parkinson's disease: a case report.

    Science.gov (United States)

    Wakita, Hiromasa; Shiga, Yasuhiro; Ohtori, Seiji; Kubota, Go; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Yamauchi, Kazuyo; Nakamura, Junichi; Takahashi, Kazuhisa; Toyone, Tomoaki; Aoki, Yasuchika; Inoue, Gen; Miyagi, Masayuki; Orita, Sumihisa

    2015-04-07

    Corrective surgery for kyphoscoliosis patients tend to be highly invasive due to osteotomy. The present case introduce less invasive corrective surgery using anterior oblique lateral interbody fusion (OLIF) technique. An 80-year-old Japanese man with a history of Parkinson's disease presented to our hospital because of severe kyphoscoliosis and gait disturbance. Considering the postsurgical complications due to osteotomy, we performed an anterior-posterior combined corrective fusion surgery: OLIF of Lumbar (L) 2-3, L3-4, and L4-5 (Medtronic Sofamor Danek, Memphis, TN, USA) followed by L5-Sacral (S) 1 anterior lumbar fusion via the OLIF approach using an anterior intervertebral cage, and posterior L3-4 and L4-5 facetectomy and posterior fusion using percutaneous pedicle screws from Thoracic (T) 10 to S1 with a T-9 hook system. The surgery was performed in a less invasive manner with no osteotomy, and it improved the sagittal alignments with moderate restoration, which improved the patient's posture and gait disturbance. The patient showed transient muscle weakness of proximal lower extremity contralateral side to the surgical site, which fully recovered by physical rehabilitation 3 months after the surgery. The surgical corrective procedure using the minimally invasive OLIF method including L5-S1 fusion showed a great advantage in treating degenerative kyphoscoliosis in a Parkinson's disease patient in its less-invasive approac.

  1. Adolescent spinal pain: The pediatric orthopedist's point of view.

    Science.gov (United States)

    Gennari, J M; Themar-Noel, C; Panuel, M; Bensamoun, B; Deslandre, C; Linglart, A; Sokolowski, M; Ferrari, A

    2015-10-01

    Ten to twenty percent of persons experience spinal pain during growth. Causes are diverse in adolescents, and it is essential to determine etiology rapidly so as to guide optimal management. It is important for the pediatric orthopedist to understand the natural history of conditions inducing spinal pain. A retrospective study included 116 adolescents presenting with spinal pain at the Hôpital Nord (Marseille, France) between January 1, 2009 and January 1, 2014. Malignant tumoral etiologies were excluded. Mean patient age was 13.6 years. Risser ranged between >0 and discal hernia, 1 of osteoid osteoma and 1 of eosinophil granuloma. Treatment was often non-operative when diagnosis was sufficiently early. In case of failure, surgery could generally be considered. Correctly indicated non-operative management or surgery changes the natural history of these pathologies. The aim of treatment is to resolve pain in adolescence, as it risks becoming chronic and disabling by adulthood. Copyright © 2015. Published by Elsevier Masson SAS.

  2. Model-based correction of tissue compression for tracked ultrasound in soft tissue image-guided surgery.

    Science.gov (United States)

    Pheiffer, Thomas S; Thompson, Reid C; Rucker, Daniel C; Simpson, Amber L; Miga, Michael I

    2014-04-01

    Acquisition of ultrasound data negatively affects image registration accuracy during image-guided therapy because of tissue compression by the probe. We present a novel compression correction method that models sub-surface tissue displacement resulting from application of a tracked probe to the tissue surface. Patient landmarks are first used to register the probe pose to pre-operative imaging. The ultrasound probe geometry is used to provide boundary conditions to a biomechanical model of the tissue. The deformation field solution of the model is inverted to non-rigidly transform the ultrasound images to an estimation of the tissue geometry before compression. Experimental results with gel phantoms indicated that the proposed method reduced the tumor margin modified Hausdorff distance (MHD) from 5.0 ± 1.6 to 1.9 ± 0.6 mm, and reduced tumor centroid alignment error from 7.6 ± 2.6 to 2.0 ± 0.9 mm. The method was applied to a clinical case and reduced the tumor margin MHD error from 5.4 ± 0.1 to 2.6 ± 0.1 mm and the centroid alignment error from 7.2 ± 0.2 to 3.5 ± 0.4 mm.

  3. Spinal infections.

    Science.gov (United States)

    Tay, Bobby K-B; Deckey, Jeffrey; Hu, Serena S

    2002-01-01

    Spinal infections can occur in a variety of clinical situations. Their presentation ranges from the infant with diskitis who is unwilling to crawl or walk to the adult who develops an infection after a spinal procedure. The most common types of spinal infections are hematogenous bacterial or fungal infections, pediatric diskitis, epidural abscess, and postoperative infections. Prompt and accurate diagnosis of spinal infections, the cornerstone of treatment, requires a high index of suspicion in at-risk patients and the appropriate evaluation to identify the organism and determine the extent of infection. Neurologic function and spinal stability also should be carefully evaluated. The goals of therapy should include eradicating the infection, relieving pain, preserving or restoring neurologic function, improving nutrition, and maintaining spinal stability.

  4. Recurrent spinal adhesive arachnoiditis: a case report

    Directory of Open Access Journals (Sweden)

    James Pitágoras de Mattos

    1988-03-01

    Full Text Available Spinal adhesive arachnoiditis is not an uncommon disease, usually having a monophasic course. We studied an atypical patient with recurrent spinal adhesive arachnoiditis nine years after intrathecal anesthesia and the first attack of the disease. Also noteworthy was the favorable evolution after surgery.

  5. Is Oxygen Supplementation Necessary for Patients under Spinal ...

    African Journals Online (AJOL)

    SITWALA COMPUTERS

    routinely to patients undergoing surgery under spinal anaesthesia, the basic aim ... spinal anaesthetic and continuously after the spinal anaesthetic up to the .... monitors used included non-invasive blood pressure. (NIBP) and ... Table 1: Patient characteristics ... One patient out of the total had a postoperative saturation of ...

  6. Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Chung Dae; Song, Chang Joon; Lee, Jeong Eun; Choi, Seung Won [Chungnam National University, Daejeon (Korea, Republic of)

    2009-02-15

    Spinal subdural hematoma is a rare disease. Simultaneous intracranial and spinal subdural hematoma is extremely rare and only 14 such cases have been reported. We report here on two cases of simultaneous intracranial and spinal subdural hematoma that occurred following a fall-down head injury and intracranial surgery, and we discuss the pathogenesis of the disease.

  7. Spinal brucellosis.

    Science.gov (United States)

    Tali, E Turgut; Koc, A Murat; Oner, A Yusuf

    2015-05-01

    Spinal involvement in human brucellosis is a common condition and a significant cause of morbidity and mortality, particularly in endemic areas, because it is often associated with therapeutic failure. Most chronic brucellosis cases are the result of inadequate treatment of the initial episode. Recognition of spinal brucellosis is challenging. Early diagnosis is important to ensure proper treatment and decrease morbidity and mortality. Radiologic evaluation has gained importance in diagnosis and treatment planning, including interventional procedures and monitoring of all spinal infections.

  8. ICU高龄患者脊柱手术后谵妄危险因素分析及护理干预%Analysis and nursing intervention on risk factors of delirium after spinal surgery in ICU elderly patients

    Institute of Scientific and Technical Information of China (English)

    廖莲梅; 曾永吉

    2016-01-01

    average hospitalization day was longer(P=0.03), the operation time and the intraoperative transfusion quantities(P=0.02, P=0.01) were larger in delirium group compared with which in non-delirium group, the differences were statically significant. The sodium ion and chloride ion postoperative 2 days and 3 days were lower, and the potassium ion postoperative 3 days was lower, the differences were statically significant(P<0.05).Conclusion The higher incidence of delirium after spinal surgery in ICU elderly patients has the high risk factors of age, preoperative hospitalization time, operation time, intraoperative fluid infusion, tracheal intubation, and electrolyte disorder. It is better to discover and correct the related factors during the perioperative period, to enhance the nursing measures, has contribute to reduce the occurrence of postoperative delirium.

  9. [Role of multislice spiral computed tomography in diagnosis of spinal injuries in polytrauma patients].

    Science.gov (United States)

    Nemsadze, G; Lapiashvili, E; Urushadze, O; Gotsadze, G

    2011-11-01

    Spinal injury in poly trauma patients is serious problem, because they cause high mortality and morbidity. According to WHO statistics, there are registered 30 million cases of spinal injuries annually, 50% of them die before reaching the hospital. In last 5 years incidence of spinal traumas has increased 2.6 fold and is about one third of all spinal diseases. That is why spinal injuries remain a challenge. The purpose of our study is to assess diagnostic efficiency of multislice spiral CT in diagnosis of spinal injuries in poly trauma patients. We randomly assessed data from 200 poly trauma patients, who underwent multislice spiral CT in poly trauma mode. In 92 (46%) patients different types of spinal fractures and injuries were detected. Age distribution was 16-72 (mean age 52 years). Out of 92 patients, 9 (4.5%) had isolated trauma, 83 (41.5%) had multiple trauma. Solitary injury of spinal column was detected in 30 (32.6%) patients, 54 (58.6%) had combined spinal injuries. In spinal injury patients the most common trauma mechanism was MVC - 56 patients (60.86%), fall from height 27 (29.36%) patients, diving 5 (5.43%) patients, gun shot wound 3 (3.26%) patients, industrial injury 1 (1.08%) patients. The most common location of the injury was lumbar vertebra (55 patients), thoracic vertebra (39 patients), cervical vertebra (28 patients). After assessing MDCT and MRI results 37 patients were operated, 6 of them underwent surgical intervention urgently, 31 had delayed surgery, that was performed after treating other life threatening injuries. Indications for surgical intervention were spinal cord compression and non stable vertebral fractures. According to our study results, MDCT is the study of choice for the diagnosis of spinal injuries in poly trauma patients. It helps to detect type and extension of the bony injury and visualize fragments in the spinal canal. It is superior to other radiological studies. 3D, MIP and MPR reconstruction gives information about

  10. Spinal Stenosis

    Science.gov (United States)

    ... Pharyngitis, Adenitis Syndrome (Juvenile) Polymyalgia Rheumatica Psoriatic Arthritis Raynaud's Phenomenon Reactive Arthritis Rheumatoid Arthritis Scleroderma Sjogren's Syndrome Spinal Stenosis Spondyloarthritis Systemic Lupus Erythematosus (Juvenile) Takayasu's ...

  11. Novalis Stereotactic Radiosurgery for Spinal Dural Arteriovenous Fistula.

    Science.gov (United States)

    Sung, Kyoung-Su; Song, Young-Jin; Kim, Ki-Uk

    2016-07-01

    The spinal dural arteriovenous fistula (SDAVF) is rare, presenting with progressive, insidious symptoms, and inducing spinal cord ischemia and myelopathy, resulting in severe neurological deficits. If physicians have accurate and enough information about vascular anatomy and hemodynamics, they achieve the good results though the surgery or endovascular embolization. However, when selective spinal angiography is unsuccessful due to neurological deficits, surgery and endovascular embolization might be failed because of inadequate information. We describe a patient with a history of vasospasm during spinal angiography, who was successfully treated by spinal stereotactic radiosurgery using Novalis system.

  12. A new lumbar posterior fixation system, the memory metal spinal system : an in-vitro mechanical evaluation

    NARCIS (Netherlands)

    Kok, Dennis; Firkins, Paul John; Wapstra, Frits H.; Veldhuizen, Albert G.

    2013-01-01

    Background: Spinal systems that are currently available for correction of spinal deformities or degeneration such as lumbar spondylolisthesis or degenerative disc disease use components manufactured from stainless steel or titanium and typically comprise two spinal rods with associated connection de

  13. Coronal Spinal Balance in Adult Spine Deformity Patients With Long Spinal Fusions: A Minimum 2- to 5-Year Follow-up Study.

    Science.gov (United States)

    Ploumis, Avraam; Simpson, Andrew K; Cha, Thomas D; Herzog, Joshua P; Wood, Kirkham B

    2015-11-01

    previous surgery were significant (Pbalance. After surgical correction of spinal deformities, coronal spinal decompensation appears in an increased number of patients at last follow-up postoperatively but without significant differences in coronal plane C7PL during the postoperative period. Attention should be paid to patients with osteoporosis and those with a combination of previous same site posterior spine surgery and new anterior approach surgery for changes of coronal balance postoperatively.

  14. Diabetes and complications of spinal surgery:a meta-analysis of comparative or controlled studies%糖尿病与脊柱手术并发症:对比或控制性研究的Meta分析

    Institute of Scientific and Technical Information of China (English)

    林乔; 李兆伟; 钱选昆; 姜金; 王建民

    2015-01-01

    背景:目前椎间盘切除、融合或减压被认为是一种有效的常规修复脊柱疾病的方法。虽然已经有大量文献报道糖尿病对脊柱手术带来不良影响,但是仍存在一定的分歧。  目的:对有关糖尿病对脊柱手术并发症影响的观察性研究及病例对照性研究进行系统性评价。  方法:根据纳入标准,搜索数据库选择糖尿病对脊柱手术结果及并发症影响的对控制或对比性研究,观察指标包括死亡率、翻修率、手术部位感染、静脉血栓发生率、失血量、手术时间及住院时间。2名作者分别进行文章数据的提取及纳入研究的方法学和质量评估。根据流行病学观察研究(MOOSE)的指导方针来进行Meta分析,使用RevMan 5.2软件进行提取数据的风险评估。  结果与结论:共纳入18篇文献,包含有2824063例患者,结果显示,糖尿病患者行脊柱手术后死亡率、手术部位感染、静脉血栓发生率均较非糖尿病患者高,住院时间较非糖尿病患者长,差异有显著性意义(P0.05)。提示糖尿病患者接受脊柱手术比非糖尿病患者有更高的风险,糖尿病增加了脊柱手术后死亡率、手术部位感染、静脉血栓的风险及住院时间。%BACKGROUND:Currently, discectomy, fusion or decompression is considered an effective and conventional method for the treatment of spinal disease. Although there have been many reports on the adverse effects of diabetes on spinal surgery, but there are stil some differences. OBJECTIVE:To systematical y evaluate the observational studies and case-control studies about the effect of diabetes on the complications of spinal surgery. METHODS:The control ed and comparative studies regarding the effect of diabetes on the results and complications of spinal surgery were searched from the database according to the inclusion criteria. The observed indicators including mortality, revision rate

  15. Malnutrition Predicts Infectious and Wound Complications Following Posterior Lumbar Spinal Fusion.

    Science.gov (United States)

    Bohl, Daniel D; Shen, Mary R; Mayo, Benjamin C; Massel, Dustin H; Long, William W; Modi, Krishna D; Basques, Bryce A; Singh, Kern

    2016-11-01

    A retrospective review of data collected prospectively by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The aim of this study was to investigate the association between preoperative hypoalbuminemia, a marker for malnutrition, and complications during the 30 days following posterior lumbar fusion surgery. Malnutrition is a potentially modifiable risk factor that may contribute to complications following spinal surgery. Although prior studies have identified associations between malnutrition, delayed wound he