Fiber-Optic Intracranial Pressure Monitoring System Using Wi-Fi-An In Vivo Study.

BACKGROUND: Continuous invasive monitoring of intracranial pressure (ICP) is essential in neurocritical care for surveillance and management of raised ICP. Fluid-based systems and strain gauge microsensors remain the current standard. In the past few decades, several studies with wireless monitoring were developed aiming to reduce invasiveness and complications. OBJECTIVE: To describe a novel Wi-Fi fiber-optic device for continuous ICP monitoring using smartphone in a swine model. METHODS: Two ICP sensors (wireless prototype and wire-based reference) were implanted in the cerebral parenchyma of a swine model for a total of 120 minutes of continuous monitoring. Every 5 minutes, jugular veins compression was performed to evaluate ICP changes. The experimentation was divided in 3 phases for comparison and analysis. RESULTS: Phase 1 showed agreement in ICP changes for both sensors during jugular compression and releasing, with a positive and strong Spearman correlation (r = 0.829, P < .001). Phase 2 started after inversion of the sensors in the burr holes; there was a positive and moderately weak Spearman correlation (r = 0.262, P < .001). For phase 3, the sensors were returned to the first burr holes; the prototype behaved similarly to the reference sensor, presenting a positive and moderately strong Spearman correlation (r = 0.669, P < .001). CONCLUSION: A Wi-Fi ICP monitoring system was demonstrated in a comprehensive and feasible way. It was possible to observe, using smartphone, an adequate correlation regarding ICP variations. Further adaptations are already being developed.

The impact of traumatic herniated discs in cervical facets dislocations treatments: systematic review and meta-analysis.

BACKGROUND: Traumatic facet dislocations in the subaxial cervical spine, also known as locked facets, are commonly associated with neurological deficits. The fear of the presence of an associated traumatic disc herniation and consequent neurological worsening usually causes a delay in the spinal realignment. This study's aim is an analysis of safety and efficacy when treating acute cervical traumatic facet dislocations using cranial-cervical traction or posterior open reduction and fixation in the presence of disc herniations. METHODS: Inclusion criteria addressed the following patient groups: (1) MRI diagnosis of traumatic cervical facet dislocations with disc herniation, (2) intervention: either cranial-cervical traction or posterior open reduction and fixation, (4) neurological outcomes after treatment, (5) adult 18 plus years of age, (6) sample sizes greater than 20 patients, (7) English language publication. The following databases and search tools were analyzed: MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, and the clinical trial registries (ClinicalTrials.gov), October 2021. RESULTS: Six studies were found, 2 with posterior open reduction and fixation and 4 with cranial-cervical traction, totalizing 197 patients. Neurological worsening was reported only in 1 case (0.5%). CONCLUSIONS: Traumatic disc herniation in cervical facet dislocations is not an absolute contraindication of cranial-cervical traction or posterior open reduction. Early realignment of the spine could bring more neurological benefits than waiting for an MRI or surgical discectomy. However, caution is needed in this review's data interpretation until prospective and well-designed studies are performed.

The surgical treatment of subaxial acute cervical spine facet dislocations in adults: a systematic review and meta-analysis.

Adult cervical spine traumatic facet joint dislocations occur when excessive traumatic forces displace the vertebrae's facets, leading to loss of joint congruence. Reduction requires either cranial traction or open surgical procedures. This study aims to appraise the effects of different surgical techniques in the treatment of subaxial cervical spine acute traumatic facet blocks in adults. This study was based on a systematic literature review and meta-analysis, registered in Prospero (CRD42021279249). The PICO question was composed of adults with acute cervical spine traumatic facet dislocations submitted to anterior or posterior surgical approaches, associated or not with cranial traction for reduction. Each surgical technique was compared to the other. The primary clinical outcomes included neurological improvement or worsening and surgical success/failure rates. The anterior approach without cranial traction was efficient in reducing facet displacements. Skull traction was an efficient and immediate method to achieve spine dislocation reductions. Differences were not present among techniques regarding neurological improvement. There were no surgical failures in patients operated on via the posterior approach. The need to decompress and stabilize the cervical spine can be achieved by anterior or posterior surgical approaches, and there is no clear answer as to which initial approach is superior to the other.

Correlation of Intraoperative Neurophysiological Parameters and Outcomes in Patients with Intramedullary Tumors.

INTRODUCTION: Intramedullary spinal cord tumors (IMSCT) account for about 2%-4% of all central nervous system tumors. Surgical resection is the main treatment step, but might cause damage to functional tissues. Intraoperative neuromonitoring (IONM) is an adopted measure to decrease surgical complications. Below, we describe the results of IMSCT submitted to surgery under IONM at a tertiary institution. METHODS: The sample consisted of consecutive patients with IMSCT admitted to the Neurological Institute of Curitiba from January 2007 to November 2016. A total of 47 patients were surgically treated. Twenty-three were male (48.9%) and 24 were female (51.1%). The mean age was 42.77 years. The mean follow-up time was 42.7 months. RESULTS: Neurological status improved in 29 patients (62%), stable in 6 (13%), and worse in 12 (25%). Patients who presented with motor symptoms at initial diagnosis had a worse outcome compared to patients with sensory impairment and pain (P = 0.026). Patients with a change in electromyography had worse neurological outcomes compared to patients who did not show changes in monitoring (P = 0.017). DISCUSSION AND CONCLUSION: No prospective randomized high evidence study has been performed to date to compare clinical evolution after surgery with or without monitoring. In our sample, surgical resection was well succeeded mainly in oligosymptomatic patients with low preoperative McCormick classification and no worsening of IONM during surgery. We believe that microsurgical resection of IMSCT with simultaneous IONM is the gold standard treatment and achieved with good results.

Terminology and Legislation referring to Percutaneous Facet Procedures to Treat Low Back Pain in Brazil ­ Current Status

Incongruities in the terminology and in the Brazilian legislation about percutaneous facet procedures (PFPs) for the treatment of chronic lower back pain are frequently the subject of litigations between health professionals and supplementary healthcare providers. The Brazilian Hierarchical Classification of Medical Procedures (CBHPM, in the Portuguese acronym) describes four types of PFPs, while the Brazilian Unified Supplementary Health Terminology (TUSS, in the Portuguese acronym) describes five distinct lumbar PFPs, which correlate with the ones described on the List of Procedures and Events in Health, created by the Brazilian National Agency of Supplementary Health (ANS, in the Portuguese acronym). In the present paper, we review the terminology of the procedures, proposing the unification of the terminology and the abolition of redundancies in the tables. Finally, we developed a single terminology proposal for the PFPs based on their complexity and objectives to be used for the treatment of lower back pain.

The effect of filum terminale sectioning for Chiari 1 malformation treatment: systematic review.

PURPOSE: Symptomatic Chiari type I malformation (CM) is treated with posterior fossa decompression with/ without duroplasty. Few authors suggested cerebellar tonsil caudal migration due to a supposed "caudal traction" of cranial nerve structures in a so-called occult tethered cord syndrome. For these authors, filum terminale (FT) sectioning may improve CM symptoms. The objective of this review is to evaluate the effect of FT sectioning on the treatment of CM. METHODS: Using the PRISMA guidelines for systematic reviews, we reviewed studies to evaluate patient's outcomes with CM who underwent FT sectioning. The MINORS instrument was used for methodological quality assessment. The included studies' levels of evidence (LOE) were classified according to the Oxford Centre of Evidence-Based Medicine. RESULTS: Two studies from the same group of authors were included. We cannot assure if the cited cases in the first study were also included in their latter published study. The described results suggest that outcomes were not collected in a standardized fashion. Outcomes are described vaguely as a percentage of improvement. Case series samples were small and included not only patients with CM but also patients with scoliosis and syringomyelia. The MINORS score reported that both studies had low methodological quality. Both included studies were classified as level 4 of evidence. CONCLUSION: There is no scientific support for filum terminale sectioning in patients with CM without evidence of tethered cord. This procedure may be considered experimental and should be validated in a strict criterion of inclusion clinical trial comparing outcomes in posterior fossa decompression.

Intraoperative vancomycin powder and post-operative infection after spinal surgery: a systematic review and meta-analysis

SUMMARY

Intraoperative Neurophysiological Monitoring in Spine Surgery: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic literature review and meta-analysis. OBJECTIVE: The objective of this systematic literature review was to evaluate if intraoperative neurophysiological monitoring (IONM) can prevent neurological injury during spinal operative surgical procedures. SUMMARY OF BACKGROUND DATA: IONM seems to have presumable positive effects in identifying neurological deficits. However, the role of IONM in the decrease of new neurological deficits remains unclear. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and Meta-analysis, we reviewed clinical comparative studies who evaluate the rate of new neurological events in patients who had a spinal surgery with and without IONM. Studies were then classified according to their level of evidence. Methodological quality was assessed according to methodological index for non-randomized studies instrument. RESULTS: Six studies were evaluated comparing neurological events with and without IONM use by the random effects model. There was a great statistical heterogeneity. The pooled odds ratio (OR) was 0.72 {0.71; 1.79}, P = 0.4584. A specific analysis was done for two studies reporting the results of IONM for spinal surgery of intramedullary lesions. The OR was 0.1993 (0.0384; 1.0350), P = 0.0550. CONCLUSION: IONM did not result into fewer neurological events with the obtained evidence of the included studies. For intramedullary lesions, there was a trend to fewer neurological events in patients who underwent surgery with IONM. Further prospective randomized studies are necessary to clarify the indications of IONM in spinal surgeries. LEVEL OF EVIDENCE: 2.

Assessment of a Learning Strategy among Spine Surgeons.

STUDY DESIGN: Pilot test, observational study. OBJECTIVE: To evaluate objectively the knowledge transfer provided by theoretical and practical activities during AOSpine courses for spine surgeons. METHODS: During two AOSpine principles courses, 62 participants underwent precourse assessment, which consisted of questions about their professional experience, preferences regarding adolescent idiopathic scoliosis (AIS) classification, and classifying the curves by means of the Lenke classification of two AIS clinical cases. Two learning strategies were used during the course. A postcourse questionnaire was applied to reclassify the same deformity cases. Differences in the correct answers of clinical cases between pre- and postcourse were analyzed, revealing the number of participants whose accuracy in classification improved after the course. RESULTS: Analysis showed a decrease in the number of participants with wrong answers in both cases after the course. In the first case, statistically significant differences were observed in both curve pattern (83.3%, p = 0.005) and lumbar spine modifier (46.6%, p = 0.049). No statistically significant improvement was seen in the sagittal thoracic modifier (33.3%, p = 0.309). In the second case, statistical improvement was obtained in curve pattern (27.4%, p = 0.018). No statistically significant improvement was seen regarding lumbar spine modifier (9.8%, p = 0.121) and sagittal thoracic modifier (12.9%, p = 0.081). CONCLUSION: This pilot test showed objectively that learning strategies used during AOSpine courses improved the participants' knowledge. Teaching strategies must be continually improved to ensure an optimal level of knowledge transfer.

Spontaneous intracranial epidural hematoma during rivaroxaban treatment.

According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.

Spontaneous intracranial epidural hematoma during rivaroxaban treatment / Hematoma epidural intracraniano espontâneo durante tratamento com rivaroxaban

Summary According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.

Resumo Segundo nossa pesquisa, descrevemos o primeiro caso na literatura de hematoma epidural intracraniano espontâneo secundário ao uso de Xareltor. Hematomas epidurais intracranianos espontâneos raramente são descritos na literatura, sendo comumente associados a doenças infecciosas cranianas, distúrbios de coagulação, malformações vasculares da dura-máter e metástases cranianas. A elaboração de relatórios de monitoramento em longo prazo de pós-comercialização e relatórios independentes provavelmente irá detectar o espectro completo de complicações hemorrágicas do uso desse medicamento.

Is There a Role for Decompression Alone for Treating Symptomatic Degenerative Lumbar Spondylolisthesis?: A Systematic Review.

BACKGROUND CONTEXT: A posterior decompression with an instrumented fusion is one of the most common surgical procedures performed for treating symptomatic spinal stenosis associated with degenerative spondylolisthesis (DS). However, some patients may benefit from a decompression alone, avoiding complications related to instrumentation and fusion. OBJECTIVE: To identify the characteristics of patients with symptomatic DS who may be successfully treated with an isolated decompression. STUDY DESIGN: A systematic literature review of studies including patients who underwent decompression without instrumentation for treatment of DS. METHODS: A systematic review of the Medline database was performed. Retrospective and prospective studies of patients with DS who underwent a decompression were included, as well as studies comparing decompression with instrumented decompression. All the articles were classified according to their level of evidence. RESULTS: Thirteen studies met all inclusion and exclusion criteria. We identified several characteristics that may be associated with a less favorable outcome after a decompression alone: a facet angle >50 degrees, a disk space of >6.5 mm, presence of low back pain rather than lower extremity symptoms, presence of hypermobility in the listhetic level on dynamic radiographs (>1.25 to 2 mm), and resection of the posterior elements. The majority of the studies comparing decompression alone to decompression and instrumented fusion included in our review suggested similar clinical outcomes with both procedures; however, with long-term follow-up, fusion may provide better outcomes. Decompression with a noninstrumented fusion is also a good alternative to improve symptoms in selected patients, potentially decreasing the risk of reoperation compared with an instrumented fusion. CONCLUSIONS: Satisfactory clinical outcome can be achieved with an isolated decompression in selected patients, avoiding the additional risks and costs of instrumentation and spinal fusion. Noninstrumented fusion is also an interesting alternative to instrumented fusion for well-selected patients to decrease complications related to instrumentation.

Descompressão neurovascular para neuralgia do trigêmio em menina de 17 anos de Idade: Relato de caso / Neurovascular decompression for trigeminal neuralgia in 17-year-old Girl: A case report

A neuralgia do trigêmeo é geralmente uma doença de idosos. Raramente, a doença apresenta-se durante a infância. Porisso, procuramos explorar o papel da compressão vascular em pacientes pediátricos com neuralgia do trigêmeo refratária.Apresentamos um caso de compressão venosa relacionado à neuralgia do trigêmeo em uma menina de 17 anos de idade. Aveia petrosa superior foi relacionada ao conflito neurovascular, com resposta incomum para descompressão neurovascular eresolução completa dos sintomas no pós-operatório...

Trigeminal neuralgia in general is a disease of the elderly. Rarely, the disease presents during childhood. Therefore we sought toexplore the role of vascular compression in pediatric patients with medically refractory trigeminal neuralgia. A case of venouscompression related to trigeminal neuralgia is presented in a 17-year-old girl. Upper petrous vein was found to be related to aneurovascular conflict with unusual response to neurovascular decompression with complete resolution of symptoms in postoperativeperiod...

Aplicabilidade da fixação transpedicular de C2 (técnica de wright) na instabilidade atlantoaxial / C2 translaminar screw fixation (wright`s technique) applicability in atlantoaxial instability

A instabilidade atlantoaxial possui múltiplas causas e muitas vezes requer tratamento cirúrgico. Várias técnicas estão disponíveis para realização da fixação atlantoaxial, todas elas com diferentes vantagens e desvantagens. Em 2004, Wrigth descreveu a técnica de fixação translaminar de C2, que oferece uma fixação rígida, porém sem a dificuldade técnica da colocação de parafusos na pars de C2 e com eliminação do risco de lesão da artéria vertebral. O objetivo deste estudo é revisar a técnica de fixação translaminar de C2, enfatizando detalhes técnicos, risco e benefícios em comparação com as outras técnicas de fixação atlantoaxial.