J Neurosurg Sci
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Spinal cord injury (SCI) inevitably extends beyond neurologic consequences. The relationship between the spinal cord and its control of other organ systems make SCI management complex, requiring treatment on a multisystem approach. ⋯ This review covers the pathophysiology, initial assessment, and stabilization in addition to acute management of cardiovascular and respiratory issues following SCI. Subsequent potential complications of deep vein thrombosis, gastrointestinal, and urinary systems and their management in the critical care setting are also addressed in this review.
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Between 15-30% of patients presenting with low back pain have some SI joint involvement. The diagnosis of SI joint involvement in low back pain is quite difficult and depends on a detailed combination of clinical manoeuvres and injection tests. In 5% of patients with SI joint pain, the joint is physically unstable (termed disruption) resulting in ineffective medical and conservative therapeutic options. In this study we present the results of the first 12 cases of SI joint disruption treated using a minimally invasive SI joint arthrodesis system in order to evaluate the safety and the efficacy of this system. ⋯ The results of this study confirm that MIS SI joint fusion using the iFuse Implant System is safe and effective method of treating patients with SI joint disruption.
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Some of cases suffering from subarachnoid hemorrhages (SAHs) in grade V on World Federation of Neurologic Surgeons (WFNS) grading can gain a good prognosis. The outcome of patients of SAH in grade V on WFNS grading in their institute was here investigated. ⋯ Surgical treatments should be considered for SAH patients without oculomotor palsy. It is necessary to make subgroups in grade V on WFNS grading in order to decide operative indication and evaluate the treatment results of SAH in grade V.
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Ventilator-associated pneumonia (VAP) is a serious concern for patients in the Neuroscience Intensive Care Unit (NSICU). The risks to patients are significant and the monetary costs are astronomical. We review a multimodality approach that substantially reduced VAP rate in our ICU METHODS: Data from all patients admitted to the NSICU between January 2005 and April 2010 were reviewed. All ventilated patients were treated according to a multimodality VAP assessment and prevention protocol, implementation of which began in August of 2008 and was completed by March 2009. Rates of VAP before, during, and after implementation of the protocol are compared. VAP rates are also compared to national rates as obtained from the National Healthcare Safety Network (NHSN). ⋯ Although intubated patients in the NSICU are at high risk for VAP, a significant reduction in VAP-related morbidity and monetary costs can be obtained with multimodality prevention and testing protocols.
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Surgical approaches to the thoracic spine have evolved in recent decades with the development of advanced instrumentation techniques and an increased emphasis on reducing surgical morbidity. Multiple methods to access this area have been described, from a conventional open to a more minimally invasive approach, such as anterior-based, via supra- or transmanubrium, via thoracoscopy, lateral-based approach, extreme lateral mini-thoracotomy, and dorsolateral approaches, transpedicular, costotransversectomy and the lateral extracavitary access. The technique used is often determined by the affected spinal level, pathological process, and surgeon preference. ⋯ Over time, these techniques have undergone improvement to limit approach-related morbidity and minimize soft tissue dissection, resulting in better patient outcomes. These different approaches present distinct advantages and disadvantages for which a thorough understanding of the regional anatomy is required to avoid approach-related complications. For these reasons, surgeon experience and confidence in the various techniques are major factors in the decision-making process and patient outcomes.