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1.
World Neurosurg ; 145: e202-e208, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33065350

RESUMO

OBJECTIVE: To determine the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on operative case volume in 8 U.S. neurosurgical residency training programs in early 2020 and to survey these programs regarding training activities during this period. METHODS: A retrospective review was conducted of monthly operative case volumes and types for 8 residency programs for 2019 and January through April 2020. Cases were grouped as elective cranial, elective spine, and nonelective emergent cases. Programs were surveyed regarding residents' perceptions of the impact of COVID-19 on surgical training, didactics, and research participation. Data were analyzed for individual programs and pooled across programs. RESULTS: Across programs, the 2019 monthly mean ± SD case volume was 211 ± 82; 2020 mean ± SD case volumes for January, February, March, and April were 228 ± 93, 214 ± 84, 180 ± 73, and 107 ± 45. Compared with 2019, March and April 2020 mean cases declined 15% (P = 0.003) and 49% (P = 0.002), respectively. COVID-19 affected surgical case volume for all programs; 75% reported didactics negatively affected, and 90% reported COVID-19 resulted in increased research time. Several neurosurgery residents required COVID-19 testing; however, to our knowledge, only 1 resident from the participating programs tested positive. CONCLUSIONS: This study documents a significant reduction in operative volume in 8 neurosurgery residency training programs in early 2020. During this time, neurosurgery residents engaged in online didactics and research-related activities, reporting increased research productivity. Residency programs should collect data to determine the educational impact of the COVID-19 pandemic on residents' operative case volumes, identify deficiencies, and develop plans to mitigate any effects.


Assuntos
Neurocirurgia/educação , Pandemias , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Internato e Residência , Pesquisa , Estudos Retrospectivos , Coluna Vertebral/cirurgia , Inquéritos e Questionários , Estados Unidos
3.
World Neurosurg ; 145: e1-e6, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32777401

RESUMO

In December 2019, coronavirus disease 2019 (COVID-19) was discovered in Wuhan, Hubei province, from where it spread rapidly worldwide. COVID-19 characteristics (increased infectivity, rapid spread, and general population susceptibility) pose a great challenge to hospitals. Infectious disease, pulmonology, and intensive care units have been strengthened and expanded. All other specialties have been compelled to suspend or reduce clinical and elective surgical activities. The profound effects on spine surgery call for systematic approaches to optimizing the diagnosis and treatment of spinal diseases. Based on the experience of one Italian region, we draw an archetype for assessing the current and predicted level of stress in the health care system, with the aim of enabling hospitals to make better decisions during the pandemic. Further, we provide a framework that may help guide strategies for adapting surgical spine care to the conditions of epidemic surge.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Pandemias , Coluna Vertebral/cirurgia , /epidemiologia , Tomada de Decisões Gerenciais , Árvores de Decisões , Assistência à Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência , Humanos , Itália/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Doenças da Coluna Vertebral/terapia , Tempo para o Tratamento
4.
PLoS One ; 15(11): e0241998, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33166330

RESUMO

Spinal fusion is a commonly performed orthopedic surgery. Autologous bone graft obtained from the iliac crest is frequently employed to perform spinal fusion. Osteogenic bone marrow stromal (a.k.a. mesenchymal stem) cells (BMSCs) are believed to be responsible for new bone formation and development of the bridging bone during spinal fusion, as these cells are located in both the graft and at the site of fusion. Our previous work revealed the importance of mitochondrial oxidative metabolism in osteogenic differentiation of BMSCs. Our objective here was to determine the impact of BMSC oxidative metabolism on osseointegration of the graft during spinal fusion. The first part of the study was focused on correlating oxidative metabolism in bone graft BMSCs to radiographic outcomes of spinal fusion in human patients. The second part of the study was focused on mechanistically proving the role of BMSC oxidative metabolism in osseointegration during spinal fusion using a genetic mouse model. Patients' iliac crest-derived graft BMSCs were identified by surface markers. Mitochondrial oxidative function was detected in BMSCs with the potentiometric probe, CMXRos. Spinal fusion radiographic outcomes, determined by the Lenke grade, were correlated to CMXRos signal in BMSCs. A genetic model of high oxidative metabolism, cyclophilin D knockout (CypD KO), was used to perform spinal fusion in mice. Graft osseointegration in mice was assessed with micro-computed tomography. Our study revealed that higher CMXRos signal in patients' BMSCs correlated with a higher Lenke grade. Mice with higher oxidative metabolism (CypD KO) had greater mineralization of the spinal fusion bridge, as compared to the control mice. We therefore conclude that higher oxidative metabolism in BMSCs correlates with better spinal fusion outcomes in both human patients and in a mouse model. Altogether, our study suggests that promoting oxidative metabolism in osteogenic cells could improve spinal fusion outcomes for patients.


Assuntos
Osseointegração , Estresse Oxidativo , Fusão Vertebral , Adolescente , Adulto , Idoso , Animais , Transplante Ósseo/métodos , Criança , Feminino , Humanos , Masculino , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Fusão Vertebral/métodos , Coluna Vertebral/metabolismo , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Adulto Jovem
5.
Medicine (Baltimore) ; 99(48): e23332, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235097

RESUMO

BACKGROUND: Perioperative intravenous lidocaine has been reported to have analgesic and opioid-sparing effects in many kinds of surgery. Several studies have evaluated its use in the settings of spine surgery. The aim of the study is to examine the effect of intravenous lidocaine in patients undergoing spine surgery. METHODS: We performed a quantitative systematic review. Databases of PubMed, Medline, Embase database and Cochrane library were investigated for eligible literatures from their establishments to June, 2019. Articles of randomized controlled trials that compared intravenous lidocaine to a control group in patients undergoing spine surgery were included. The primary outcome was postoperative pain intensity. Secondary outcomes included postoperative opioid consumption and the length of hospital stay. RESULT: Four randomized controlled trials with 275 patients were included in the study. postoperative pain compared with control was reduced at 6 hours after surgery (WMD -0.50, 95%CI, -0.76 to -0.25, P < .001), at 24 hours after surgery (WMD -0.50, 95%CI, -0.70 to -0.29, P < .001) and at 48 hours after surgery (WMD -0.57, 95%CI, -0.96 to -0.17, P = .005). The effect of intravenous lidocaine on postoperative opioid consumption compared with control revealed a significant effect (WMD -15.36, 95%CI, -21.40 to -9.33 mg intravenous morphine equivalents, P < .001). CONCLUSION: This quantitative analysis of randomized controlled trials demonstrated that the perioperative intravenous lidocaine was effective for reducing postoperative opioid consumption and pain in patients undergoing spine surgery. The intravenous lidocaine should be considered as an effective adjunct to improve analgesic outcomes in patients undergoing spine surgery. However, the quantity of the studies was very low, more research is needed.


Assuntos
Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Coluna Vertebral/cirurgia , Administração Intravenosa , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Humanos , Tempo de Internação , Lidocaína/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
BMC Surg ; 20(1): 258, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33121450

RESUMO

BACKGROUND: To compare the safety and accuracy of the 3D-printed operation guide template technique and the free-hand technique in the placement of the S2-alar-iliac (S2AI) screw. METHODS: We conducted a retrospective analysis of 47 patients undergoing S2AI screw placement in our hospital, divided into the 3D-printed operation guide template group and the free-hand screw placement group. The duration of single S2AI screw placement was documented in all patients. A postoperative CT scan was performed to assess screw placement effectiveness according to the distance from the screw tip to the breach of the cortical bone wall. RESULTS: In total, 42 screws were placed in the guide template group, with an average screw placement duration of 151.6 ± 44.8 s. Screw placement grading was as follows: 40 screws in grade 0, two in grade 1, and none in grades 2 and 3. This grading resulted in excellent and good rates of 95.2% and 100%, respectively. In total, 52 screws were placed in the free-hand group, with an average screw placement duration of 138.3 ± 45.9 s. Screw placement grading was as follows: 42 screws in grade 0, seven in grade 1, three in grade 2, and none in grade 3. This grading resulted in excellent, good and acceptable rates 80.8%, 94.2% and 100%, respectively. Screw placement duration did not significantly differ between the groups (p > 0.05). The excellent rate of screw placement was greater in the guide template group than in the free-hand group (p < 0.05), but the good and acceptable rates did not significantly differ between the two groups (p > 0.05). CONCLUSION: Both techniques can be applied to S2AI screw placement. The 3D-printed guide technique is superior to the free-hand technique in terms of safety and accuracy.


Assuntos
Ílio , Impressão Tridimensional , Sacro , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Adulto , Idoso , Parafusos Ósseos , Feminino , Humanos , Ílio/diagnóstico por imagem , Ílio/cirurgia , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Sacro/cirurgia , Doenças da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X
7.
Zhonghua Wai Ke Za Zhi ; 58(11): 892-896, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120454

RESUMO

With the advantages of less operative injury and quicker postoperative recovery time, percutaneous endoscopic spine surgery system is currently one of the most widely used minimal invasive spine surgery techniques in China. However, this technique usually requires surgeon to operate in a single cannula, which brings much inconvenience such as limited vision, small range of motion and low efficiency. Meanwhile, the increasingly popular technique of unilateral biportal endoscopic (UBE) surgery possesses the advantages of better operation visual field, more flexible in operation, shorter learning curve period, handier surgical instruments for spine surgeon, and minimize radiation dosage caused by intraoperative fluoroscopy when comparing with single cannula endoscopic technique, since UBE requires an additional portal for surgical instruments while the anther portal is placed for arthroscope and pressure pump irrigation system. This technique has been applied to the treatment of degenerative diseases of cervical and lumbar spine, facet cyst, spinal epidural lipomatosis and abscess, and has achieved satisfactory clinical results.


Assuntos
Descompressão Cirúrgica , Endoscopia , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , China , Endoscopia/instrumentação , Endoscopia/métodos , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos
8.
Curr Opin Anaesthesiol ; 33(6): 718-723, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33002955

RESUMO

PURPOSE OF REVIEW: This review evaluates more complex surgical procedures to see whether they might be suitable for ambulatory surgery. Operations that have shown an increasing daycase rate in England include thyroidectomy, joint arthroplasty, spinal surgery and hysterectomy, and these procedures are evaluated. Similarly, there have been recent developments in the management of nonelective ambulatory surgery with more timely throughput and home discharge for suitable patients. RECENT FINDINGS: Caveats on patient selection with the development of focussed educational programmes about the proposed operation have assisted with the development of shorter discharge times. Strict antiemetic guidelines, multimodal analgesic protocols and postoperative multidisciplinary follow-up are core components of the pathway for effective ambulatory management. Communication after discharge should include phone calls from the Ambulatory Unit and easy access to the medical staff who conducted their operation. SUMMARY: There should be no reason why more complex surgical operations could not be included in a day surgery armamentarium. Similarly, the evidence for more effective use of timely emergency care with shortened length of stay is increasing.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Artroplastia , Histerectomia , Coluna Vertebral/cirurgia , Tireoidectomia , Emergências , Feminino , Humanos , Tempo de Internação , Alta do Paciente
9.
Anesthesiology ; 133(6): 1184-1191, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32898243

RESUMO

BACKGROUND: Frailty and cognitive impairment are associated with postoperative delirium, but are rarely assessed preoperatively. The study was designed to test the hypothesis that preoperative screening for frailty or cognitive impairment identifies patients at risk for postoperative delirium (primary outcome). METHODS: In this prospective cohort study, the authors administered frailty and cognitive screening instruments to 229 patients greater than or equal to 70 yr old presenting for elective spine surgery. Screening for frailty (five-item FRAIL scale [measuring fatigue, resistance, ambulation, illness, and weight loss]) and cognition (Mini-Cog, Animal Verbal Fluency) were performed at the time of the preoperative evaluation. Demographic data, perioperative variables, and postoperative outcomes were gathered. Delirium was the primary outcome detected by either the Confusion Assessment Method, assessed daily from postoperative day 1 to 3 or until discharge, if patient was discharged sooner, or comprehensive chart review. Secondary outcomes were all other-cause complications, discharge not to home, and hospital length of stay. RESULTS: The cohort was 75 [73 to 79 yr] years of age, 124 of 219 (57%) were male. Many scored positive for prefrailty (117 of 218; 54%), frailty (53 of 218; 24%), and cognitive impairment (50 to 82 of 219; 23 to 37%). Fifty-five patients (25%) developed delirium postoperatively. On multivariable analysis, frailty (scores 3 to 5 [odds ratio, 6.6; 95% CI, 1.96 to 21.9; P = 0.002]) versus robust (score 0) on the FRAIL scale, lower animal fluency scores (odds ratio, 1.08; 95% CI, 1.01 to 1.51; P = 0.036) for each point decrease in the number of animals named, and more invasive surgical procedures (odds ratio, 2.69; 95% CI, 1.31 to 5.50; P = 0.007) versus less invasive procedures were associated with postoperative delirium. CONCLUSIONS: Screening for frailty and cognitive impairment preoperatively using the FRAIL scale and the Animal Verbal Fluency test in older elective spine surgery patients identifies those at high risk for the development of postoperative delirium.


Assuntos
Disfunção Cognitiva/diagnóstico , Delírio/diagnóstico , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Complicações Pós-Operatórias/diagnóstico , Cuidados Pré-Operatórios/métodos , Coluna Vertebral/cirurgia , Idoso , Estudos de Coortes , Feminino , Idoso Fragilizado/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Tempo
10.
Clinics (Sao Paulo) ; 75: e1824, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935824

RESUMO

OBJECTIVES: The recent advancements in spine fixation aid in the treatment of complex spinal pathologies. Both the iliac screw (IS) and the S2-alar-iliac (S2AI) screw provide adequate stability in the fixation of complex lumbosacral spine pathologies, leading to a significant increased rate of using these techniques in the daily practice of the spine surgeons. This study aims to analyze, describe, and compare the insertion and positioning parameters of the S2AI screw and IS techniques in children without spinal deformities. METHODS: An observational retrospective study was conducted at a university hospital in 2018, with 25 computed tomography (CT) images selected continuously. Mann-Whitney-Shapiro-Wilk tests were performed. The reliability of the data was assessed using the intraclass correlation. The data were stratified by age group only for Pearson's correlation analysis. RESULTS: The mean age was 11.7 years (4.5 SD). The mean IS length was 106.63 mm (4.59 SD). The mean length of the S2AI screw was 104.13 mm (4.22 SD). The mean skin distance from the IS entry point was 28.13 mm (4.27 SD) and that for the S2AI screw was 39.96 mm (4.54 SD). CONCLUSIONS: Through CT, the S2AI screw trajectory was observed to have a greater bone thickness and skin distance than the IS. There was a linear correlation between age and screw length for both techniques. A similar relationship was observed between skin distance and age for the S2AI screw technique. In children, the S2AI screw technique presents advantages such as greater cutaneous coverage and implant thickness than the IS technique.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Sacro , Fusão Vertebral/métodos , Coluna Vertebral/diagnóstico por imagem , Criança , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Orthopade ; 49(10): 870-876, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32926204

RESUMO

Spinal alignment changes with age and degeneration. Different compensatory mechanisms of the spine are necessary to preserve spinal balance. The capacity of compensation of the spine decreases with age. Thus, the pelvis and the lower limbs become involved in the compensatory mechanism. Concomitant osteoarthritis of the hip could impair this capacity. The biomechanical principles of compensation are described with respect to planning reconstructive hip and spine surgery.


Assuntos
Pelve/cirurgia , Coluna Vertebral/cirurgia , Cirurgiões , Humanos , Extremidade Inferior , Radiografia
13.
Orthopade ; 49(10): 905-912, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32936313

RESUMO

Pathologies of the hip, spine and the lower extremity are often concomitant due to their three-dimensional anatomic and physiological interrelation. The real challenge lies in defining which of the pathologies is most relevant for the patient in terms of clinical symptoms and which organ should be treated first. The purpose of this review article is two-fold: Firstly, to explain the treatment dilemma of hip-spine syndrome to the treating physician. Secondly, to highlight the significance of spinal pathology in this context.


Assuntos
Coluna Vertebral/cirurgia , Cirurgiões , Humanos , Extremidade Inferior , Síndrome
14.
J Am Acad Orthop Surg ; 28(22): e988-e994, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32868701

RESUMO

Biomechanical function, specifically implantation technique and immediate surgical fixation, of orthopaedic implants is the primary consideration during the development of orthopaedic implants. Biologic and material characteristics are additional factors to include in the design process because of the direct impact on short- and long-term implant performance. The body's initial interaction with implant materials can affect protein- and cell-based function, thereby either promoting or impeding osseointegration. An understanding and inclusion of the biologic response, material surface morphology, and material surface chemistry in implant design is crucial because these factors ultimately determine implant function and patient outcomes. Highlighting the biologic- and material-related advantages and inadequacies of current and potential implant materials as well as applications may guide further research and development of implant materials and designs.


Assuntos
Interface Osso-Implante , Teste de Materiais , Osseointegração , Próteses e Implantes , Desenho de Prótese , Coluna Vertebral/cirurgia , Artroplastia , Fenômenos Biomecânicos , Humanos , Propriedades de Superfície
15.
Mayo Clin Proc ; 95(9): 1906-1915, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32736943

RESUMO

OBJECTIVE: To elucidate factors that influence opioid prescribing behaviors of key stakeholders after major spine surgery, with a focus on barriers to optimized prescribing. METHODS: In-person semi-structured interviews were performed with 20 surgical and medical professionals (January 23, 2019 to June 11, 2019) at a large academic medical center, including resident physicians, midlevel providers, attending physicians, and clinical pharmacists. Interviews centered on perceptions of postoperative prescribing practices were coded and analyzed using a qualitative inductive approach. RESULTS: Several unique themes emerged. First, wide interprovider variation exists in the perceived role of opioid prescribing guidelines. Second, there are important relationships between clinical experience, time constraints, and postoperative opioid prescribing. Third, opioid tapering is a major area of inconsistency. Fourth, there are serious challenges in managing analgesic expectations, particularly in those with chronic pain. Finally, there is currently no process to facilitate the hand-off or transition of opioid prescribing responsibility between surgical and primary care teams, which represents a major area for practice optimization efforts. CONCLUSION: Despite increased focus on postoperative opioid prescribing, there remain numerous areas for improvement. The development of tools and processes to address critical gaps in postoperative prescribing will be essential for our efforts to reduce long-term opioid use after major spine surgery and improve patient care.


Assuntos
Analgésicos Opioides/uso terapêutico , Continuidade da Assistência ao Paciente/normas , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica , Atitude do Pessoal de Saúde , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Pesquisa Qualitativa , Coluna Vertebral/cirurgia , Carga de Trabalho
16.
Spine (Phila Pa 1976) ; 45(18): 1285-1292, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32756270

RESUMO

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: The aim of this study was to investigate the impact of COVID-19 pandemic on the clinical practices of spine surgeons within the Asia Pacific region. SUMMARY OF BACKGROUND DATA: COVID-19 pandemic had changed spine surgeons' clinical practices and their concerns toward personal and family risk of infection. METHODS: This cross-sectional survey was carried out from May 4, 2020 to June 4, 2020. The questionnaire was administered using REDCAP. The online questionnaire includes four sections. First section includes surgeon's demographics, background, type of clinical practice, and status of pandemic in their country. Second section includes volume and the type of spine surgery practice before the COVID pandemic. Third section includes changes of clinical practice during the pandemic and the last section was regarding their concern on COVID transmission. RESULTS: Total of 222 respondents from 19 countries completed the questionnaire. During the pandemic, 92.3% of the respondents felt their clinical practice was affected. 58.5% respondents reported reduced outpatient clinic hours and 74.6% respondents reported reduced operation theatre hours due to the enforcement by the hospital administration. The mean reduction of clinic volume for all countries was 48.1%. There was a significant reduction in the number of surgeries performed in Japan, Malaysia, India, Philippines, and South Korea. This was due to reduced patient load. More than 60% of respondents were worried being infected by COVID-19 virus and >68% were worried of transmission to their family members. CONCLUSION: COVID-19 pandemic has significantly affected the clinical and surgical practice of spine surgeons in the Asia Pacific region. Clinics were closed or the practice hours reduced. Similarly, surgical theaters were closed, reduced, or limited to semi-emergency and emergency surgeries. Spine surgeons were moderately concerned of contracting COVID-19 during their clinical practice but were extremely concerned to transmit this disease to their family members. LEVEL OF EVIDENCE: 4.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Coluna Vertebral/cirurgia , Cirurgiões , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Ásia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Estudos Transversais , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgiões/estatística & dados numéricos
17.
Medicine (Baltimore) ; 99(32): e21579, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769906

RESUMO

Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ±â€Š86 perfusion unite (PU), and the SCBF decreased to 228 ±â€Š68 PU after VCR (P = .008). The SCBF increased to 296 ±â€Š102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ±â€Š65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.


Assuntos
Cifose/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Escoliose/cirurgia , Medula Espinal/irrigação sanguínea , Coluna Vertebral/cirurgia , Adolescente , Adulto , Feminino , Humanos , Cifose/complicações , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Escoliose/complicações , Medula Espinal/cirurgia , Coluna Vertebral/fisiopatologia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(32): e21720, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769940

RESUMO

The surgical treatment of congenital scoliosis under 10 years is difficult as it involves resecting vertebrae. Moreover, patient follow-up after surgery is extremely important because the patient is a child whose growth has not been completed. However, there are very few long-term follow-up studies after surgical treatment of congenital scoliosis. Therefore, this study is designed to evaluate surgical outcomes after posterior hemivertebra resection in children under 10 years and its long-term effects.Twenty-one patients with congenital scoliosis who were younger than 10 years at the time of the surgery and received posterior hemivertebra resection and fusion using pedicle screw fixation were included in this study.There were significant improvements in the main curve, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis after surgery (P < .001, .021, .047, .043, .006, respectively). Coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis remained within the normal range during the follow-up period; however, main curve deteriorated significantly (P = .005). Trunk appearance of perception scale improved significantly after surgery (P = .031) and was maintained during the follow-up period (P = .078).In conclusion, posterior hemivertebra resection and fusion using pedicle screw fixation in patients under 10 years old with congenital scoliosis is a safe and effective procedure that can achieve rigid fixation and deformity correction. Complete resection of the hemivertebra is important for deformity correction and prevention of curve progression, and careful long-term follow-up is necessary.


Assuntos
Escoliose/cirurgia , Coluna Vertebral/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Fixadores Internos , Masculino , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Escoliose/complicações , Escoliose/fisiopatologia , Curvaturas da Coluna Vertebral/classificação , Curvaturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Resultado do Tratamento
19.
Plast Reconstr Surg ; 146(5): 642e-650e, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32826729

RESUMO

BACKGROUND: Advances in surgical technology and adjuvant therapies along with an aging and increasingly morbid U.S. population have led to an increase in complex spine surgery. With this increase comes an elevated risk of complications, including those related to the surgical wound, with some studies demonstrating wound complication incidences approaching 45 percent. The authors hypothesize that immediate muscle flap closure improves outcomes in high-risk patients. METHODS: Three hundred one consecutive index cases of spinal wound closure using local muscle flaps performed by the senior author at a single institution between 2006 and 2018 were reviewed. The primary outcome was major wound complication (reoperation and/or readmission because of surgical-site infection, late infection, dehiscence, seroma, or hematoma). Logistic regression analysis was performed to identify predictors of this endpoint. RESULTS: Major wound complications occurred in 6.6 percent of patients (reoperation, 3.6 percent; readmission, 3.0 percent), with a 6.0 percent infection rate and five cases requiring instrumentation removal because of infection. Risk factors identified included radiotherapy (OR, 5.9; p = 0.004), age 65 years or older (OR, 2.8; p = 0.046), and prior spine surgery (OR, 4.3; p = 0.027). The incidence of major wound complication increased dramatically with each additional risk factor. Mean drain dwell duration was 21.1 ± 10.0 days and not associated with major wound complications, including infection (OR, 1.04; p = 0.112). CONCLUSIONS: Immediate local muscle flap closure following complex spine surgery on high-risk patients is associated with an acceptable rate of wound complications and, as these data demonstrate, is safe and effective. Consideration should be given to immediate muscle flap closure in appropriately selected patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Retalhos Cirúrgicos/transplante , Ferida Cirúrgica/cirurgia , Técnicas de Fechamento de Ferimentos/efeitos adversos , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Coluna Vertebral/cirurgia , Retalhos Cirúrgicos/efeitos adversos , Ferida Cirúrgica/etiologia , Resultado do Tratamento
20.
Br J Radiol ; 93(1115): 20200465, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32783618

RESUMO

Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.


Assuntos
Neoplasias Ósseas/terapia , Oncologia/tendências , Neoplasias Musculares/terapia , Antineoplásicos/administração & dosagem , Dor do Câncer/terapia , Terapia Combinada/métodos , Criocirurgia/métodos , Eletroporação/métodos , Potenciais Evocados , Feminino , Fluoroscopia/métodos , Previsões , Fraturas Ósseas/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Doença Iatrogênica/prevenção & controle , Lipossomos/administração & dosagem , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Micro-Ondas/uso terapêutico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Ablação por Radiofrequência/métodos , Terapia por Radiofrequência/métodos , Radiologia Intervencionista/métodos , Radiologia Intervencionista/tendências , Neoplasias da Coluna Vertebral/terapia , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodos
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