World Neurosurg
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Ventriculitis is a serious complication when using external ventricular drains (EVDs). Bactericidal silver coating has been reported to reduce risk of infection. In the clinical setting, the diagnosis is often made based on symptoms and analyses of cerebrospinal fluid, with treatment initiated before infection is verified by culture. The bactericidal effect might not correlate with a reduced rate of clinically diagnosed infections. This retrospective study aimed to analyze if use of silver-coated EVDs is associated with a reduced rate of ventriculitis. ⋯ The previously reported bactericidal effect of silver-coated EVDs did not alter the clinical course to significantly reduce the number of treated cases of ventriculitis. The introduction of silver-coated EVDs cannot be motivated by reduced use of antibiotics or shorter hospital stay.
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Multicenter Study
Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients.
Rod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated. ⋯ Rod fracture occurred in 9.5% of patients with apparently solid radiographic fusion after ASD surgery. Advanced age, obesity, small diameter rods (5.5 mm), osteotomy, and lower comorbidity burden were significantly associated with rod fracture. Nearly one-half of these patients noted worsening pain, and 21.1% required revision surgery. Instrumentation failure may occur and may be symptomatic even in the setting of apparent fusion on plain radiographs.
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Choosing the fusion level for posterior fusion in patients with Lenke 5C adolescent idiopathic scoliosis (AIS) is highly associated with coronal balance. Previous studies indicated that in patients with lowest end vertebra tilt >25°, surgeons could extend distal fusion to avoid coronal imbalance (CIB). This study aimed to assess the risk factors for CIB in Lenke 5C scoliosis and to discuss how to select fusion level. ⋯ Distal fusion extension at LEV+1 is more likely to result in CIB at the first and final follow-up, especially when the bending lumbosacral hemicurve is >15°. Fusion at LEV+1 should not be chosen when LEV is at L4.
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Craniovertebral junction diseases, although considered rare, are common in northern parts of India. This study was conducted to evaluate the clinico-radiologic and surgical outcome of patients with a minimum follow-up of 1 year. Our study also compared bony fusion among various techniques of posterior fusion. ⋯ The key to successful management of craniovertebral junction disease is individualized selection of judicious surgical intervention from various available techniques.
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While prophylaxis with intravenous unfractionated heparin (UFH) can effectively prevent venous thromboembolism (VTE) during the neurocritical care of patients with severe aneurysmal subarachnoid hemorrhage (aSAH), the risk for intracranial bleeding complications might increase. Owing to this therapeutic dilemma, the UFH administration regimen in this critical patient population remains highly controversial. ⋯ Even in high-risk neurocritical patients with severe SAH and prolonged ICU treatment, low-dose UFH-administration for VTE prophylaxis is equally effective as therapeutic UFH administration and carries a lower risk of bleeding complications.