[Effect of Breathing Exercise Using Panflutes on the Postoperative Compliance, Pulmonary Infections and Life Satisfaction in Elderly Patients Undergoing Spinal Surgery].

PURPOSE: The purpose of this study was to examine the effects of breathing exercises performed using panflutes in elderly patients undergoing spinal surgery. METHODS: The study design was a nonequivalent control group non-synchronized pre-post test. The study included 24 patients in both the experimental group and the control group. The experimental group completed a daily breathing exercise regimen using panflutes for 30minutes after meals, whereas the control group was provided standard preoperative education, including breathing exercises using incentive spirometers. After the exercise regimen, breathing exercise compliance, pulmonary infections, and life satisfaction were measured in both groups, and the data were analyzed using the SPSS/WIN program. RESULTS: The compliance rate of breathing exercises was significantly higher in the experimental group. The experimental group presented no pulmonary infections in the later period, whereas the control group presented higher pulmonary infection rates in the same period. In addition, the life satisfaction score in the experimental group significantly increased. CONCLUSION: The breathing exercise program using panflutes for elderly patients undergoing spinal surgery enhanced their breathing exercise compliance and their daily life satisfaction in addition to reducing their pulmonary infection rates.

Awake Fiberoptic Intubation in Cervical Spine Injury: A Comparison between Atomized Local Anesthesia versus Airway Nerve Blocks.

Background In cooperative patients with cervical spine injury, awake fiberoptic intubation is an excellent option for elective and semi urgent situations. It allows documentation of neurologic examination before and after intubation and surgical positioning. We have compared anesthesia of airway by nerve block and the local anesthesia atomizer undergoing awake fiberoptic intubation in cervical spine injury patients, in terms of the intubation time and discomfort. Objective To compare the intubation time and discomfort in patient with cervical spine injury with anticipated difficult airway potential to aggravate pre-existing injury undergoing awake fiberoptic intubation, based on cough and gag scores, between anesthesia of airway by (transtracheal and bilateral superior laryngeal) nerve block with local anesthetic agent and the local anesthesia atomizer. Method After institutional ethical approval and having informed written consent, 30 patients scheduled for elective surgery who require awake fiberoptic intubation, were included in the study. Patients were allotted by computer-generated random series into two groups; Group N received nerve block (transtracheal and bilateral recurrent laryngeal nerve block) and Group A received atomized lignocaine. Result The time taken for awake fiberoptic intubation was significantly lower in nerve blocks group as compared with the atomizer group [Group N: 90.2±11.7secs and Group A: 210.4±10.6 secs (p=0.041)]. Atomizer group had an increased coughing and gagging episodes than nerve block group [Group N: one patient, Group A: 11 patients (p=0.006)]. Ease of intubation and patient comfort were significantly better in nerve block group. Demographic and hemodynamic parameters were comparable in the two groups. Conclusion The nerve blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) provides adequate airway anesthesia, lesser patient discomfort, and faster intubation to aid in awake fiberoptic intubation in patients with anticipated difficult airway as compared to topical anesthesia using atomizer.

[Sanatorium-and-surgical treatment of patients with complicated spinal trauma in a specialized department of a sanatorium].

We studied the results of sanatorium treatment of 256 patients with complicated spinal injury and decubital ulcers. 74% of patients were male patients aged 38.5 ± 11.8 years. 89.4% of patients suffered from severe abnormalities, mild abnormalities were registered in 10.6% of patients. In 82.6% of patients decubital ulcers were localized to the skin only on one site, in 17.4% was registered multiple localization. Duration of the patients'follow-up varied from one to three years or more. Patients were divided into 2 clinical groups: the first group consisted of 132 patients who were applied during the preoperative preparation balneological factors and nanosilver, 124 patients included in the second group, which preoperative preparation was carried out in conventional-manner. Using complex medical factors in preparation for operations contributed to reducing the duration of training from 26 ± 3 days to 14 ± 2 days. The application of complex restorative treatment system allowed in the first group compared with the second group increased the number of patients with good results.

[Rehabilitative treatment of patients with complicated spinal injuries and trophic disorders in specialized neurological center].

The analysis of treatment results 132 patients with consequences with spine injury and the presence of venous disorders which in conditions of specialized health resort management system applied in complex restorative treatment, which includes patogeneti no-reasonable comprehensive preparation, surgery and further restorative treatment. Based on the analysis and systematization of the results developed diagnostic and therapeutic algorithm and algorithm for planning surgical tactics.

The effect of prior lumbar surgeries on the flexion relaxation phenomenon and its responsiveness to rehabilitative treatment.

BACKGROUND CONTEXT: Abnormal pretreatment flexion-relaxation in chronic disabling occupational lumbar spinal disorder patients has been shown to improve with functional restoration rehabilitation. Little is known about the effects of prior lumbar surgeries on flexion-relaxation and its responsiveness to treatment. PURPOSE: To quantify the effect of prior lumbar surgeries on the flexion-relaxation phenomenon and its responsiveness to rehabilitative treatment. STUDY DESIGN/SETTING: A prospective cohort study of chronic disabling occupational lumbar spinal disorder patients, including those with and without prior lumbar spinal surgeries. PATIENT SAMPLE: A sample of 126 chronic disabling occupational lumbar spinal disorder patients with prior work-related injuries entered an interdisciplinary functional restoration program and agreed to enroll in this study. Fifty-seven patients had undergone surgical decompression or discectomy (n=32) or lumbar fusion (n=25), and the rest had no history of prior injury-related spine surgery (n=69). At post-treatment, 116 patients were reevaluated, including those with prior decompressions or discectomies (n=30), lumbar fusions (n=21), and no surgery (n=65). A comparison group of 30 pain-free control subjects was tested with an identical assessment protocol, and compared with post-rehabilitation outcomes. OUTCOME MEASURES: Mean surface electromyography (SEMG) at maximum voluntary flexion; subject achievement of flexion-relaxation (SEMG≤3.5 µV); gross lumbar, true lumbar, and pelvic flexion ROM; and a pain visual analog scale self-report during forward bending task. Identical measures were obtained at pretreatment and post-treatment. METHODS: Patients entered an interdisciplinary functional restoration program, including a quantitatively directed, medically supervised exercise process and a multimodal psychosocial disability management component. The functional restoration program was accompanied by a SEMG-assisted stretching training program, designed to teach relaxation of the lumbar musculature during end-range flexion, thereby improving or normalizing flexion-relaxation and increasing lumbar flexion ROM. At 1 year after discharge from the program, a structured interview was used to obtain socioeconomic outcomes. RESULTS: At pre-rehabilitation, the no surgery group patients demonstrated significantly better performance than both surgery groups on absolute SEMG at maximum voluntary flexion and on true lumbar flexion ROM. Both surgery groups were less likely to achieve flexion-relaxation than the no surgery patients. The fusion patients had reduced gross lumbar flexion ROM and greater pain during bending compared with the no surgery patients, and reduced true lumbar flexion ROM compared with the discectomy patients. At post-rehabilitation, all groups improved substantially on all measures. When post-rehabilitation measures were compared with the pain-free control group, with gross and true lumbar ROM corrected by 8° per spinal segment fused, there were no differences between any of the patient groups and the pain-free control subjects on spinal ROM and only small differences in SEMG. The three groups had comparable socioeconomic outcomes at 1 year post-treatment in work retention, health-care utilization, new injury, and new surgery. CONCLUSIONS: Despite the fact that the patients with prior surgery demonstrated greater pretreatment SEMG and ROM deficits, functional restoration treatment, combined with SEMG-assisted stretching training, was successful in improving all these measures by post-treatment. After treatment, both groups demonstrated ROM within anticipated limits, and the majority of patients in all three groups successfully achieved flexion-relaxation. In a chronic disabling occupational lumbar spinal disorder cohort, surgery patients were nearly equal to nonoperated patients in responding to interdisciplinary functional restoration rehabilitation on measures investigated in this study, achieving close to normal performance measures associated with pain-free controls. The responsiveness and final scores shown in this study suggests that flexion-relaxation may be a useful, objective diagnostic tool to measure changes in physical capacity for chronic disabling occupational lumbar spinal disorder patients.

Lead toxicity and management of gunshot wounds in the lumbar spine.

INTRODUCTION: Gunshot wounds are one of the commonest causes of spinal injury. Management of these patients differs from other blunt trauma injuries to the spine. We present a case of a gunshot wound to the lumbar spine that occurred in 1985 which was treated non-operatively. METHODS: In the last 10 years, the patient was admitted multiple times for confusion and lead toxicity with blood levels over 100 µg/dl. Inpatient chelation therapy was implemented. After multiple recommendations for surgery, the patient agreed to have as much of the bullet removed as possible. The patient successfully underwent decompression and fusion from both anterior and posterior approaches. Lead levels subsequently declined. CONCLUSION: The purpose of this paper is to show a case of a gunshot wound to the spine that ultimately caused plumbism and required surgery. Technical aspects of the surgery are described as well as pre- and post-procedural imaging. Recommendations for the general management of spine gunshot wounds are also described.

Efficacy and cost-effectiveness of cell saving blood autotransfusion in adult lumbar fusion.

The objective of this study was to explore the use of cell saver blood autotransfusion in spinal surgery and to evaluate the efficacy and cost-effectiveness of cell saver blood autotransfusion during lumbar spine fusion in adults. Specific indications for the use of cell saver in adult lumbar fusion surgery have not yet been clearly determined. A total of 50 consecutive candidates for posterolateral fusion with internal fixation were prospectively randomized into either receiving perioperatively cell saving autotransfusion (Group A: 25 patients) or not (Group B: 25 patients). The use of cell saving technique did not exclude the use of allogenic blood transfusion. Surgical indications were spinal stenosis, spondylolisthesis, adolescent idiopathic scoliosis, degenerative scoliosis and fractures. Medical and financial data were recorded. A cost-analysis was performed. Patients in Group A received 880 +/- 216 mL from cell saver and 175 +/- 202 mL allogenic blood. The patients in Group B received 908 +/- 244 mL allogenic blood. Blood volumes data collected were expressed in mean +/- SD values. The cost of blood transfusion in Group A was 995 +/-euro447 per patient and 1220 +/- 269 in Group B (P < 0.05). In elective lumbar fusion blood requirements can be satisfied with the use of autotransfusion. The use of cell saver appears to be useful and cost-effective during most elective lumbar fusions.

Resultados del tratamiento quirúrgico de las fracturas toracolumbares tipo C de la AO / Results of the surgical treatment of type C AO thoracolumbar fractures

AO Type C Thoracolumbar fractures are the most complex and unstable spine injuries, with a high frecuency of neurological impairment. The goal of this study is to describe the clinical characteristics, management and outcome in worker’s compensation patients with type C AO thoracolumbar fractures that were surgically treated in our hospital between January 1994 and December 2004. We collected 88 patients, 68 of them had work related accidents. Four patients were discarded because of insufficient data. The median follow up was 58 months. Of the 64 patients evaluated (mean age 35.7 years), 94 percent were men. The most common mechanism of injury was height fall (41 percent). Associated injuries occurred in 80 percent of the patients (23 percent had another spine fracture). Neurological impairment was present in 64 percent, 22 percent had incomplete, while 42 percent had complete impairment. The majority of the patients presented a C3 AO thoracolumbar fracture (50 percent). The average preoperative time was 6 days (range 0-64). The mean time of surgery was 224 minutes (range 80-640). Only 9.3 percent of the patients required a complementary anterior approach. The median hospitalization time was 61 days (6-275) and the mean postoperative rest was 9.8 months (1.4-34). We had 11 acute complications and 6 delayed complications. Return to work occurred in 64 percent of the patients, while 59 percent was compensated. Among the patients presenting partial neurological impairment, 50 percent improved at least one degree in the Frankel scale.

Las fracturas tóracolumbares tipo C de la AO corresponden a las lesiones espinales más complejas e inestables, con una alta incidencia de compromiso neurológico. El objetivo del presente estudio es describir las características clínicas, manejo y evolución de los pacientes accidentados del trabajo, con fracturas tóracolumbares tipo C de la AO, operados en nuestro hospital. Revisamos en forma retrospectiva los casos entre enero de 1994 y diciembre de 2004. Recolectamos 88 pacientes, 68 de los cuales correspondían a accidentados del trabajo. Cuatro casos fueron eliminados por información incompleta. La mediana de seguimiento fue de 58 meses. De los 64 pacientes evaluados (edad promedio 35,7 años),el 94 por ciento eran hombres. El mecanismo de lesión más común fue caída de altura (41 por ciento). Un 80 por ciento de los pacientes presentaron lesiones asociadas (23 por ciento con fractura de columna a otro nivel). Un 64 por ciento ingresó con compromiso neurológico, de los cuales, el 22 por ciento fue parcial y 42 por ciento completo. La mayoría de las fracturas fueron tipo C3 de la clasificación AO (50 por ciento). El tiempo promedio preoperatorio fue de 6 días (0-64). La duración promedio de la cirugía fue de 224 minutos (80-640). Un 9,3 por ciento de los pacientes requirió de una vía anterior complementaria. La mediana de hospitalización fue de 61 días (6-275) y el tiempo promedio de reposo post operatorio fue de 9,8 meses (1,4-34 meses). Hubo 11 complicaciones precoces y 6 tardías. Un 64 por ciento retornó al trabajo y un 59 por ciento fue indemnizado. De los pacientes con compromiso neurológico parcial, un 50 por ciento recuperó al menos un grado en la escala de Frankel.

A historical hypothesis of the first recorded neurosurgical operation: Isis, Osiris, Thoth, and the origin of the djed cross.

A new textual analysis of the central religious aspect of the ancient Egyptian creation myth reveals what appears to be a description of the oldest recorded neurosurgical operation, occurring circa 3000 BC. The analysis results in a hypothesis suggesting that traction reduction was used successfully to reverse a paralyzing cervical spine injury of an early Egyptian leader (Osiris), which inspired the story of his resurrection. The Egyptian mother god Isis, working with the god Thoth (the inventor of medicine), resurrects Osiris by treating his damaged cervical spine. Numerous references in the Papyrus of Ani (Book of the Dead) to Osiris regaining the strength and control of his legs are linked textually to the treatment of his spine. The connection between the intact spine and the ability to rise and stand is used as a distinct metaphor for life and death by the spinal representation of the "djed column" painted on the back of the numerous Egyptian sarcophagi for thousands of years. Controversy over the translation of the vertebral references in Egyptian texts is clarified by considering the specific neurosurgical meanings of hieroglyphs appearing in both the Edwin Smith medical papyrus and in the Papyrus of Ani, and in light of recent scholarly reassessments of those hieroglyphs in the Egyptological literature.

[Clinical application of medical grade calcium sulfate as a bone graft substitute].

OBJECTIVE: To investigate the clinical effect of medical grade calcium sulfate(Osteoset) as a bone graft substitute. METHODS: From December 2004 to May 2005, 9 cases of bone defect(limb group) were repaired with Osteoset pellets; bone defect was caused by benign tumor in limbs, including 3 cases of fibroma xanthomas in humerus (1 case) and acetabulum (2 cases), 2 cases of bone cysts in humerus (1) and radius (1), 1 case of nonossifying fibroma, 1 case of ossifying fibroma and 2 cases of osteofibrous dysplasia in femurs. Five cases of lumbar posterolateral fusion (spine group) were treated with Osteoset pellets as autograft volume expander, including 2 cases of lumbar spinal stenosis, 2 cases of lumbar spondylolisthesis and 1 case of lumbar spondylolysis. Radiological method was used to evaluate the repair effect of Osteoset pellets. RESULTS: The mean follow-up time was 6.2 months (3 to 9 months). Osteoset pellets began to be absorbed after 1 to 3 months of operation, and were totally absorbed and replaced by osseous tissue after 4 to 6 months. No local recurrence was detected in limb group and the function of limbs was normal. At 6 months after operation, all patients in spine group got bony fusion. CONCLUSION: Medical grade calcium sulfate (Osteoset) is an ideal bone graft substitute with excellent bone repair effect.

[Modern methods of the treatment of injured persons with combined vertebrospinal trauma].

The issues of rehabilitational treatment of injured persons after polytrauma occurrence with compressive fracture of spine using electrostimulation were considered. The application of such an approach have had promoted the essential lowering of traumaticity and the treatment duration as well, the prognosis improvement, the length of temporary disability period reduction.

History of spine surgery in the ancient and medieval worlds.

There is a paucity of surviving texts from ancient and medieval times that can shed light on the early development of spine surgery. Nevertheless, the author reviews many of the available books and fragments and discusses early developments in the field of spine surgery from the point of view of physicians' personalities, general themes, and actual surgical practices. For purposes of an overview and to highlight changing trends in spine surgery, he divides the paper into four eras of medicine: 1) Egyptian and Babylonian; 2) Greek and early Byzantine; 3) Arabic; and 4) medieval.

[Vertebroplasty: percutaneous augmentation of vertebrae].

Vertebroplasty presents a new method for fortification of structural impaired or partially collapsed vertebrae due to various pathological disorders. According to the original method published 15 years ago, acrylic bone cement is injected percutaneously into the vertebral body under local anesthesia and fluoroscopic guidance. Indications include osteoporotic fractures, benign tumors as vertebral hemangiomas or metastatic tumors affecting the spine. Reported results are good and complications are uncommon. This article reviews the new method for restoration of the collapsed vertebra and new cement materials with osteoconductive properties.

[Treatment approaches in gunshot injuries of the extremities]. / Behandlung von Schussverletzungen des Bewegungsapparates.

In the view of efficiency and cost effectiveness the increasing incidence of gunshot wounds in Europe demands a modification of treatment protocols. The general basis are debridement of soft tissue injuries, antibiotics and fracture stabilization. The pathology of gunshot wounds and established treatment algorhithms, however have to be adjusted to the ongoing development of gun technology and the thereby caused specific lesions. The treatment of injuries caused by high velocity projectiles necessitates a proactive surgical strategy. Small caliber gunshot wounds can be treated more conservatively. The following review presents an overview on the ballistic and surgical basis for the treatment of gunshot wounds of the musculoskeletal system.

Hyperbaric oxygenation as a successful therapeutic approach in oral wound dehiscence after operative stabilization of an unstable post-traumatic odontoid non-union.

The non-operative treatment of unstable traumatic Anderson's type II odontoid fractures has a high risk potential to develop non-unions. Even after operative stabilization literature reveals non-union rates up to 20%. Acute life threatening complications are tetraplegia and apnoea. Long-term complications induce chronic myelopathy resulting from persistent myeloradicular compression. We report the case of a patient with a 17-year-old post-traumatic pseudarthrosis of the dens axis following conservative treatment of an unstable type II fracture. By that time, the female patient, then 37 years old, was admitted to our hospital with early signs of cervical tetraplegia. After initial reposition and short-term immobilization with a halothoracic vest we performed a ventrodorsal atlantoaxial spondylodesis. Failure of anterior cervical plate stabilization and autologous graft resorption without a solid segmental fusion instigated a secondary surgical intervention. Postoperative therapy-resistant oral wound dehiscence showed an exposed autograft and osteosynthetic material. The reported positive effect of hyperbaric oxygenation on wound healing in problem cases led us to attempt this means of therapy. With a daily exposure to hyperbaric oxygenation, the dehiscence closed within 25 days. As a result of our experience in this case, hyperbaric oxygenation should be considered as a therapeutic option in postoperative complication management in orthopaedic surgery.

Mobilization of patients after spinal surgery for acute spinal cord injury.

STUDY DESIGN: A retrospective review was conducted covering records of patients who underwent spinal surgery after acute spinal cord injury. OBJECTIVE: To study the relation between time of operation and mobilization of patients. SUMMARY OF BACKGROUND DATA: No such report has existed in the literature. METHODS: Reviews were conducted for the medical records of 102 consecutive patients with acute spinal cord injury admitted to the National Spinal Injuries Center whose spines had been stabilized surgically. The surgeries had been performed either in the National Spinal Injuries Center or in hospitals of the United Kingdom or Continental Europe not specialized in comprehensive care of spinal cord injury. For the patients in three groups, the date of operation and the date of mobilization were compared. The causes for delay in mobilization were identified. RESULTS: A trend of negative correlation was found between the mean number of days from injury to operation and the mean number of days from injury to mobilization. Conversely, a trend of positive correlation was found between the mean number of days from injury to admission or transfer to the National Spinal Injuries Center and the mean number of days from injury to mobilization. Long stay in bed was associated with complications. None of the patients in Group A stayed in bed longer than 77 days, whereas 13 patients in Groups B and C combined had a longer stay. The difference was statistically significant (P = 0.02, chi2). Eight of these patients had pressure sores. CONCLUSION: To ensure early mobilization, early spinal surgery must be supported by specialized comprehensive care.

[Study on effect of spine surgery on gastric function and its efficacy of relevant treatments].

OBJECTIVE: To study the effect of spine surgery (SpS) on gastric function and the efficacy of relevant treatments. METHODS: Sixty patients in the spine surgery group, 20 patients in the extremity surgery (ES) group and 20 healthy subjects in the control group were observed. Electrogastrography (EGG) was used to observe gastroelectric activity before and after operation. Twenty patients among the SpS group were examined with barium meal under actinoscopy to observe the gastric peristaltic waves before and after operation. The SpS group was randomly subdivided into 3 groups, and treated by Xiangsha Yangwei pill (XSYW), moxibustion and motilium respectively. At the same time, the EGG of various groups was observed and the change of preoperative and postoperative EGG were compared. RESULTS: The gastroelectric rhythm of SpS group was remarkably abnormal, both frequency and amplitude of EGG were significantly different from the other two groups (P < 0.05, P < 0.01). The gastric peristaltic waves were reduced, and the emptying time was obviously prolonged. EGG was significantly improved after either of the three treatments statistically (P < 0.05), the effect of XSYW was the best, but in comparing with the other two, the difference was not significant (P > 0.05). CONCLUSION: SpS could change the gastroelectric rhythm to cause the gastric functional disorder and induce gastroparesis, EGG can get satisfactory results in the diagnosis of these illnesses. XSYW, moxibustion and motilium all have significant effects on the gastric function after SpS.

Elective tracheal intubation in cervical spine injuries.

Patients presenting for surgical stabilisation of an unstable cervical spine are at risk of sustaining a further iatrogenic spinal cord injury during intubation of the trachea. Controversy exists regarding the optimal anaesthetic technique for securing the airway. We reviewed the techniques employed for intubating the trachea in our hospital over a five year period. Tracheal intubation was achieved using two different techniques: awake fibre-optic intubation with local anaesthesia, and general anaesthesia via the intravenous or inhalational route with neuromuscular blockade. Forty five patients were included. 16 patients demonstrated a pre-operative neurological deficit. Awake fibre-optic intubation was used in 27 cases, general anaesthesia was employed via the intravenous route in 17 cases and the inhalational route in 1 case. Weighted traction was employed in all cases to immobilize the cervical spine during intubation. There was no new neurological sequelae with any of these techniques. Our study suggests that there is no optimal anaesthetic technique for intubating the trachea in patients with cervical spine injuries and it is noteworthy that in line traction was used in every case.