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1.
Med Sci Monit ; 26: e919971, 2020 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-32198342

RESUMO

BACKGROUND Intravenous lidocaine administered during surgery improves postoperative outcomes; however, few studies have evaluated the relationship between intravenous lidocaine and volatile anesthetics requirements. This study assessed the effects of lidocaine treatment on sevoflurane consumption and postoperative consciousness disorders in children undergoing major spine surgery. MATERIAL AND METHODS Patients were randomly divided into 2 treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 min, followed by a continuous infusion at 1 mg/kg/h to 6 h after surgery. The following data were assessed: end-tidal sevoflurane concentration required to maintain a bispectral index BIS between 40 and 60, intraoperative blood pressure, heart rate, demand for fentanyl, and consciousness level assessed after surgery using the Richmond Agitation-Sedation Scale. Any treatment-related adverse events were recorded. RESULTS Compared to the control group, lidocaine treatment reduced by 15% the end-tidal sevoflurane concentration required to maintain the intraoperative hemodynamic stability and appropriate level of anesthesia (P=0.0003). There were no intergroup differences in total dose of fentanyl used, average mean arterial pressure, or heart rate measured intraoperatively. The postoperative level of patient consciousness did not differ during the first 6 h between groups. After 9 h, more patients in the control group were still sleepy (P=0.032), and there were fewer perioperative complications in the lidocaine group. CONCLUSIONS Lidocaine treatment decreases sevoflurane consumption and improves recovery profiles in children undergoing major spine surgery.


Assuntos
Período de Recuperação da Anestesia , Lidocaína/administração & dosagem , Sevoflurano/administração & dosagem , Coluna Vertebral/cirurgia , Adolescente , Anestesia Geral , Anestésicos Combinados/administração & dosagem , Criança , Relação Dose-Resposta a Droga , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Infusões Intravenosas , Período Intraoperatório , Lidocaína/efeitos adversos , Lidocaína/sangue , Masculino , Monitorização Intraoperatória , Sevoflurano/sangue
2.
Zhongguo Zhen Jiu ; 40(2): 147-51, 2020 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-32100499

RESUMO

OBJECTIVE: To observe the auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery. METHODS: A total of 64 patients with lumbar disc herniation who underwent percutaneous lateral transforaminal endoscope surgery were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with injection of 1% lidocaine for routine local infiltration anesthesia. The patients in the observation group were treated with wrist-ankle acupuncture at lower 5 area and lower 6 area for 30 min, 5 min before routine local infiltration anesthesia; immediately, 15 min, 30 min after insertion the left-right technique, up-down technique, and rotation technique were applied for six times, respectively. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO2) and pain visual analogue scale (VAS) were compared between the two groups at the time points of intraoperative puncture (T1), circular saw grinding (T2), and placement of working channel (T3). The intention of reoperation was recorded immediately after operation and 24 h after operation. The expectation and treatment credibility scale (ETCS) was used to evaluate the relationship between patients' expectation and efficacy 5 min before operation and immediately after operation. RESULTS: At T2 and T3 during the operation, the MAP and HR in the obserrvation group were lower than those in the control group, while SpO2 was higher than that in the control group (P<0.05). At T1, there was no significant difference of MAP, HR and SpO2 between the two groups (P>0.05). At T2, the peak VAS and average VAS in the observation group were lower than those in the control group (P<0.05), but there was no significant difference at T1 and T3 (P>0.05). The intention of reoperation in the observation group was higher than that in the control group both immediately after operation and 24 h after operation (P<0.05). In the observation group, the scores of each item in ETCS immediately after operation were higher than those 5 min before operation (P<0.05), while in the control group there was no significant difference between immediately after operation and 5 min before operation (P>0.05). The scores of ETCS1, ETCS2 and ETCS3 immediately after operation in the observation group were higher than those in the control group (P<0.05). CONCLUSION: The wrist-ankle acupuncture has positive auxiliary analgesic effect on lumbago during transforaminal endoscope surgery, and strengthens the patients' confidence on the operation effect.


Assuntos
Analgesia por Acupuntura , Tornozelo , Endoscopia , Punho , Analgésicos , Humanos , Coluna Vertebral/cirurgia
4.
Medicine (Baltimore) ; 99(2): e18756, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914098

RESUMO

RATIONALE: Liver transplantation (LT) is the preferred surgical option for the treatment of early hepatocellular carcinoma (HCC). In contrast, surgical treatment of progressive HCC metastasized to the spine following LT constitutes a considerable challenge. Here, we report the first case of progressive HCC metastasized to the T12 vertebra after local radiotherapy, treated successfully with en bloc lumpectomy following LT for HCC. PATIENT CONCERNS: A 40-year-old man who had undergone LT for the treatment of HCC 2 months prior presented to our clinic with symptoms of progressive back pain. Magnetic resonance imagining (MRI) and positron emission tomography (PET) examinations showed a solitary metastasis at T12 without recurrence in the liver or metastasis to other organs. DIAGNOSES: The patient was diagnosed with HCC metastasized to the T12 vertebra after liver transplantation. INTERVENTIONS: Local radiation therapy of the T12 vertebra was performed; however, the lesion continued to grow one month after irradiation. Accordingly, the patient was treated with en bloc lumpectomy of the T12 vertebra. After surgery, the patient reported significant pain relief. At 11 months post-surgery, a C4 metastasis with spinal cord compression was revealed by MRI. Multiple grafted liver metastases were also detected by ultrasound along with several lung metastases, which were discovered by X-ray. The patient was treated with a pedicle screw system and a mesh cage filled with frozen autografts for C4 metastasis. OUTCOMES: The patient died 15 months after liver transplantation due to recurrence in the liver and metastasis to the lung. LESSONS: En bloc lumpectomy may be a viable therapeutic option for patients with progressive solitary spinal metastases after LT refractory to radiotherapy. Use of immunosuppressive therapy after LT may significantly inhibit immune function, making patients more susceptible to HCC recurrence and bone metastasis.


Assuntos
Neoplasias Ósseas/secundário , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Adulto , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/métodos , Masculino , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia
5.
World Neurosurg ; 133: e784-e788, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605859

RESUMO

OBJECTIVE: The utility of preoperative biomarkers for assessing perioperative complications in patients undergoing spine surgery (SS) is unclear, and no study has assessed the ability of preoperative natriuretic peptides to predict adverse events following SS. This study aimed to evaluate the prognostic importance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients undergoing SS. METHODS: We prospectively followed 154 consecutive adult patients ≥50 years old hospitalized for elective SS. The outcomes of interest were length of stay in hospital and perioperative medical complications during hospitalization, defined as pneumonia, deep or organ space surgical site infection, bacteremia, prolonged mechanical ventilation >48 hours, unplanned reintubation, acute renal failure, sepsis or septic shock, venous thromboembolism (deep vein thrombosis or pulmonary embolism), cardiac arrest, stroke, myocardial infarction, return to operating room, and in-hospital mortality. RESULTS: In 21 (13.6%) patients, 32 episodes of medical adverse events occurred. Older patients and patients with more comorbid conditions, such as heart failure, diabetes, cerebrovascular disease, coronary artery disease, and chronic obstructive pulmonary disease, tended to have a higher rate of adverse events. Patients with adverse events had higher NT-proBNP and troponin levels on admission compared with patients without adverse events. Multivariate analysis showed that NT-proBNP >242 pg/ml (odds ratio 2.374; 95% confidence interval, 1.000-2.958; P = 0.001) and presence of diabetes (odds ratio 2.16; 95% confidence interval, 1.86-7.89; P = 0.008) were significant and independent predictors of perioperative adverse events. CONCLUSIONS: This study demonstrates that preoperative NT-proBNP level in patients undergoing SS could be a valuable prognostic marker for several postoperative complications.


Assuntos
Peptídeo Natriurético Encefálico/sangue , Procedimentos Ortopédicos/efeitos adversos , Fragmentos de Peptídeos/sangue , Complicações Pós-Operatórias/sangue , Coluna Vertebral/cirurgia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
6.
World Neurosurg ; 133: e874-e892, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541754

RESUMO

OBJECTIVE: The increasing challenges facing the training of future neurosurgeons have led to continued development of simulation-based training, particularly for neurosurgical subspecialties. The simulators must be scientifically validated to fully assess their benefit and determine their educational effects. In this second part, we aim to identify the available simulators for spine, pediatric neurosurgery, interventional neuroradiology, and nontechnical skills, assess their validity, and determine their effectiveness. METHODS: Both Medline and Embase were searched for English language articles that validate simulation models for neurosurgery. Each study was screened according to the Messick validity framework, and rated in each domain. The McGaghie model of translational outcomes was then used to determine a level of effectiveness for each simulator or training course. RESULTS: Overall, 114 articles for 108 simulation-based training models or courses were identified. These articles included 24 for spine simulators, 3 for nontechnical skills, 10 for 9 pediatric neurosurgery simulators, and 12 for 11 interventional neuroradiology simulators. Achieving the highest rating for each validity domain were 3 models for content validity; 16 for response processes; 1 for internal structure; 2 for relations to other variables; and only 1 for consequences. For translational outcomes, 2 training courses achieved a level of effectiveness of >2, showing skills transfer beyond the simulator environment. CONCLUSIONS: With increasing simulators, there is a need for more validity studies and attempts to investigate translational outcomes to the operating theater when using these simulators. Nontechnical skills training is notably lacking, despite demand within the field.


Assuntos
Competência Clínica , Procedimentos Neurocirúrgicos/educação , Treinamento por Simulação/métodos , Medula Espinal/cirurgia , Coluna Vertebral/cirurgia , Criança , Humanos , Radiologia/educação
7.
Orthopade ; 49(1): 39-58, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31346644

RESUMO

BACKGROUND: Spine surgeries can pose many complications; however, peak timing of post-operative complications in the field of spine surgery is still not sufficiently delineated in the literature as yet. Nevertheless the determination of peak timing of post-operative complications has a significant influence on patient education and post-operative follow-up. MATERIALS AND METHODS: This single-center study analyzed the medical records of 1179 patients that underwent spinal instrumentation between 2010 and 2015 at 3, 6, 12, 24 and 36 months postoperatively. Complications were analyzed according to their time of onset. RESULTS: Of the 1179 patients included, 199 (16.9%) underwent revision surgery due to a complication. Peak timing for complications (72.9%) occurred within the first 3 months after surgery. Infection was the most common reason for revision surgery (42.7%) and most infections occurred within the first 3 months after surgery (early infections) (91.8% of infections). Peak timing for material failure occurred in the second post-operative year (46% of all detected prosthesis failures) (2.5% of all complications). DISCUSSION: Peak timing of post-operative complications post spinal instrumentation occurs as early on as within the first 3 months after surgery and post-operative infections remain the most common post-operative complication overall. Nonetheless, regular and long-term postoperative clinical and radiological follow-up is crucial, since in particular prosthesis failure has its peak timing in the second post-operative year.


Assuntos
Complicações Pós-Operatórias , Coluna Vertebral/cirurgia , Humanos , Radiografia , Reoperação , Estudos Retrospectivos
8.
World Neurosurg ; 133: 291-301, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31627004

RESUMO

Paulus of Aegina (625-690 ad) was the last of the prolific Byzantine physicians. His works consolidated and extended the knowledge of his predecessors, with pioneering efforts to improve the surgical management of spinal injuries. In this article, we review the literature to present an overview of the remarkable evolution of spine surgery throughout classical antiquity. In particular, we discuss the contributions of Paulus to this corpus and explore his classic 7-book anthology, Epitomoe Medicae Libri Septem (Medical Compendium in Seven Books). In reviewing Paulus' legacy, we show the significant milestones in the early development of anatomic and functional knowledge of the spine.


Assuntos
Procedimentos Ortopédicos/história , Médicos/história , Coluna Vertebral/cirurgia , História Antiga , Humanos
9.
Yonsei Med J ; 61(1): 94-99, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887805

RESUMO

Developing new surgical instruments is challenging. While making surgical instruments could be a good field of application for 3D printers, attempts to do so have proven limited. We designed a new endoscope-assisted spine surgery system, and using a 3D printer, attempted to create a complex surgical instrument and to evaluate the feasibility thereof. Developing the new surgical instruments using a 3D printer consisted of two parts: one part was the creation of a prototype instrument, and the other was the production of a patient model. We designed a new endoscope-assisted spine surgery system with a cannula for the endoscope and working instruments and extra cannula that could be easily added. Using custom-made patient-specific 3D models, we conducted discectomies for paramedian and foraminal discs with both the newly designed spine surgery system and conventional tubular surgery. The new spine surgery system had an extra portal that can be well bonded in by a magnetic connector and greatly expanded the range of access for instruments without unnecessary bone destruction. In foraminal discectomy, the newly designed spine surgery system showed less facet resection, compared to conventional surgery. We were able to develop and demonstrate the usefulness of a new endoscope-assisted spine surgery system relying on 3D printing technology. Using the extra portal, the usability of endoscope-assisted surgery could be greatly increased. We suggest that 3D printing technology can be very useful for the realization and evaluation of complex surgical instrument systems.


Assuntos
Endoscópios , Impressão Tridimensional/instrumentação , Coluna Vertebral/cirurgia , Instrumentos Cirúrgicos , Discotomia , Humanos
10.
World Neurosurg ; 135: e307-e320, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31841719

RESUMO

OBJECTIVE: To investigate preoperative baseline anemia, stratified by severity as a function of hematocrit level, as a risk factor for perioperative complications in geriatric patients undergoing spinal procedures. BACKGROUND: Previous literature has examined the impact of anemia on risk for complications and adverse outcomes in patients undergoing elective spinal procedures. However, there is a paucity of literature analyzing the impact of anemia in the geriatric population, specifically. METHODS: The American College of Surgeons-National Surgical Quality Improvement Database was used to identify patients older than 65 years who had undergone elective spinal procedures and were subsequently stratified into 3 separate cohorts based on hematocrit levels: severe/moderate (hematocrit level <30%), mild (30%-37%), and no anemia (>38%). These patient samples were then analyzed using multivariate analyses to assess severity of anemia as a risk factor for complications in elderly patients undergoing spinal procedures. RESULTS: When anemia classes were analyzed as separate independent risk factors for complications, mild anemia (class II) was a significant risk factor for the same complications as moderate/severe anemia (class III/IV), with the exception of 2 complications, compared with nonanemic patients. Mild anemia was independently associated with wound dehiscence (odds ratio, 1.521; 95% confidence interval, 1.126-2.054; P = 0.006), whereas moderate/severe anemia did not show an increased risk for wound dehiscence. However, moderate/severe anemia independently increased the risk for deep venous thromboembolism (odds ratio, 1.437; 95% confidence interval, 1.028-2.011; P = 0.034), compared with mild anemia. Both categories of anemia independently increased the risk for additional complications such as deep incisional surgical site infection, organ/space surgical site infection, pneumonia, unplanned intubation, ventilator dependence, progressive renal insufficiency, acute renal failure, urinary tract infections, cardiac arrest, myocardial infarctions, blood transfusions, systemic sepsis, reoperation, extended length of stay of ≥5 days, unplanned readmission, and mortality. CONCLUSIONS: This study indicated that patients with preoperative baseline anemia were at risk for requiring transfusions, renal failure, and infectious complications. Physicians should be cognizant of anemia as a risk factor affecting numerous perioperative complications and adverse outcomes to work toward improving health-related quality of life.


Assuntos
Anemia/complicações , Complicações Pós-Operatórias/epidemiologia , Coluna Vertebral/cirurgia , Idoso , Anemia/sangue , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Complicações Pós-Operatórias/cirurgia , Qualidade de Vida , Reoperação/efeitos adversos , Fatores de Risco , Infecções Urinárias/etiologia
11.
Bone Joint J ; 101-B(12): 1563-1569, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31787003

RESUMO

AIMS: The aim of this study was to compare the surgical and quality-of-life outcomes of children with skeletal dysplasia to those in children with idiopathic early-onset scoliosis (EOS) undergoing growth-friendly management. PATIENTS AND METHODS: A retrospective review of two prospective multicentre EOS databases identified 33 children with skeletal dysplasia and EOS (major curve ≥ 30°) who were treated with growth-friendly instrumentation at younger than ten years of age, had a minimum two years of postoperative follow-up, and had undergone three or more lengthening procedures. From the same registries, 33 matched controls with idiopathic EOS were identified. A total of 20 children in both groups were treated with growing rods and 13 children were treated with vertical expandable prosthetic titanium rib (VEPTR) instrumentation. RESULTS: Mean preoperative major curves were 76° (34° to 115°) in the skeletal dysplasia group and 75° (51° to 113°) in the idiopathic group (p = 0.55), which were corrected at final follow-up to 49° (13° to 113°) and 46° (12° to 112°; p = 0.68), respectively. T1-S1 height increased by a mean of 36 mm (0 to 105) in the skeletal dysplasia group and 38 mm (7 to 104) in the idiopathic group at the index surgery (p = 0.40), and by 21 mm (1 to 68) and 46 mm (7 to 157), respectively, during the distraction period (p = 0.0085). The skeletal dysplasia group had significantly worse scores in the physical function, daily living, financial impact, and parent satisfaction preoperatively, as well as on financial impact and child satisfaction at final follow-up, than the idiopathic group (all p < 0.05). The domains of the 24-Item Early-Onset Scoliosis Questionnaire (EOSQ24) remained at the same level from preoperative to final follow-up in the skeletal dysplasia group (all p > 0.10). CONCLUSION: Children with skeletal dysplasia gained significantly less spinal growth during growth-friendly management of their EOS and their health-related quality of life was significantly lower both preoperatively and at final follow-up than in children with idiopathic EOS. Cite this article: Bone Joint J 2019;101-B:1563-1569.


Assuntos
Doenças do Desenvolvimento Ósseo/complicações , Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Estudos Retrospectivos , Escoliose/etiologia , Coluna Vertebral/crescimento & desenvolvimento , Coluna Vertebral/cirurgia , Resultado do Tratamento
13.
Zhonghua Wai Ke Za Zhi ; 57(11): 878-880, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694139

RESUMO

Meralgia paresthetica (MP) after posterior spine surgery is caused by mechanical compression injury of lateral femoral cutaneous nerve, which presents as numbness or paresthesia in the confined area of the anterolateral thigh. MP after posterior spine surgery is a common postoperative complication, and the incidence is 12.7%-25.5%. Because its clinical manifestations are mild and easy to be ignored, often leading to treatment delays. This article mainly reviews the incidence, risk factors, prevention and treatment of MP after posterior spine surgery.


Assuntos
Neuropatia Femoral/terapia , Coluna Vertebral/cirurgia , Neuropatia Femoral/etiologia , Neuropatia Femoral/prevenção & controle , Humanos , Hipestesia/etiologia , Incidência , Parestesia/etiologia , Fatores de Risco
14.
Spine (Phila Pa 1976) ; 44(22): E1311-E1316, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31688814

RESUMO

STUDY DESIGN: Multicenter database review of consecutive adult spinal deformity (ASD) patients. OBJECTIVE: The aim of this study was to identify associations between changes in spinopelvic parameters and cervical alignment after thoracolumbar arthrodesis for ASD. SUMMARY OF BACKGROUND DATA: Reciprocal cervical changes occur after instrumented thoracic spinal arthrodesis. The timing and relationship of these changes to sagittal alignment and upper instrumented vertebra (UIV) selection are unknown. METHODS: In 171 ASD patients treated with thoracolumbar arthrodesis from 2008 to 2012, we assessed changes from baseline to 6-week, 1-year, and 2-year follow-up in C2-C7 sagittal vertical axis (SVA), T1 slope, and C2-C7 lordosis. We used multivariate models to analyze associations between these parameters and UIV selection (T9 or distal vs. proximal to T9) and changes at each time point in thoracic kyphosis (TK), lumbar lordosis (LL), C7-S1 SVA, pelvic incidence, pelvic tilt, and sacral slope. RESULTS: Two-year changes in C2-C7 SVA and T1 slope were significantly associated with baseline to 6-week changes in TK and LL and with UIV selection. Baseline to 2-year changes in C2-C7 lordosis were associated with baseline to 6-week changes in C7-S1 SVA (P = 0.004). Most changes in C2-C7 SVA occurred during the first 6 weeks postoperatively (mean 6-week change in C2-C7 SVA: 2.7 cm, 95% confidence interval [CI]: 0.7-4.7 cm; mean 2-year change in SVA: 2.3 cm, 95% CI: -0.1 to 4.6 cm). At 2 years, on average, there was decrease in C2-C7 lordosis, most of which occurred during the first 6 weeks postoperatively (mean 6-week change: -3.2°, 95% CI: -4.8° to -1.2°; mean 2-year change: -1.3°, 95% CI: - 3.2° to 0.5°). CONCLUSION: After thoracolumbar arthrodesis, reciprocal changes in cervical alignment are associated with postoperative changes in TK, LL, and C7-S1 SVA and with UIV selection. The largest changes occur during the first 6 weeks and persist during 2-year follow-up. LEVEL OF EVIDENCE: 3.


Assuntos
Artrodese , Curvaturas da Coluna Vertebral , Coluna Vertebral , Adulto , Humanos , Estudos Retrospectivos , Curvaturas da Coluna Vertebral/fisiopatologia , Curvaturas da Coluna Vertebral/cirurgia , Coluna Vertebral/fisiopatologia , Coluna Vertebral/cirurgia
15.
Spine (Phila Pa 1976) ; 44(22): 1578-1584, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689253

RESUMO

STUDY DESIGN: Retrospective review with qualitative phone interview. OBJECTIVE: This study aims to identify the factors leading to delayed diagnosis or referral to a spinal surgeon in patients who subsequently require surgery for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: AIS can be effectively treated with bracing to prevent curve progression in skeletally immature patients. Australia currently has in place a national self-detection screening program to diagnose AIS. METHODS: A retrospective review was performed for patients who underwent surgery for scoliosis at Princess Margaret Hospital for Children and Royal Perth Hospital between June 1, 2010 and May 27, 2014. Data were retrieved from the digital medical record and a semistructured phone interview was used to determine path to diagnosis and referral. RESULTS: Mean Cobb angle at first specialist review was 49.5°â€Š±â€Š14.0° for patients who subsequently required surgery for AIS. These patients experienced an average interval of 20.7 months from detection of symptoms to review in a specialist clinic. CONCLUSION: In a condition in which early detection and intervention may halt progression of disease, AIS is detected relatively late and there are specific delays to diagnosis and referral to specialist clinics. LEVEL OF EVIDENCE: 4.


Assuntos
Encaminhamento e Consulta/estatística & dados numéricos , Escoliose , Adolescente , Humanos , Entrevistas como Assunto , Estudos Retrospectivos , Escoliose/diagnóstico , Escoliose/epidemiologia , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento , Austrália Ocidental
16.
Acta Clin Croat ; 58(Suppl 1): 48-52, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741559

RESUMO

During neurosurgery procedures it is vital to assure optimal cerebral perfusion and oxygenation. Despite physiological autoregulation of brain perfusion, maintaining hemodynamic stability and good oxygenation during anesthesia is vital for success. General anesthesia with mechanical ventilation and current drugs provide excellent hemodynamic condition and it is the first choice for most neurosurgery procedures. However, sometimes it is very hard to avoid brief increase or decrease in blood pressure especially during period of intense pain, or without pain stimulation. This could be detrimental for patients presented with high intracranial pressure and brain edema. Modifying anesthesia depth or treatment with vasoactive drugs usually is needed to overcome such circumstances. On the other hand it is important to wake the patients quickly after anesthesia for neurological exam. That is why regional anesthesia of scalp and spine could show beneficial effects by decreasing pain stimuli and hemodynamic variability with sparing effect of anesthetics drugs. Also regional techniques provide excellent postoperative pain relief, especially after spinal surgery.


Assuntos
Anestesia por Condução/métodos , Hemodinâmica , Procedimentos Neurocirúrgicos , Anestesia Geral , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Couro Cabeludo/cirurgia , Coluna Vertebral/cirurgia
17.
Medicine (Baltimore) ; 98(47): e18048, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764829

RESUMO

STUDY DESIGN: Retrospective review. BACKGROUND: Inferior facetectomies, with the utilization of segmental pedicle screw constructs for corrective fixation, can provide adequate flexibility and post less risk of neural tissue and blood loss. We analyzed outcomes of surgical treatment for adolescent idiopathic scoliosis (AIS) using inferior facetectomies and segmental pedicle screw constructs. We hypothesized that adequate main curve correction and suitable surgical outcomes would be observed using this technique. METHODS: We reviewed 38 AIS patients who underwent inferior facetectomies and segmental pedicle screw constructs by 2 surgeons at a single institution between May 2014 and December 2016. Coronal and sagittal radiographic measurements were evaluated over 1-year follow-up by 2 trained observers not associated with the surgeries. Surgical details, complications, and hospital length of stay (LOS) were also recorded. RESULTS: Mean fusion levels were 11.0 ±â€Š1.7. The mean Cobb angle of main AIS curves improved from 48.6±â€Š10.1 degree preoperatively to 11.8±â€Š6.2 degree postoperatively and 12.4±â€Š6.2 degree at 1-year follow-up, which percentage correction was 75.9% and 74.6%, respectively. The mean thoracic kyphosis (T5-12) angle was 20.7±â€Š11.6 degree preoperatively, 17.4±â€Š8.0 degree postoperatively, and 16.8±â€Š8.4 degree at 1-year follow-up. The mean surgical time, estimated blood loss, and LOS were 232.4 ±â€Š35.7 minutes, 475.0 ±â€Š169.6 mL, and 3.5 ±â€Š1.3 days. Twelve patients received blood transfusion. There were no neurological or wound complications. CONCLUSIONS: This case series demonstrated adequate correction of main AIS curves, acceptable thoracic kyphosis and blood loss, and short surgical time and LOS in AIS patients treated with inferior facetectomies and segmental pedicle screw constructs, potentially indicating that inferior facetectomies are adequate and suitable for AIS surgery when segmental pedicle screw constructs are utilized.


Assuntos
Procedimentos Ortopédicos/métodos , Parafusos Pediculares , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Adolescente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
18.
Bratisl Lek Listy ; 120(10): 794-801, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31663357

RESUMO

BACKGROUND: Intraoperative neuromonitoring using tc-MEPs satisfactorily detects motor tract integrity changes during spinal surgery. However, tc-MEP is affected by anesthesia and other factors, in which the stimulation threshold increases because the waveform amplitude decreases over time with the accumulation and boluses of anesthetics. METHODS: We conducted a retrospective study of 139 patients. The average age was 30 years. Tc-MEPs were recorded bilaterally from the tibialis anterior muscle and the abductor hallucis muscle. Statistical tests were used to investigate the changes to evaluate anesthetic effects. RESULTS: There were no significant differences in tc-MEP amplitude change (%) between the groups of propofol (13 %), remifentanil (22 %) and sufentanil (26 %, p < 0.01). Significant differences were found between the groups of propofol, remifentanil, and sufentanil (20 %) and bolus sufentanil (‒30 %), and bolus ketamine (730 %, p < 0.008). Major differences were observed between bolus sufentanil (‒30 %) and bolus ketamine (730 %, p < 0.001). When comparing tc-MEPs with no amplitude, no significant difference was found between the groups of propofol (26 %), remifentanil (24 %), and sufentanil (28 %, p < 0.007). Substantial difference was found between the groups of propofol, remifentanil, and sufentanil (mean 26 %) and the group where ketamine boluses were administered. We didn't observe any loss of amplitude (0 %, p < 0.0002). CONCLUSION: IONM may be useless in patients where boluses of sufentanil are administered and also with Medical Research Council grades 3 and below. Consider applying IONM in patients with severe spinal deformity along with a higher age of over 50 and neurological deficit. Increasing stimulus intensity or facilitation techniques may be considered to improve the usefulness of tc-MEP. Our concept of findings supports the neurophysiological monitoring findings in other studies (Tab. 10, Ref. 45).


Assuntos
Anestesia , Monitorização Neurofisiológica Intraoperatória , Coluna Vertebral/cirurgia , Adulto , Anestésicos Intravenosos , Potencial Evocado Motor , Humanos , Ketamina/administração & dosagem , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Estudos Retrospectivos , Sufentanil/administração & dosagem
19.
Spine (Phila Pa 1976) ; 44(21): 1492-1498, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31609917

RESUMO

STUDY DESIGN: A prospective, within-subject study was conducted. OBJECTIVE: We aimed to compare the influence of anesthetic fade under maximum stimulation conditions between constant-current and constant-voltage stimulation techniques. SUMMARY OF BACKGROUND DATA: The monitoring of muscle-evoked potentials after electrical stimulation to the brain [Br(E)-MSEP)] is useful for assessing the integrity of spinal cord motor tracts during major spine surgery. Nonetheless, Br(E)-MSEP responses are known to deteriorate over the duration of surgeries performed under general anesthesia. This phenomenon is known as anesthetic fade. METHODS: We recruited 117 patients undergoing various spinal surgeries from the cervical to the lumbar level. We excluded 29 cases with insufficient data. The decrease rate of the Br(E)-MSEP amplitude for each muscle was examined. Br(E)-MSEP monitoring with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions was applied. Compound muscle action potentials (CMAPs) were bilaterally recorded from the abductor pollicis brevis, deltoid, abductor hallucis, tibialis anterior, gastrocnemius, and quadriceps muscles. We defined the decrease rate as follows: (initial CMAPs-final CMAPs)/initial CMAPs × 100. Differences in the decrease rate were evaluated between stimulators, limbs (upper vs. lower), and operative time group (lowest quartile vs. highest quartile). RESULTS: The overall decrease rate (across all muscles) increased as the operative time increased, and the rate was higher in the lower limbs than in the upper limbs. In addition, the overall decrease rate was lower with constant-voltage stimulation than with constant-current stimulation. Furthermore, the decrease rate for constant-current stimulation was significantly higher than that for constant-voltage stimulation, regardless of the operative time. CONCLUSION: The CMAP waveform with constant-voltage stimulation is less susceptible to anesthetic fade than that with constant-current stimulation, even during long surgeries. LEVEL OF EVIDENCE: 3.


Assuntos
Anestésicos/farmacologia , Encéfalo/efeitos dos fármacos , Potencial Evocado Motor/fisiologia , Músculo Esquelético/fisiologia , Procedimentos Neurocirúrgicos/métodos , Coluna Vertebral/cirurgia , Adulto , Anestesia Geral , Estimulação Elétrica , Eletrodos , Potenciais Evocados , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Spine (Phila Pa 1976) ; 44(22): 1585-1590, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31568265

RESUMO

STUDY DESIGN: Health Services Research. OBJECTIVE: The purpose of this study is to determine the variability of Medicaid (MCD) reimbursement for patients who require spine procedures, and to assess how this compares to regional Medicare (MCR) reimbursement as a marker of access to spine surgery. SUMMARY OF BACKGROUND DATA: The current health care environment includes two major forms of government reimbursement: MCD and MCR, which are regulated and funded by the state and federal government, respectively. METHODS: MCD reimbursement rates from each state were obtained for eight spine procedures, utilizing online web searches: anterior cervical decompression and fusion, posterior cervical decompression and fusion, posterior lumbar decompression, single-level posterior lumbar fusion, posterior fusion for deformity (less than six levels; six to 12 levels; 13+ levels), and lumbar microdiscectomy. Discrepancy in reimbursement for these procedures on a state-to-state basis, as well as overall differences in MCD versus MCR reimbursement, was determined. Procedures were examined to identify whether certain surgical interventions have greater discrepancy in reimbursement. RESULTS: The average MCD reimbursement was 78.4% of that for MCR. However, there was significant variation between states (38.8%-140% of MCR for the combined eight procedures). On average, New York, New Jersey, Florida, and Rhode Island provided MCD reimbursements <50% of MCR reimbursements in the region. In total, 20 and 42 states provided <75% and 100% of MCR reimbursements, respectively. Based upon relative reimbursement, MCD appears to value microdiscectomy (84.1% of MCR; P = 0.10) over other elective spine procedures. Microdiscectomy also had the most interstate variation in MCD reimbursement: 39.0% to 207.0% of MCR. CONCLUSION: Large disparities were found between MCR and MCD when comparing identical procedures. Further research is necessary to fully understand the effect of these significant differences. However, it is likely that these discrepancies lead to suboptimal access to necessary spine care. LEVEL OF EVIDENCE: 4.


Assuntos
Descompressão Cirúrgica , Reembolso de Seguro de Saúde , Medicaid , Procedimentos Ortopédicos , Coluna Vertebral/cirurgia , Descompressão Cirúrgica/economia , Descompressão Cirúrgica/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/estatística & dados numéricos , Medicaid/economia , Medicaid/estatística & dados numéricos , Procedimentos Ortopédicos/economia , Estados Unidos
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