Emergency stabilisation by single-stage posterior transpedicular approach for treatment of unstable lumbar spine fracture with neurological injury.

Management of unstable thoracolumbar fractures remains controversial. Furthermore, when these are accompanied by related neurological injury, the choice of approach, decompression technique and timing of the intervention could have a neuroprotective effect. In terms of site, the lumbar spine represents only 1.2% of cases, yet fractures with severe instability and neurological injury call for attainment of the same goals, i.e., neurological stability and decompression. After suffering high-energy trauma as a result of an accidental fall, a young male patient presenting with unstable injury of the lumbar spine and neurological impairment compatible with incomplete cauda equina syndrome was treated with emergency stabilisation and decompression through single-stage posterior transpedicular approach. At one year of the intervention, the patient is making good progress, with absence of lumbar pain, isolated deficit in left ankle dorsiflexion with no need of orthosis or cane, adequate sphincter control and return to his previous activity. Patients who present with unstable injury of the lumbar spine and incomplete neurological involvement can benefit from emergency stabilisation and decompression treatment by posterior transpedicular approach, with improvement in neurological status and functional recovery.

Monitorización neurofisiológica intraoperatoria del nervio frénico: utilidad y descripción de la técnica / Intraoperative neurophysiological monitoring of the phrenic nerve: utility and descriptions of the technique

En procedimientos quirúrgicos de las regiones supraclaviculares y laterales cervicales, así como en cirugías cardíacas y mediastínicas, la función diafragmática puede comprometerse desde la base del riesgo de lesión del nervio frénico y/o la raíz C4. Son escasas las publicaciones que tratan la estimulación intraoperatoria de estas estructuras nerviosas para evaluar su funcionalidad y, en nuestro conocimiento, hasta ahora no se ha hipotetizado acerca de si es posible reducir las tasas de lesión situadas en hasta el 26% en algunos estudios de cirugía cardíaca. Describimos la técnica empleada para la monitorización neurofisiológica del nervio frénico. Asimismo, se discute su utilidad y ventajas respecto a otras técnicas. Concluimos que con la incorporación creciente de la monitorización neurofisiológica intraoperatoria en los últimos años, es posible su aplicación al nervio frénico en los procedimientos en los que se considere que existe riesgo de lesión del mismo y, con ella, puede ser factible la reducción de las tasas de lesión iatrógena

In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies. We describe the technique used for the neurophysiological monitoring of the phrenic nerve. Also, its usefulness and advantages over other techniques are discussed. We conclude that, with the increasing incorporation in recent years of intraoperative neurophysiological monitoring, its application to the phrenic nerve is possible in procedures with a risk of injury and, thus, the reduction of iatrogenic injury rates may be feasible

Intraoperative neurophysiological monitoring of the phrenic nerve: utility and descriptions of the technique. / Monitorización neurofisiológica intraoperatoria del nervio frénico: utilidad y descripción de la técnica.

In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies. We describe the technique used for the neurophysiological monitoring of the phrenic nerve. Also, its usefulness and advantages over other techniques are discussed. We conclude that, with the increasing incorporation in recent years of intraoperative neurophysiological monitoring, its application to the phrenic nerve is possible in procedures with a risk of injury and, thus, the reduction of iatrogenic injury rates may be feasible.

Exceptional response to brivaracetam in a patient with refractory idiopathic generalized epilepsy and absence seizures.

Brivaracetam is currently indicated as adjunctive therapy for patients with focal-onset seizures with or without secondary generalization. However, it has been suggested that it could provide broad-spectrum efficacy given its similarity to levetiracetam and based on the results from preclinical studies and others of patients with generalized epilepsy. We present the case of a woman with refractory idiopathic generalized epilepsy and absence seizures with dramatic response to brivaracetam. Our report supports a consideration of treatment with this new antiepileptic drug on a case-by-case basis in patients with refractory generalized epilepsy, while we await further studies on this topic.