scholarly journals A novel use of cement as a salvage procedure in patients with complex spinal injuries with proximal junctional failure

2018 ◽  
Vol 100 (6) ◽  
pp. e154-e157 ◽  
Author(s):  
K Divani ◽  
S Selvadurai ◽  
S Molloy
Keyword(s):  
High Risk ◽  
Major Surgery ◽  
Salvage Procedure ◽  
Proximal Junctional Kyphosis ◽  
High Risk Patients ◽  
Pain Scores ◽  
Risk Patients ◽  
Life Threatening ◽  
Proximal Junctional Failure ◽  
Junctional Kyphosis

Long-construct fixations can be complicated by proximal junctional kyphosis. In elderly, high-risk patients with numerous comorbidities, lengthy surgical times and increased blood loss associated with revision osteotomies and extension of fusions are not often tolerated and pose serious life-threatening risks. We present a salvage technique used in a patient with proximal junctional failure and demonstrate its role in improving symptoms and functionality in those not deemed fit for major surgery. Pre- and postoperative pain scores in accordance with the visual analogue scale, walking distances and radiographs were reviewed in a patient who underwent the salvage technique to ascertain the subjective and objective difference in pain and functionality. The patient showed marked improvement in pain scores and walking distances postoperatively. Additionally, the degree of proximal junctional kyphosis was lower on postoperative radiographs. While holding risks of its own, our described technique can be performed in select cases and is a good salvage procedure in high-risk patients. It prevents their exposure to the risks that accompany large revision operations and fusion models with further potential to fail. We recommend that our technique is performed only at specialist centres.

scholarly journals Proximal Junctional Kyphosis Prevention Strategies: A Video Technique Guide

2017 ◽  
Vol 13 (5) ◽  
pp. 581-585 ◽  
Author(s):  
Michael M. Safaee ◽  
Joseph A. Osorio ◽  
Kushagra Verma ◽  
Shay Bess ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
High Risk ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Surgical Techniques ◽  
Transverse Process ◽  
Proximal Junctional Kyphosis ◽  
Prevention Strategies ◽  
High Risk Patients ◽  
Risk Patients ◽  
Junctional Kyphosis

AbstractBACKGROUND: Proximal junctional kyphosis (PJK) is a well-recognized complication in patients undergoing posterior instrumented fusion procedures for adult spinal deformity. Strategies that reduce rates of PJK have the potential to improve the safety of these operations and decrease cost by eliminating the need for revision surgery.OBJECTIVE: To present a set of surgical techniques that can decrease rates of PJK in adults undergoing surgery for spinal deformity.METHODS: We summarize the use of vertebroplasty, transverse process hooks, terminal rod contouring, and ligament augmentation as means to reduce rates of PJK.RESULTS: We present PJK prevention strategies and a video technique guide that are safe, technically feasible, and add minimal operative time to these surgical procedures. When applied to appropriate high-risk patients, these techniques have the potential to dramatically reduce rates of PJK, which improves quality of life and decreases the cost associated with this treating adult spinal deformity.CONCLUSION: PJK prevention strategies represent a critical area for improvement in surgery for adult spinal deformity. We present a summary of techniques that are safe, feasible, and add minimal time to the overall procedure. These techniques warrant investigation in a thoughtful, prospective manner, but are supported by existing data and compelling biomechanical rationale. Our hope is that these strategies can be applied, particularly in high-risk patients, to help reduce rates of PJK.

Behavioral Emergencies and Crises

2010 ◽  
pp. 739-762
Author(s):  
Phillip M. Kleespies ◽  
Justin M. Hill
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
High Risk ◽  
Work Environment ◽  
Emotional Impact ◽  
High Risk Patients ◽  
Risk Patients ◽  
Life Threatening ◽  
Behavioral Emergencies ◽  
And Training

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.

scholarly journals Oxygen delivery optimization using lithium indicator dilution and pulse power analysis during major surgery in high-risk patients

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 2) ◽  
pp. P305
Author(s):  
S Lobo ◽  
N Oliveira ◽  
F Lobo ◽  
E Rezende ◽  
B Borges ◽  
...  
Keyword(s):  
High Risk ◽  
Oxygen Delivery ◽  
Power Analysis ◽  
Indicator Dilution ◽  
Pulse Power ◽  
Major Surgery ◽  
High Risk Patients ◽  
Risk Patients

Behavioral Emergencies and Crises

2014 ◽  
pp. 746-770
Author(s):  
Phillip Kleespies ◽  
Justin M. Hill
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
High Risk ◽  
Work Environment ◽  
Emotional Impact ◽  
High Risk Patients ◽  
Risk Patients ◽  
Life Threatening ◽  
Behavioral Emergencies ◽  
And Training

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.

scholarly journals Lipid lowering drugs and recurrences of life-threatening ventricular arrhythmias in high-risk patients

2000 ◽  
Vol 36 (3) ◽  
pp. 766-772 ◽  
Author(s):  
Johan De Sutter ◽  
Rene Tavernier ◽  
Marc De Buyzere ◽  
Luc Jordaens ◽  
Guy De Backer
Keyword(s):  
High Risk ◽  
Ventricular Arrhythmias ◽  
Lipid Lowering ◽  
High Risk Patients ◽  
Lipid Lowering Drugs ◽  
Risk Patients ◽  
Life Threatening

The Benefits of Pre-Assessment with Cardio-Pulmonary Exercise Testing

2010 ◽  
Vol 20 (5) ◽  
pp. 173-176 ◽  
Author(s):  
Shirley Collier
Keyword(s):  
High Risk ◽  
Case Studies ◽  
Exercise Testing ◽  
Major Surgery ◽  
Patient Case ◽  
Local Practice ◽  
High Risk Patients ◽  
Co Morbidity ◽  
Risk Patients

This article reviews the benefits of pre-assessment with cardio-pulmonary exercise testing (CPX) and the effectiveness of preoperative interventions in high-risk patients undergoing major surgery. Three patient case studies will be presented from local practice, to give examples of how patients' co-morbidity has been improved prior to surgery or how decisions for surgery can be modified as a result of the CPX test.

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