1/20. Cardiac arrest during surgery and ventilation in the prone position: a case report and systematic review.We present a case report of successful resuscitation following cardiac arrest in a patient undergoing surgery in the prone position. A systematic review of the literature identified 22 further cases. risk factors for intra-operative cardiac arrest in patients in the prone position include: cardiac abnormalities in patients undergoing major spinal surgery, hypovolaemia, air embolism, wound irrigation with hydrogen peroxide, poor positioning and occluded venous return. Cardiac arrest is also a risk in the increasing number of patients with acute respiratory distress syndrome ventilated in the prone position. Management of prone cardiac arrest may be improved by identification of high-risk patients, careful patient positioning, use of invasive monitoring and placement of self-adhesive defibrillator paddles. Suitable techniques for cardiopulmonary resuscitation including methods for chest compression, defibrillation and the management of air embolism are discussed.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/20. transfusion medicine management for reconstructive spinal repair in a patient with von Willebrand's disease and a history of heavy surgical bleeding.STUDY DESIGN: A case report of a multidisciplinary approach to a second reconstructive back surgery in a patient with von Willebrand's disease, flatback syndrome, and a history of heavy surgical bleeding is presented. OBJECTIVE: To review the perioperative planning and assessment of hemostasis and transfusion medicine management, including administration of Humate P, a factor viii preparation with high von willebrand factor content. SUMMARY OF BACKGROUND DATA: Reconstructive spinal procedures may require significant transfusion support even in patients with normal preoperative hemostasis. In addition to the hemostatic problem caused by von Willebrand's disease, the reported patient requested minimal exposure to allogeneic blood products because of hepatitis c infection acquired from previous transfusions. methods: The multidisciplinary team included the patient, hematologist, blood bank medical director, anesthesiologist, and operating surgeon. Preoperative assessment showed a Type 2A von Willebrand's disease variant. A careful planning process included a test infusion of desmopressin and extensive autologous donations of red cells, plasma, and platelets, which were collected before the procedure. RESULTS: Anterior and posterior spine fusions were performed during a 14-hour procedure. hemostasis and clinical response were excellent. Humate P was administered perioperatively as assessed by the baseline factor viii and von Willebrand's disease levels, the plasma volume, the half-life of infused Humate P, and the anticipated risk and tolerance for bleeding. The estimated blood loss was 5 L. Replacement included 9 units of autologous red cells, 6 units of autologous plasma, 2 autologous plateletpheresis collections, a single allogeneic plateletpheresis product, and 17,000 units of Humate P administered over the perioperative period. CONCLUSIONS: Using a careful multidisciplinary approach, excellent hemostasis can be achieved with minimal exposure to untreated allogeneic blood products during aggressive spinal surgery in a patient with a clinically significant congenital coagulopathy.- - - - - - - - - - ranking = 6keywords = spinal (Clic here for more details about this article) |
3/20. Single-stage excision of hemivertebrae via the posterior approach alone for congenital spine deformity: follow-up period longer than ten years.STUDY DESIGN: Evaluation of the long-term results for single fully segmented hemivertebrae were subjected to single-stage excision via posterior approach alone. OBJECTIVES: To describe the long-term results of this procedure. SUMMARY OF BACKGROUND DATA: In the case of congenital spinal deformity caused by a single, full hemivertebra, excision of the hemivertebra is ideal for obtaining a good correction percentage even in short segments. Recently, single-stage excision of a hemivertebra using a combined anterior and posterior approach has been reported. methods: Five patients with a hemivertebra underwent surgery. The hemivertebra involved the thoracolumbar region in three cases and the lumbosacral region in two cases. After removal of a lamina of the hemivertebra, the body of the hemivertebra was visualized easily because the spinal cord had deviated to the concave side of the curve. The vertebral body, along with its cranial and caudal discs, was curetted with this approach. Thereafter, bone chips were grafted into the defect created by vertebrectomy. The results of this surgical procedure, especially those observed during long-term follow-up evaluation, were investigated. RESULTS: For patients with a thoracolumbar hemivertebra, scoliosis improved from 49 degrees /- 6 degrees to 22.3 degrees /- 3.5 degrees, for a 54.3% correction. The correction ratio for kyphosis was 67.4%. Over an average 12.8-year follow up period, loss of scoliotic curvature correction was only 3.7 degrees. In contrast, the hemivertebral correction ratio for patients with a lumbosacral hemivertebra remained 32.5% because of difficulty using internal fixation associated with patient age. At the most recent follow-up assessment, one patient exhibited deterioration of coronal spinal balance. CONCLUSION: The described procedure was less invasive because it avoided an anterior approach, yet it yielded satisfactory long-term results for thoracolumbar hemivertebrae.- - - - - - - - - - ranking = 3keywords = spinal (Clic here for more details about this article) |
4/20. Arterial embolization of a secondary aneurysmatic bone cyst of the thoracic spine prior to surgical excision in a 15-year-old girl.We report on a 15-year-old girl with a secondary aneurysmatic bone cyst of the thoracic spine with extension into the spinal canal on the basis of an osteoblastoma. Surgical treatment was facilitated by preoperative embolization of the highly-vascular tumor. Excision of the tumor was performed without extensive intraoperative blood loss. Following excision, transpedicular-stabilization of the spinal column was achieved using a fixateur intern. We conclude that superselective embolization of benign lesions of the spinal column constitutes a feasible means of reducing intraoperative bleeding complications, thus enhancing resectability.- - - - - - - - - - ranking = 3keywords = spinal (Clic here for more details about this article) |
5/20. Atraumatic bloodless removal of intramedullary hemangioblastomas of the spinal cord.OBJECT: The goal of this study was to summarize the author's personal experience in the surgical treatment of 19 patients with intramedullary spinal cord hemangioblastomas. methods: All cases were from the author's private practice and were treated between 1967 and 1990. In all cases the intramedullary hemangioblastomas were totally removed by using a unique microsurgical technique of bipolar coagulation, which is fully described in this paper. A bipolar forceps was used to shrink each tumor and detach it from its feeding and draining vessels. Tumor resection was successfully accomplished in all patients. blood loss was minimal, averaging less than 100 ml, and what little bleeding occurred did so during laminotomy or laminectomy. No bleeding occurred during tumor removal, and no transfusions were given. All patients were symptomatic preoperatively, and all recovered or improved following surgery. CONCLUSIONS: The technique described in this paper makes tumor removal safe, effective, and relatively easy.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
6/20. Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine.OBJECT: The purpose of this study was twofold. First the authors evaluated preoperative embolization alone to reduce estimated blood loss (EBL) when resecting hypervascular lesions of the thoracolumbar spine. Second, they compared this experience with intraoperative cryotherapy alone or in conjunction with embolization to minimize further EBL. methods: Twelve patients underwent 13 surgeries for hypervascular spinal tumors. In 10 cases the surgeries were augmented by preoperative embolization alone. In one patient, two different surgeries involved intraoperative cryocoagulation, and in one patient surgery involved a combination of preoperative embolization and intraoperative cryocoagulation for tumor resection. When cryocoagulation was used, its extent was controlled using intraoperative ultrasonography or by establishing physical separation of the spinal cord from the tumor. In the 10 cases in which embolization alone was conducted, intraoperative EBL in excess of 3 L occurred in five. Mean EBL was of 2.8 L per patient. In one patient, who underwent only embolization, excessive bleeding (> 8 L) required that the surgery be terminated and resulted in suboptimum tumor resection. In another three cases, intraoperative cryocoagulation was used alone (in two patients) or in combination with preoperative embolization (in one patient). In all procedures involving cryocoagulation of the lesion, adequate hemostasis was achieved with a mean EBL of only 500 ml per patient. No new neurological deficits were attributable to the use of cryocoagulation. CONCLUSIONS: Preoperative embolization alone may not always be satisfactory in reducing EBL in resection of hypervascular tumors of the thoracolumbar spine. Although experience with cryocoagulation is limited, its use, in conjunction with embolization or alone, suggests it may be helpful in limiting EBL beyond what can be achieved with embolization alone. Cryocoagulation may also assist resection by preventing spillage of tumor contents, facilitating more radical excision, and enabling spinal reconstruction. The extent of cryocoagulation could be adequately controlled using ultrasonography or by establishing physical separation between the tumor and spinal cord. Additionally, somatosensory evoked potential monitoring may provide early warning of spinal cord cooling.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
7/20. Spinal deformity associated with carbohydrate-deficient glycoprotein syndrome (Jaeken's syndrome): a report of three cases.STUDY DESIGN: case reports are presented. OBJECTIVE: To report the association between carbohydrate-deficient glycoprotein syndrome Type 1a (CDGS Type 1a) and spinal deformity. SUMMARY OF BACKGROUND DATA: Carbohydrate-deficient glycoprotein syndrome Type 1a is an autosomal recessive metabolic disorder that may occur in association with spinal deformity. methods: Analyses of three cases are presented, including a review of the natural history of the disease. RESULTS: Three cases were reviewed in which spinal deformities developed in patients with CDGS Type 1a. Two patients required surgical correction of their spinal deformity, and one patient, at this writing, is undergoing conservative treatment. Before surgery, the pediatric hematology service was consulted regarding the patients' CDGD-related hypercoagulability. Of the two patients who underwent surgical correction, one had severe blood loss (7500 mL), and both cases were treated for infection via intravenous antibiotics. CONCLUSIONS: The incidence of CDGS Type 1a is 1 in 80,0000. Spinal deformity appears to be common in patients with CDGS Type 1a. Therefore, young patients with spinal deformities in combination with mental retardation, failure to thrive, abnormal fat distribution, and other symptoms of CDGS Type 1a should be assessed for this disorder, and patients with CDGS Type 1a should be screened also for spinal deformities. If abnormalities are identified early, treatment outcomes may be optimized.- - - - - - - - - - ranking = 6keywords = spinal (Clic here for more details about this article) |
8/20. Glanzmann's thrombasthenia proposed optimal management during surgery and delivery.Glanzmann's thrombasthenia (GT) is an autosomal recessive disorder of platelet function. Conventional management is by platelet transfusion, given before invasive interventions. Alloimmunization resulting in platelet refractoriness and an unpredictable response to platelet infusion have provided particular management difficulties in the past. More recently recombinant (r)VIIa (Novoseven) has a valuable role in the treatment of platelet function disorders. Treatment of a patient with GT during two pregnancies and spinal surgery is reported. An algorithm is presented to provide a structured and consistent approach to treatment.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
9/20. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis.STUDY DESIGN: A retrospective analysis was performed of the clinical outcomes of patients with pyogenic or tuberculotic spondylitis who were treated with two-stage surgery (first stage: placement of posterior instrumentation; second stage: anterior debridement and bone grafting). OBJECTIVE: To evaluate the clinical outcomes of the abovementioned two-stage surgical treatment for pyogenic or tuberculotic spondylitis. SUMMARY OF BACKGROUND DATA: Although several methods of surgical treatment for pyogenic and tuberculotic spondylitis have been reported, there have been few reports of two-stage surgical treatment. methods: Eight patients (7 male, 1 female) with pyogenic or tuberculotic spondylitis (pyogenic: 6; tuberculotic: 2) were treated by two-stage surgery (first: placement of posterior instrumentation, second: anterior debridement and bone graft). Age at the time of surgery was 63.5 /- 9.91 years (average /- SD) (range: 47 to 77 years). Most of the patients had systemic problems, such as pneumonia, diabetes mellitus, or chronic renal failure. First, posterior spinal instrumentation was placed. Then, anterior debridement and bone grafting were performed. patients were evaluated before and after surgery in terms of pain level, hematologic parameters, neurologic status, and Barthel index. RESULTS: Average duration of surgery for both procedures was less than 4 hours. Changes in the pain level, blood parameters, and Barthel index demonstrated significant clinical improvement in all patients. Posterior wound infection occurred in two patients who were in poor general condition. CONCLUSIONS: This two-stage surgical treatment for pyogenic or tuberculotic spondylitis provided satisfactory results and can also be used in patients who are in poor general condition.- - - - - - - - - - ranking = 5keywords = spinal (Clic here for more details about this article) |
10/20. Avascular necrosis of the femoral head after surgery for lumbar spinal stenosis.STUDY DESIGN: Case report. OBJECTIVE: To report a previously undescribed complication of lumbar spinal surgery under prolonged hypotensive anesthesia. BACKGROUND DATA: Avascular necrosis of bone most commonly affects the femoral head. The etiology of the condition is understood in only 75% of cases. There have been no prior reports of this condition following lumbar spine surgery carried out under hypotensive anesthetic. methods: Notes review, clinical examination, plain radiographs, and magnetic resonance imaging diagnosed three patients who developed avascular necrosis of the femoral heads (five joints in total) after surgery for lumbar spinal stenosis. All three were treated with total hip replacement (five joints), and the diagnosis of avascular necrosis was confirmed in two by histopathological examination. RESULTS: All three patients have recovered full mobility following hip replacement surgery. None had any residual symptoms of lumbar spinal stenosis or hip disease, and none of them had shown any clinical evidence of avascular necrosis in any other bone. CONCLUSIONS: The development of avascular necrosis of the femoral heads following surgery for spinal stenosis may be due to hypotensive anesthesia, prone positioning on a Montreal mattress, or a combination of the two. Careful intraoperative positioning may reduce the risk of this occurring after spinal surgery. However, close postoperative surveillance and a high index of suspicion of worsening hip pathology in patients who appear to mobilize poorly after lumbar spinal surgery may be the only method of early detection and treatment for this condition.- - - - - - - - - - ranking = 10keywords = spinal (Clic here for more details about this article) |
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