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Spinal Surgery (spinal + surgery)
Selected AbstractsManagement of scoliosis in Duchenne muscular dystrophy: a large 10-year retrospective studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 6 2006M Kinali MD Scoliosis affects 75 to 90% of patients with non-ambulant Duchenne muscular dystrophy (DMD). Spinal surgery is the treatment of choice but the indication varies among centres. Some offer surgery to all non-ambulant patients, irrespective of scoliosis severity. Early surgery has the advantage of targeting DMD when cardiorespiratory function is preserved, but not all patients develop scoliosis. We report our 10-year experience of scoliosis management in 123 patients with DMD who were at least 17 years old at the time of the study. Scoliosis was absent in 10%, and mild, non-progressive (at least 30°) in 13% of patients. Another 13% had moderate scoliosis (31,50°) and were managed conservatively. Surgery was considered in 57% (70/123) of patients with scoliosis greater than 50° and eventually performed in 35%. The remaining patients either refused surgery (9%) or were unfit because of cardiorespiratory compromise (13%). In a further 7%, scoliosis (greater than 50°), first noted after 14 years of age, was progressing slowly and surgery was not performed. At 17 years there was no difference in survival, respiratory impairment, or sitting comfort among patients managed conservatively or with surgery. One-third (44/123) of our patients were managed satisfactorily without receiving spinal surgery. We provide insight into the natural history of scoliosis in DMD that should help families and clinicians with decision-making when surgery is considered. [source] Vitamin D Receptor Expression in Human Muscle Tissue Decreases With Age,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 2 2004HA Bischoff-Ferrari Abstract Intracellular 1,25-dihydroxyvitamin D receptor (VDR) is expressed in human skeletal muscle tissue. However, it is unknown whether VDR expression in vivo is related to age or vitamin D status, or whether VDR expression differs between skeletal muscle groups. Introduction: We investigated these factors and their relation to 1,25-dihydroxyvitamin D receptor (VDR) expression in freshly removed human muscle tissue. Materials and Methods: We investigated biopsy specimens of the gluteus medius taken at surgery from 20 female patients undergoing total hip arthroplasty (mean age, 71.6 ± 14.5; 72% > 65 years) and biopsy specimens of the transversospinalis muscle taken at surgery from 12 female patients with spinal operations (mean age, 55.2 ± 19.6; 28% > 65 years). The specimens were obtained by immunohistological staining of the VDR using a monoclonal rat antibody to the VDR (Clone no. 9A7). Quantitative VDR expression (number of VDR positive nuclei) was assessed by counting 500 nuclei per specimen and person. Serum concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were assessed at day of admission to surgery. Results: All muscle biopsy specimens stained positive for VDR. In the univariate analyses, increased age was associated with decreased VDR expression (r = 0.5: p = 0.004), whereas there were no significant correlations between VDR expression and 25-hydroxyvitamin D or 1,25-dihydroxyvitamin D levels. VDR expression did not differ between patients with hip and spinal surgery. In the multivariate analysis, older age was a significant predictor of decreased VDR expression after controlling biopsy location (gluteus medius or the transversospinalis muscle), and 25-hydroxyvitamin D levels (linear regression analysis: ,-estimate = ,2.56; p = 0.047). Conclusions: Intranuclear immunostaining of the VDR was present in muscle biopsy specimens of all orthopedic patients. Older age was significantly associated with decreased VDR expression, independent of biopsy location and serum 25-hydroxyvitamin D levels. [source] Anaesthetic requirement and stress hormone responses in patients undergoing lumbar spine surgery: anterior vs. posterior approachACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2009K. Y. YOO Background: The intensity of nociceptive stimuli reflects the severity of tissue injury. The anaesthetic requirement and stress hormonal responses were determined to learn whether they differ according to different surgical approaches (anterior vs. posterior) during the spinal surgery. Methods: Patients undergoing lumbar spine surgery without neurological deficits were divided into two groups: one having posterior (n=13) and the other having anterior fusion (n=13). The end-tidal sevoflurane concentrations (ETSEVO) required to maintain the bispectral index score at 40,50 were determined. Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), serum osmolality and plasma concentrations of catecholamines, cortisol and vasopressin (AVP) were measured. Results: There were no differences in MAP, HR, CVP and serum osmolality between the groups. ETSEVO was higher in the anterior than in the posterior group (P<0.05). The plasma concentrations of norepinephrine and cortisol increased in both groups during the surgery, whereas those of epinephrine remained unchanged. AVP concentrations increased during the surgery in the anterior group, and remained unaltered in the posterior group. The anterior group needed more analgesics (P<0.01) during the first 1 h after the operation. Conclusions: The anterior approach required a deeper level of anaesthesia while undergoing spinal surgery and more use of post-operative analgesics than the posterior approach. It was also associated with a more pronounced AVP release during the surgery. [source] Effects of dexmedetomidine on intraoperative motor and somatosensory evoked potential monitoring during spinal surgery in adolescentsPEDIATRIC ANESTHESIA, Issue 11 2008JOSEPH D. TOBIAS MD Summary Background:, Dexmedetomidine may be a useful agent as an adjunct to an opioid,propofol total intravenous anesthesia (TIVA) technique during posterior spinal fusion (PSF) surgery. There are limited data regarding its effects on somatosensory (SSEPs) and motor evoked potentials (MEPs). Methods:, The data presented represent a retrospective review of prospectively collected quality assurance data. When the decision was made to incorporate dexmedetomidine into the anesthetic regimen for intraoperative care of patients undergoing PSF, a prospective evaluation of its effects on SSEPs and MEPs was undertaken. SSEPs and MEPs were measured before and after the administration of dexmedetomidine in a cohort of pediatric patients undergoing PSF. Dexmedetomidine (1 ,g·kg,1 over 20 min followed by an infusion of 0.5 ,g·kg,1·h,1) was administered at the completion of the surgical procedure, but prior to wound closure as an adjunct to TIVA which included propofol and remifentanil, adjusted to maintain a constant depth of anesthesia as measured by a BIS of 45,60. Results:, The cohort for the study included nine patients, ranging in age from 12 to 17 years, anesthetized with remifentanil and propofol. In the first patient, dexmedetomidine was administered in conjunction with propofol at 110 ,g·kg,1·min,1 which resulted in a decrease in the bispectral index from 58 to 31. Although no significant effect was noted on the SSEPs (amplitude or latency) or the MEP duration, there was a decrease in the MEP amplitude. The protocol was modified so that the propofol infusion was incrementally decreased during the dexmedetomidine infusion to achieve the same depth of anesthesia. In the remaining eight patients, the bispectral index was 52 ± 6 at the start of the dexmedetomidine loading dose and 49 ± 4 at its completion (P = NS). There was no statistically significant difference in the MEPs and SSEPs obtained before and at completion of the dexmedetomidine loading dose. Conclusion:, Using the above-mentioned protocol, dexmedetomidine can be used as a component of TIVA during PSF without affecting neurophysiological monitoring. [source] ORIGINAL ARTICLE: Risk of intravascular injection in transforaminal epidural injectionsANAESTHESIA, Issue 9 2010F. S. Nahm Summary Transforaminal epidural injection is an effective method for treating spinal pain but can cause devastating complications that result from accidental vascular uptake of the injectate or a direct vascular injury. We prospectively evaluated the patient factors that might be associated with intravascular uptake during transforaminal epidural injections. A total of 2145 injections were performed on 1088 patients under contrast-enhanced real-time fluoroscopic guidance. The collected data included the patient's age, sex, body mass index, diagnosis, injection level, side of injection, history of spinal surgery at the targeted level, and the number of injections at the targeted site. The overall incidence of intravascular injection was 10.5% (224/2145). The highest incidence was at the cervical level (28/136; 20.6%), followed by the sacral level (111/673; 16.5%), the thoracic level (23/280; 8.2%) and the lumbar level (64/1056; 6.1%). The difference was significant for the cervical and sacral level compared with the lumbar and thoracic levels (p < 0.001). Intravascular injection was not associated with the other patient characteristics studied. [source] Non-invasive ventilation in the treatment of ventilatory failure following corrective spinal surgeryANAESTHESIA, Issue 3 2001M. J. Doherty Non-invasive positive pressure ventilation has previously been used successfully to treat both acute and chronic ventilatory failure secondary to a number of conditions, including scoliosis. We report two patients in whom it was used, on three separate occasions, to treat acute ventilatory failure following corrective spinal surgery. Non-invasive positive pressure ventilation may be useful postoperatively in high-risk patients undergoing major spinal surgery in an attempt to prevent intubation and its attendant complications. [source] Acute visual loss after spinal surgeryACTA OPHTHALMOLOGICA, Issue 4 2010Jana Midelfart Hoff Abstract. Purpose:, To report visual loss after prone spinal surgery. Methods:, Computed tomography scan, fundus photography, optical coherence tomography (OCT). Results:, A 56-year-old man demonstrated loss of vision in the left eye after cervical spinal surgery. Clinical examination revealed loss of vision to finger counting, severe visual field defect and blurred neural rim area around the optic disc in the left eye. Six weeks later, visual acuity in the left eye was 6/9 and there was inferior visual field defect. Six months after the surgery, significant reduction of retinal nerve fibre layer thickness around the optic nerve head was measured with OCT, consistent with the visual field defect. Conclusion:, Ischemic optic neuropathy is the most common cause of visual loss after spine surgery and special emphasis should be given to protect the eye against possible pressure during the surgery. [source] Avulsion of ascending lumbar and iliolumbar veins in anterior spinal surgery: An anatomical studyCLINICAL ANATOMY, Issue 5 2007G. Sivakumar Abstract To expose the disc between the 4th and 5th lumbar vertebrae in anterior spinal surgery, left to right retraction of inferior vena cava and aorta is required. This manoeuvre can be complicated by venous haemorrhage that, in most cases, is due to avulsion of the left ascending lumbar vein (ALV) or the left iliolumbar vein (ILV). We dissected 23 embalmed cadavers to assess the factors that contribute to the risk of tearing these two veins during retraction. We describe a triangular region that should help surgeons in identifying the ALV and ILV. This triangle is defined by the lateral border of the common iliac vein, the medial border of the psoas major muscle, and the superior end-plate of the L5 vertebral body. We observed that 3 cm between the termination of the left ALV, or a common stem with the ILV, and the termination of the common iliac vein is the critical distance, less than which the risk of venous avulsion is highest. Although the sample considered is small, our study seems to suggest that male patients tend to have a higher risk of venous avulsion than female patients. Clin. Anat. 20:553,555, 2007. © 2007 Wiley-Liss, Inc. [source] Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literatureCLINICAL MICROBIOLOGY AND INFECTION, Issue 4 2010I. Uçkay Clin Microbiol Infect 2010; 16: 353,358 Abstract Propionibacterium acnes is the most frequent anaerobic pathogen found in spondylodiscitis. A documented case required microbiological proof of P. acnes with clinical and radiological confirmation of inflammation in a localized region of the spine. Microbiological samplings were obtained by surgery or aspiration under radiological control. Twelve males and 17 females (median age, 42 years) with spondylodiscitis due to P. acnes were diagnosed within the last 15 years. Three patients were immunosuppressed. All patients reported back pain as the main symptom, and most were afebrile. Three patients had a peripheral neurological deficit, one a motor deficit, and two a sensory deficit attributable to the infection; and six patients had an epidural abscess. The most frequent risk factor was surgery, which was present in the history 28 of 29 (97%) patients. The mean delay between spinal surgery and onset of disease was 34 months, with a wide range of 0,156 months. Osteosynthesis material was present in twenty-two cases (76%). In 24 (83%) patients, additional surgery, such as débridement or spondylodesis, was performed. Previous osteosynthesis material was removed in 17 of the 22 (77%) patients where it was present. Total cure was reported in all patients, except one, after a mean duration of antibiotic therapy of 10.5 weeks (range, 2,28 weeks). In conclusion, spondylodiscitis due to P. acnes is an acute infection closely related to previous surgery. The most prominent clinical feature is pain, whereas fever is rare, and the prognosis is very good. [source] | ||||||||||