scholarly journals Early operative morbidity in 184 cases of anterior vertebral body tethering

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
James Meyers ◽  
Lily Eaker ◽  
Theodor Di Pauli von Treuheim ◽  
Sergei Dolgovpolov ◽  
Baron Lonner
Keyword(s):  
Vertebral Body ◽  
Standard Of Care ◽  
Allogenic Blood Transfusion ◽  
Complication Rates ◽  
Current Standard ◽  
Allogenic Blood ◽  
Nerve Root Injury ◽  
Major Complications ◽  
Root Injury ◽  
Superficial Wound

AbstractFusion is the current standard of care for AIS. Anterior vertebral body tethering (AVBT) is a motion-sparing alternative gaining interest. As a novel procedure, there is a paucity of literature on safety. Here, we report 90-day complication rates in 184 patients who underwent AVBT by a single surgeon. Patients were retrospectively reviewed. Approaches included 71 thoracic, 45 thoracolumbar, 68 double. Major complications were those requiring readmittance or reoperation, prolonged use of invasive materials such as chest tubes, or resulted in spinal cord or nerve root injury. Minor complications resolved without invasive intervention. Mean operative time and blood loss were 186.5 ± 60.3 min and 167.2 ± 105.0 ml, respectively. No patient required allogenic blood transfusion. 6 patients experienced major (3.3%), and 6 had minor complications (3.3%). Major complications included 3 chylothoracies, 2 hemothoracies, and 1 lumbar radiculopathy secondary to screw placement requiring re-operation. Minor complications included 1 patient with respiratory distress requiring supplementary oxygen, 1 superficial wound infection, 2 cases of prolonged nausea, and 1 Raynaud phenomenon. In 184 patients who underwent AVBT for AIS, major and minor complication rates were both 3.3%.

scholarly journals Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

2015 ◽  
Vol 39 (4) ◽  
pp. E6 ◽  
Author(s):  
Michael F. Shriver ◽  
Jack J. Xie ◽  
Erik Y. Tye ◽  
Benjamin P. Rosenbaum ◽  
Varun R. Kshettry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nerve Root ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Wound Complications ◽  
Complication Rates ◽  
Nerve Root Injury ◽  
Lumbar Microdiscectomy ◽  
Root Injury

OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

scholarly journals Clinical and Echocardiographic Trends in Percutaneous Balloon Mitral Valvuloplasty

2020 ◽  
Author(s):  
Ofir Koren ◽  
Asaf Israeli ◽  
Ehud Rozner ◽  
Nassem Darawshy ◽  
Yoav Turgeman
Keyword(s):  
Standard Of Care ◽  
Complication Rates ◽  
Success Rates ◽  
Current Standard ◽  
Mitral Valvuloplasty ◽  
Patient Demographics ◽  
Percutaneous Balloon Mitral Valvuloplasty ◽  
Percutaneous Balloon ◽  
Male Patients ◽  
Over Time

Abstract Background Percutaneous balloon mitral valvuloplasty (PBMV) is the current standard of care for selected patients with rheumatic mitral stenosis. We examined trends in patient demographics, Wilkins score and additional echocardiographic characteristics, success rates, and complications over a 30-year period.Methods We conducted a retrospective observational descriptive study. The study population consists of patients hospitalized in intensive cardiac care (ICCU) due to significant symptomatic MS, from January 1990 to May 2019.Results 417 patients who underwent PBMV were eligible. Age did not change significantly over time. Male patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became more prevalence (p=0.02, p=0.02, p=0.001, p=0.01, p=0.02, and p=0.001 respectively). Wilkins score and all its components increased over time, which was higher in females (p=0.01), and was not correlated with age (p=0.95). Severe leaflets immobility (Grade 4) predicted complications (p=0.03, respectively). Wilkins over 9 successfully predicted the occurrence of complications, conversely, no efficient cutoff was found in the following decades. Wilkins score managed to predict a technically successful procedure (p=0.02), but not complications (p=0.12). Lastly, complication rates did not significantly change over the years.Conclusion Our research covers three decades of experience in PBMV and shows several trends: We see more male patients, who have multiple comorbidities. The Wilkins score increased over the years and was predictive of successful operations as opposed to complications who were predicted mainly by the leaflet mobility index.

Chondrocyte Viability at Time of Transplantation for Osteochondral Allografts Preserved by the Missouri Osteochondral Preservation System versus Standard Tissue Bank Protocol

2017 ◽  
Vol 31 (08) ◽  
pp. 772-780 ◽  
Author(s):  
Aaron Stoker ◽  
James Stannard ◽  
James Cook
Keyword(s):  
Femoral Condyle ◽  
Tissue Bank ◽  
Standard Of Care ◽  
Tissue Banks ◽  
Complication Rates ◽  
Current Standard ◽  
Cell Viability Assay ◽  
Chondrocyte Viability ◽  
Viability Assay ◽  
Osteochondral Allografts

AbstractThe Missouri Osteochondral Preservation System (MOPS) has been reported to effectively preserve osteochondral allografts (OCAs) twice as long as current tissue bank protocols in preclinical studies. However, viability of OCAs preserved using the MOPS protocol at the time of clinical implantation compared with the current standard of care (SOC) is not known. Viable chondrocyte density (VCD) at time of transplantation will be significantly higher in OCAs preserved using the MOPS protocol compared with OCAs preserved using the current tissue bank protocol and will significantly affect clinical complication rates. Femoral condyle OCAs were obtained from American Association of Tissue Banks accredited tissue banks for clinical use. The OCAs were stored using the current SOC protocol for each respective tissue bank (n = 26) or the MOPS protocol (n = 50). Nonimplanted femoral condyle OCA tissue normally discarded after surgery was collected and assessed for VCD within 1 hour after surgery. Control OCA samples (n = 34) were obtained from one tissue bank. VCD was determined using a validated cell viability assay. Patients (n = 76) had in-clinic follow-up at least 6 months after OCA transplantation. At the time of clinical implantation, mean storage time for OCAs in the SOC cohort was 20.4 days, and in the MOPS cohort was 44.2 days, after procurement. VCD in OCAs in the MOPS cohort was not significantly different from normal healthy cartilage VCD and 100% were above the desired minimum essential level 70% of control VCD at the time of transplantation. VCD in OCAs in the SOC cohort was significantly (p < 0.001) lower than controls and MOPS, and only 27% were above 70% of control VCD at the time of transplantation. MOPS preserves OCA chondrocyte viability at significantly higher levels than current tissue bank storage protocols for a longer period of time after procurement. All MOPS-preserved OCAs exceeded minimum essential VCD levels for up to 56 days after procurement.

Rating Spinal Nerve Extremity Impairment Using the Sixth Edition

2009 ◽  
Vol 14 (4) ◽  
pp. 1-6
Author(s):  
Christopher R. Brigham
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Nerve Injuries ◽  
Sixth Edition ◽  
Federal Employee ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Rating Process

Abstract The AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.

Cervical Ganglia and Nerve Root Injury: Evidence for Respiratory Arrest as Initiating Injury in Pediatric Head Trauma

2014 ◽  
Vol 4 (4) ◽  
pp. 514-519
Author(s):  
Mary Ann Sens ◽  
Sarah E. Meyers ◽  
Mark A. Koponen ◽  
Arne H. Graff ◽  
Ryan D. Reynolds ◽  
...  
Keyword(s):  
Head Trauma ◽  
Nerve Root ◽  
Respiratory Arrest ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Pediatric Head Trauma ◽  
Cervical Ganglia

Acute Rejection Following Kidney Transplantation: State-of-the-Art and Future Perspectives

2020 ◽  
Vol 26 (28) ◽  
pp. 3468-3496
Author(s):  
Emilio Rodrigo ◽  
Marcio F. Chedid ◽  
David San Segundo ◽  
Juan C.R. San Millán ◽  
Marcos López-Hoyos
Keyword(s):  
Kidney Transplantation ◽  
Acute Rejection ◽  
Rescue Therapy ◽  
Standard Of Care ◽  
Rejection Rate ◽  
New Drugs ◽  
High Dose ◽  
Current Standard ◽  
Antibody Mediated Rejection ◽  
Cellular Rejection

: Although acute renal graft rejection rate has declined in the last years, and because an adequate therapy can improve graft outcome, its therapy remains as one of the most significant challenges for pharmacists and physicians taking care of transplant patients. Due to the lack of evidence highlighted by the available metaanalyses, we performed a narrative review focused on the basic mechanisms and current and future therapies of acute rejection in kidney transplantation. : According to Kidney Disease/Improving Global Outcomes (KDIGO) guidelines, both clinical and subclinical acute rejection episodes should be treated. Usually, high dose steroids and basal immunosuppression optimization are the first line of therapy in treating acute cellular rejection. Rabbit antithymocytic polyclonal globulins are used as rescue therapy for recurrent or steroid-resistant cellular rejection episodes. Current standard-of-care (SOC) therapy for acute antibody-mediated rejection (AbMR) is the combination of plasma exchange with intravenous immunoglobulin (IVIG). Since a significant rate of AbMR does not respond to SOC, different studies have analyzed the role of new drugs such as Rituximab, Bortezomib, Eculizumab and C1 inhibitors. Lack of randomized controlled trials and heterogenicity among performed studies limit obtaining definite conclusions. Data about new direct and indirect B cell and plasma cell depleting agents, proximal and terminal complement blockers, IL-6/IL-6R pathway inhibitors and antibody removal agents, among other promising drugs, are reviewed.

scholarly journals Inhibition of Glycine Re-Uptake: A Potential Approach for Treating Pain by Augmenting Glycine-Mediated Spinal Neurotransmission and Blunting Central Nociceptive Signaling

Biomolecules ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 864
Author(s):  
Christopher L. Cioffi
Keyword(s):  
Spinal Cord ◽  
Dorsal Horn ◽  
Therapeutic Potential ◽  
Opioid Analgesic ◽  
Critical Role ◽  
Analgesic Efficacy ◽  
Standard Of Care ◽  
Current Standard ◽  
Glycine Transporters ◽  
Pathological Pain

Among the myriad of cellular and molecular processes identified as contributing to pathological pain, disinhibition of spinal cord nociceptive signaling to higher cortical centers plays a critical role. Importantly, evidence suggests that impaired glycinergic neurotransmission develops in the dorsal horn of the spinal cord in inflammatory and neuropathic pain models and is a key maladaptive mechanism causing mechanical hyperalgesia and allodynia. Thus, it has been hypothesized that pharmacological agents capable of augmenting glycinergic tone within the dorsal horn may be able to blunt or block aberrant nociceptor signaling to the brain and serve as a novel class of analgesics for various pathological pain states. Indeed, drugs that enhance dysfunctional glycinergic transmission, and in particular inhibitors of the glycine transporters (GlyT1 and GlyT2), are generating widespread interest as a potential class of novel analgesics. The GlyTs are Na+/Cl−-dependent transporters of the solute carrier 6 (SLC6) family and it has been proposed that the inhibition of them presents a possible mechanism by which to increase spinal extracellular glycine concentrations and enhance GlyR-mediated inhibitory neurotransmission in the dorsal horn. Various inhibitors of both GlyT1 and GlyT2 have demonstrated broad analgesic efficacy in several preclinical models of acute and chronic pain, providing promise for the approach to deliver a first-in-class non-opioid analgesic with a mechanism of action differentiated from current standard of care. This review will highlight the therapeutic potential of GlyT inhibitors as a novel class of analgesics, present recent advances reported for the field, and discuss the key challenges associated with the development of a GlyT inhibitor into a safe and effective agent to treat pain.

scholarly journals Updated Insights on EGFR Signaling Pathways in Glioma

2021 ◽  
Vol 22 (2) ◽  
pp. 587
Author(s):  
Alexandru Oprita ◽  
Stefania-Carina Baloi ◽  
Georgiana-Adeline Staicu ◽  
Oana Alexandru ◽  
Daniela Elise Tache ◽  
...  
Keyword(s):  
Signaling Pathways ◽  
Treatment Strategies ◽  
Growth Factor Receptor ◽  
Standard Of Care ◽  
Egfr Signaling ◽  
Current Standard ◽  
Egfr Amplification ◽  
Epidermal Growth ◽  
New Diagnosis ◽  
Clear Clinical Benefit

Nowadays, due to recent advances in molecular biology, the pathogenesis of glioblastoma is better understood. For the newly diagnosed, the current standard of care is represented by resection followed by radiotherapy and temozolomide administration, but because median overall survival remains poor, new diagnosis and treatment strategies are needed. Due to the quick progression, even with aggressive multimodal treatment, glioblastoma remains almost incurable. It is known that epidermal growth factor receptor (EGFR) amplification is a characteristic of the classical subtype of glioma. However, targeted therapies against this type of receptor have not yet shown a clear clinical benefit. Many factors contribute to resistance, such as ineffective blood–brain barrier penetration, heterogeneity, mutations, as well as compensatory signaling pathways. A better understanding of the EGFR signaling network, and its interrelations with other pathways, are essential to clarify the mechanisms of resistance and create better therapeutic agents.

Sign in / Sign up

Export Citation Format

Share Document