Short-Term Clinical and Radiographical Outcome after Application of Anchored Intervertebral Spacers in Dogs with Disc-Associated Cervical Spondylomyelopathy.

OBJECTIVES: The purpose of this study was to assess the short-term outcome of a new intervertebral anchored fusion device (C-LOX) for the treatment of disc associated cervical spondylomyelopathy (DA-CSM) in dogs, based on clinical and radiographical follow-up data. MATERIALS AND METHODS: To be included in the study, dogs had to be clinically affected by DA-CSM treated with surgical distraction/stabilization using the anchored intervertebral spacer (C-LOX). Neurological signs, as well as diagnostic imaging performed pre-, immediately postoperatively, and after 6 weeks and 3 months were assessed. If available, clinical follow-up after 3 months was documented. RESULTS: Thirty-seven cases were enrolled in the study. Outcome at 3 months was available in 25 dogs; improvement of neurological status was documented in 25/25 cases.The most common postoperative complication was screw loosening and/or breakage (n = 22), followed by subsidence (n = 15). Four dogs required revision surgery. CLINICAL SIGNIFICANCE: Distraction/stabilization of DA-CSM in dogs with the C-LOX device resulted in short-term clinical improvement in 33/37 treated cases. The high incidence of screw loosening was taken into consideration and modification of the implant with a new locking system and new screw dimensions was required. The C-LOX device seems to be a valuable alternative to more complicated distraction-fusion techniques.

Cumulative total effective whole-body radiation dose in critically ill patients.

BACKGROUND: Uncertainty exists about a safe dose limit to minimize radiation-induced cancer. Maximum occupational exposure is 20 mSv/y averaged over 5 years with no more than 50 mSv in any single year. Radiation exposure to the general population is less, but the average dose in the United States has doubled in the past 30 years, largely from medical radiation exposure. We hypothesized that patients in a mixed-use surgical ICU (SICU) approach or exceed this limit and that trauma patients were more likely to exceed 50 mSv because of frequent diagnostic imaging. METHODS: Patients admitted into 15 predesignated SICU beds in a level I trauma center during a 30-day consecutive period were prospectively observed. Effective dose was determined using Huda's method for all radiography, CT imaging, and fluoroscopic examinations. Univariate and multivariable linear regressions were used to analyze the relationships between observed values and outcomes. RESULTS: Five of 74 patients (6.8%) exceeded exposures of 50 mSv. Univariate analysis showed trauma designation, length of stay, number of CT scans, fluoroscopy minutes, and number of general radiographs were all associated with increased doses, leading to exceeding occupational exposure limits. In a multivariable analysis, only the number of CT scans and fluoroscopy minutes remained significantly associated with increased whole-body radiation dose. CONCLUSIONS: Radiation levels frequently exceeded occupational exposure standards. CT imaging contributed the most exposure. Health-care providers must practice efficient stewardship of radiologic imaging in all critically ill and injured patients. Diagnostic benefit must always be weighed against the risk of cumulative radiation dose.