RESUMO
We studied 108 adult cases of elective lumbar surgery using dermatomal somatosensory-evoked potential (DSEP) monitoring to evaluate its usefulness due to concern over potential neurologic injury during pedicle screw insertion. Both surgeons used all of the necessary precautions required during surgery so that DSEP monitoring was not the "primary," but rather a backup system for operative security. Quality tracings were obtained in 71% of cases; anesthetic difficulties being the major cause of poor monitoring. There were no neurological complications related to pedicle screw insertion. We found that DSEP monitoring was an excellent method to verify intraoperative neurological status, but required a high degree of cooperation between the anesthesiologists, monitoring technician, and surgeons. In today's cost-containment environment, its usefulness is subjected to the expertise of the spine surgeon and the hospital setting.
Assuntos
Anestésicos/farmacologia , Potenciais Somatossensoriais Evocados/efeitos dos fármacos , Vértebras Lombares/cirurgia , Fusão Vertebral/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Procedimentos Cirúrgicos Eletivos , Feminino , Hospitais Comunitários , Humanos , Período Intraoperatório , Vértebras Lombares/fisiologia , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/economia , Fusão Vertebral/instrumentaçãoAssuntos
Potenciais Somatossensoriais Evocados , Isquemia/fisiopatologia , Perna (Membro)/irrigação sanguínea , Coluna Vertebral/cirurgia , Adulto , Artéria Femoral , Humanos , Isquemia/etiologia , Monitorização Intraoperatória , Radiografia , Coluna Vertebral/diagnóstico por imagem , Trombose/complicações , Torniquetes/efeitos adversosRESUMO
The treatment of thoracolumbar spinal fractures has evolved significantly in the last 50 years. Clear classification systems now allow physicians to predict which fracture patterns will require surgery and which may be adequately treated non-operatively. These indications, as well as a brief overview of thoracolumbar spinal fracture care, are presented.
Assuntos
Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Humanos , Fixadores Internos , Vértebras Lombares/diagnóstico por imagem , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagemRESUMO
Ninety-six patients (63 females and 33 males) who underwent total joint arthroplasty or spinal reconstructive surgery were randomized to receive either a Solcotrans Plus or a Stryker-CBC ConstaVAC closed-wound drainage system. A binomial test showed that the Stryker-CBC ConstaVAC system was significantly preferred over the Solcotrans Plus system for ease of use, as reported by nurses. However, Solcotrans Plus was more cost-effective because a larger volume of blood shed by a patient could be reinfused while maintaining the standards of the American Association of Blood Banks. The difference in the occurrence of side effects between the two systems was not statistically significant.
Assuntos
Transfusão de Sangue Autóloga/instrumentação , Ortopedia/métodos , Cuidados Pós-Operatórios , Sucção/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Transfusão de Sangue Autóloga/economia , Transfusão de Sangue Autóloga/enfermagem , Análise Custo-Benefício , Estudos de Avaliação como Assunto , Feminino , Humanos , Manutenção , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/psicologia , Segurança , Sucção/economia , Sucção/enfermagem , Inquéritos e QuestionáriosRESUMO
Interpeduncular segmental fixation of the lumbar and lumbosacral spine with Luque screws and plates is becoming increasingly popular. In this retrospective study, 52 consecutive patients treated with this technique were followed for 16 to 44 months (average, 21). Indications for surgical arthrodesis included lumbar instability from degenerative disease (16 cases), spondylolisthesis (25 cases), pseudarthrosis (eight cases), fracture (two cases), and tumor (one case). Fusion with instrumentation spanned one level in nine patients, two in 38 patients, three in four patients, and four in one patient. Patients wore a rigid lumbar orthosis for an average of six months (range, two to 16). Ten complications occurred in nine patients: two superficial wound infections, four neurologic complications, three loosened screws, and one broken screw. An overall fusion rate of 96% was achieved; pseudarthrosis is suspected in one case and failed arthrodesis secondary to trauma in a second patient. At four months postoperatively, solid unions had resulted in most of the cases, as seen roentgenographically. All patients reported decreased back pain; however, one patient is addicted to narcotics. Twenty-five of the 29 patients employed were able to return to work at an average of six months postoperatively.
Assuntos
Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adolescente , Adulto , Idoso , Placas Ósseas , Parafusos Ósseos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Radiografia , Doenças da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/instrumentaçãoRESUMO
Controlled mobilization is necessary in certain situations during the management of patients undergoing reconstructive spinal surgery. Chart review of 39 patients (20 maintained on the Roto-rest bed, 19 maintained on the Foster frame) was undertaken. Both beds protected spinal stability and no delays occurred in any staged surgical procedure. Patients maintained on the Roto-rest bed did have a significantly higher incidence of skin problems (p less than .05), but had no pulmonary emboli. Pulmonary emboli occurred in two of the 19 patients maintained on the Foster frame. Successful use of the Roto-rest bed was dependent upon skilled nursing personnel who were knowledgeable in the mechanical aspects of the bed and could provide a sense of security for the patient. No evidence was found that the Roto-rest bed affected the patients' use of postoperative analgesics. Both beds provided adequate controlled mobilization. Consideration of the patients' total medical profile would determine the choice of bed.
Assuntos
Leitos , Cuidados Pós-Operatórios/instrumentação , Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos RetrospectivosRESUMO
A 36-year-old white male schoolteacher presented with a painless, semifluctuant mass on the volar aspect of his forearm and symptoms of ring finger tenosynovitis and median nerve compression. At operation there was a widespread infestation of the flexor tendon compartment, the carpal tunnel, and the tendon sheaths of the ringer finger with Onchocerca volvulus, a filarial nematode, not previously reported in the these tissues.