Journal of neurosurgery. Spine
-
The Accreditation Council for Graduate Medical Education (ACGME) implemented resident duty-hour restrictions on July 1, 2003, in concern for patient and resident safety. Whereas studies have shown that duty-hour restrictions have increased resident quality of life, there have been mixed results with respect to patient outcomes. In this study, the authors have evaluated the effect of duty-hour restrictions on morbidity, mortality, length of stay (LOS), and charges in patients who underwent spine surgery. ⋯ The implementation of duty-hour restrictions was associated with an increased risk of postoperative complications for patients undergoing spine surgery. Therefore, contrary to its intended purpose, duty-hour reform may have resulted in worse patient outcomes. Additional studies are needed to evaluate strategies to mitigate these effects and assist in the development of future health care policy.
-
Adult spinal deformity (ASD) surgery is increasing in the spinal neurosurgeon's practice. ⋯ The results of this survey suggest that ASD knowledge could be improved in neurosurgery. Knowledge may be augmented with neurosurgical experience, spinal surgery fellowships, and spinal specialization. Neurosurgical education should particularly focus on radiology/spinal pelvic alignment, especially pelvic obliquity and coronal imbalance and operative techniques for ASD.
-
A novel method of spinopelvic ring reconstruction after partial sacrectomy for a chondrosarcoma is described. Chondrosarcoma is one of the most common primary malignant bone tumors, and en bloc resection is the mainstay of treatment. Involvement of the pelvis as well as the sacrum and lumbar spine can result in a technically difficult challenge for en bloc resection and for achievement of appropriate load-bearing reconstruction. ⋯ This is similar to a modified Galveston technique with vascularized fibula in place of the Galveston rods. The vascularized fibula provided appropriate biomechanical support, allowing the patient to return to independent ambulation. There was no tumor recurrence; neurological status remained stable; and the allograft construct integrated well and even increased in size on CT scans and radiographs in the course of a follow-up longer than 7 years.
-
Segmental instability in the lumbar spine can result from a number of mechanisms including intervertebral disc degeneration and facet joint degradation. Under traumatic circumstances, elevated loading may lead to mechanical yield of the annular fibers, which can decrease load-carrying capacity and contribute to instability. The purpose of this study was to quantify the biomechanics of intervertebral annular yield during tensile loading with respect to spinal level and anatomical region within the intervertebral disc. ⋯ Data in this study demonstrated that yielding of intervertebral disc fibers occurs relatively early in the mechanical response of the tissues and that stiffness is considerably decreased following yield. Therefore, yielding of annular fibers may result in decreased segmental stability, contributing to accelerated degeneration of bony components and possible idiopathic pain.
-
There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. ⋯ The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.