Serum concentration-guided intravenous magnesium sulfate administration for neuroprotection in patients with aneurysmal subarachnoid hemorrhage: a retrospective evaluation of a 12-year single-center experience.

Delayed cerebral infarction (DCI) is a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). The benefits of magnesium sulfate as an alternative treatment are controversial, and most previous studies examined its benefits only as adjunctive treatment to traditional nimodipine. We retrospectively analyzed aSAH patients records with magnesium sulfate between 2010 and 2021. We aimed for a serum magnesium concentration of 2-2.5 mmol/l between post-hemorrhage days 3 and 12. The patients were separated in three groups based on average serum magnesium concentration (magnesium >2 mmol/l, reduced magnesium 1.1-1.9 mmol/l, and no magnesium). Additionally, we assessed delayed cerebral infarction (DCI) and clinical outcome at follow-up, using the modified Rankin Scale (mRS), categorized in favorable (0-3) and unfavorable outcome (4-5). In this analysis, 548 patients were included. Hereof, radiological evidence of DCI could be found in 23.0% (n = 126) of patients. DCI rates were lower if patients' average serum magnesium was higher than 2 mmol/l (magnesium 18.8%, n = 85; reduced magnesium 38.3%, n = 23; no magnesium 51.4%, n = 18; p < 0.001). Also, at the last follow-up, patients in the group with a higher serum magnesium concentration had better outcome (favorable outcome: magnesium 64.7%, n = 293; reduced magnesium 50.0%, n = 30; no magnesium 34.3%, n = 12; p < 0.001). This 12-year study reveals the value of serum concentration-guided magnesium administration in aSAH patients. Our findings demonstrate the safety and efficacy when titrated to a serum concentration of 2-2.5 mmol/l. We observed higher rates of delayed cerebral infarction and unfavorable outcomes in patients with serum concentrations below 2 mmol/l.

Retrospective analysis of cervical corpectomies: implant-related complications of one- and two-level corpectomies in 45 patients.

Cervical corpectomies are increasingly used to treat degenerative, metastatic, inflammatory and traumatic multisegmental diseases. The postoperative results are thought to correlate mainly with the number of resected vertebral bodies. Thus, the aim of the study was to analyse complications and early outcome of these procedures to document the implant-related complications in order to set up a prospective clinical trial. Forty-five patients, who were treated in our department from 2011 to 2014 and who were available for a minimum follow-up of 1 year, were consecutively included in this retrospective evaluation. The median age was 61 (±11) years with a female to male sex ratio of 19 to 26, respectively. In these patients, cervical corpectomies (one-, two- and three-level procedures) were performed. The average number of resected levels was 1.2 levels. The intraoperative loss of blood (LOB), the red cell transfusions (rcT), the length of operation (LOO) and the usage of drains were investigated and correlated with intra- and postoperative complications. The mean LOO was 244 min (±68) with a mean LOB of 511 ml (±531). The overall complication rate was 22.9% (10 patients). Six patients (13.3%) had implant-related complications due to loosening and toggling of the screws and/or cage subsidence. Two patients (4.4%) had a postoperative haematoma and another two patients (4.4%) suffered from neurological deterioration due to an ongoing and severe myelopathic syndrome. All these patients received revision surgery. The average time from the first to revision surgery was 90 days. Cervical corpectomies still remain procedures with a high complication rate mainly represented by implant-related failures. These implant-related complications range from screw/plate loosening or toggling to graft dislocation with subsidence and might be associated with constructs extended to the C7 vertebral body. In our study population, the rate of implant failure was comparable to the literature, but not obviously correlated with the number of vertebral bodies resected. This may be attributed to the different disease entities. Thus, our results support the use of circumferential approaches for selected instability scenarios (metastatic or inflammatory diseases, kyphosis, osteoporosis, etc.) of one- and two-level corpectomies.