Diagnostics, pathogenesis and treatment of damage to the dura mater in spinal injury

2018 ◽  
Vol 20 (2) ◽  
pp. 74-82
Author(s):  
A. G. Martikyan ◽  
A. A. Grin
Keyword(s):  
Dura Mater ◽  
Gold Standard ◽  
Spinal Injury ◽  
Late Complications ◽  
Spinal Injuries ◽  
Spinal Trauma ◽  
Defect Closure ◽  
Study Objective ◽  
Safe Method ◽  
Dural Tears

The study objectiveis to discuss the issues concerning to pathogenesis, diagnostics and treatment of dura mater tear in spinal injuries. The issues regarding to the risk factors for dura mater tears and complications of surgical treatment in spinal injuries were considered.Results.It is established that the frequency of dural tears in spinal trauma varies from 7.7 to 65.0 %. The most informative and safe method of diagnosis is magnetic resonance myelography, but its specificity does not reach 100 %. To prevent the development of early and late complications in the postoperative period is mainly used dura mater sealing, preferably expanding plastic.Conclusion.The absence of the “gold standard” of dura mater defect closure in spinal trauma is associated with a variety of forms of dura mater damages and the difficulties of its plasticity and sealing.

scholarly journals Influence of application parameters of ultrasonic-assisted bone instruments on the tear force of a substitute material for spinal dura mater

2018 ◽  
Vol 4 (1) ◽  
pp. 611-614
Author(s):  
Marie C. Foelkel ◽  
Vitali Herzog ◽  
Markus Meier ◽  
Michael M. Morlock
Keyword(s):  
Dura Mater ◽  
Spinal Surgery ◽  
Nerve Tissue ◽  
Cnc Machine ◽  
Full Factorial Experiment ◽  
Critical Areas ◽  
Ultrasonic Assisted ◽  
Substitute Material ◽  
Dural Tears ◽  
Full Factorial

AbstractAn ultrasonic-assisted bone instrument can be used for the dissection of bone in spinal surgery. During surgery, the tip of such a bone instrument can touch spinal dura mater. Especially during critical re-operations, high forces can be unintentionally applied on spinal dura mater. To prevent dural tears, the influence of application parameters on the tear force shall be analyzed. Collagen foil is used as a substitute material for spinal dura mater because of its similar mechanical properties and structure. Sponge cloth is placed below collagen foil to imitate cerebrospinal fluid and nerve tissue. A 3-axis CNC-machine is used to automate the movement of the bone instrument. In a full factorial experiment the influence of amplitude, shape of movement and velocity of movement on the tear force is analyzed. Amplitude has the strongest effect because of the increase in input energy. Velocity also has a significant influence, probably because of the strain rate increasing with velocity. Thus, a surgeon should mainly reduce the amplitude and furthermore the velocity of movement to generate higher safety in critical areas.

scholarly journals Surgery Delay Increases Length of Stay in Thoracolumbar Trauma

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lawrence Zeldin ◽  
Sean N Neifert ◽  
Robert J Rothrock ◽  
Ian T McNeill ◽  
Jonathan S Gal ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spinal Injury ◽  
Specific Effect ◽  
Spinal Trauma ◽  
Spine Injury ◽  
Complication Rates ◽  
Improvement Program ◽  
Delayed Surgery ◽  
Significant Difference ◽  
Surgery Timing

Abstract INTRODUCTION The ideal timing from admission of a thoracolumbar spinal trauma patient to the start of surgery at US trauma centers remains a hotly contested area of debate. The effect of surgical latency on patient outcomes in thoracolumbar trauma remains unclear. METHODS All 2013 to 2015 thoracolumbar spinal trauma cases from the American College of Surgeons Trauma Quality Improvement Program (TQIP) were analyzed. Patients with unsurvivable spine injury, polytraumas (serious injuries in more than one bodily region), and those discharged within 24 h were excluded. Patients were classified into 3 groups by surgery timing: less than 8 h (early, N = 1699), between 8 and 24 h (normal, N = 946), and over 24 h (delayed, N = 1601). Mortality, length of stay (LOS), and complication rates were compared between groups. Demographic variables and complication rates were compared. Multivariate logistic regression was utilized to determine the specific effect of surgery timing on outcomes. RESULTS Patients with earlier surgery presented with more severe spinal trauma (P < .0001). Patients in the normal surgical timing cohort were most likely to have altered mental status (4.97% vs 3.24%, P = .05), and less likely to suffer from UTI (4.97% vs 3.24%, P = .03). Patients in the delayed cohort were older (46.2 vs 43.7 yr, P = .0003), more likely to have a longer LOS (11.3 vs 10.6 d, P = .02), return to the ICU (2.94% vs 1.29%, P = .001), experience unplanned intubation (2.06% vs 1%, P = .01) and suffer from cardiac arrest (0.53% vs 1.19%, P = .04). Upon multivariate analysis, delayed surgery was an independent risk factor for prolonged LOS (OR: 1.21, 95% CI: 0.56-1.87, P = .0003). CONCLUSION Patients with earlier surgery possessed more severe spinal injury. When adjusting for demographics and severity, no significant difference is seen in mortality between the different surgery times; however, LOS is prolonged in patients with delayed surgery.

scholarly journals Spinal Motocross Injuries in the United Kingdom

2018 ◽  
Vol 6 (1) ◽  
pp. 232596711774864
Author(s):  
Rohit Singh ◽  
Amit Bhalla ◽  
Matthew Ockendon ◽  
Stuart Hay
Keyword(s):  
United Kingdom ◽  
Spinal Injury ◽  
Burst Fracture ◽  
Current Trend ◽  
Early Spring ◽  
Spinal Injuries ◽  
Data Series ◽  
The Past ◽  
The United Kingdom ◽  
Age Range

Background: Motocross is a form of motorcycle racing held on established off-road circuits and has been a recreational and competitive sport across the world for >100 years. In the United Kingdom alone, motocross has grown into a phenomenally ambitious and popular franchise. There are >200 motocross clubs across the country, permitting >900 events annually. Purpose: To assess the current trend of spine-related motocross injuries over the past 5 years. Study Design: Descriptive epidemiology study. Methods: Data were prospectively collected over 5 years (August 2010–August 2015) at our regional trauma and spine unit, regardless of whether the rider was performing the sport competitively or recreationally. Results: During the study period, spine-related injuries were identified for 174 patients (age range, 6-75 years) who were directly referred to our department following recreational or competitive motocross, with most injuries being sustained within the early spring and summer months, representing the start of the motocross season. A significant number of injuries were in males (n = 203, 94%), with the majority of injuries occurring within the 21- to 30-year-old age group. A total of 116 (54%) injuries required operative treatment. The most common spinal injury was thoracolumbar burst fracture (n = 95), followed by chance fractures (n = 26). Conclusion: This data series emphasizes the prevalence and devastation of motocross-related spinal injuries in the United Kingdom and may serve in administering sanctions and guidelines to governing bodies of motocross. The spinal injuries that occur during motocross have significant capital connotations for regional spinal centers. The recent surge in motocross popularity is correlated with the number of injuries, which have increased over the past 5 years by almost 500%.

scholarly journals Spinal Injuries in Canadian Ice Hockey: Documentation of Injuries Sustained from 1943-1999

2004 ◽  
Vol 31 (4) ◽  
pp. 460-466 ◽  
Author(s):  
C.H. Tator ◽  
C.F. Provvidenza ◽  
L. Lapczak ◽  
J. Carson ◽  
D. Raymond
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Spinal Injuries ◽  
Ice Hockey ◽  
Common Mechanism ◽  
Cord Injury ◽  
Hockey Players ◽  
Rules Changes ◽  
Type Of Fracture

Objectives:Study objectives were: (a) to examine the causes and incidence of major spinal cord injuries sustained by ice hockey players; and (b) to add recently reported Canadian cases to the Canadian Ice Hockey Spinal Injury Registry to determine the effectiveness of prevention efforts.Methods:The study was a review of questionnaires returned retrospectively by physicians and other sources reporting ice hockey related spinal injuries in Canada. Physicians reported on the mechanism of injury, vertebral level of injury, presence of neurologic deficit, type of event, and type of fracture.Results:Between 1943 and 1999, 271 major spinal injuries were reported in Canadian ice hockey players, of which 49.0% occurred to players 16-20 years of age. Ontario has had a disproportionately large number of injuries compared to some provinces, especially Quebec. Of the spinal cord injuries, 65.8% resulted from colliding with the boards, and 36.6% were due to players being pushed or checked from behind. The recent survey shows that there has been a decline in the number of major spinal cord injuries in Canadian ice hockey, especially those causing paralysis due to checking or pushing from behind.Conclusion:Impact of the head with the boards after being checked or pushed from behind was the most common mechanism of spinal cord injury. Injury prevention programs are becoming effective in reducing the overall number of injuries, especially those due to checking from behind. Greater awareness of the occurrence and mechanisms of injury through educational programs and rules changes by organized hockey have reduced the annual incidence of catastrophic spinal injuries in Canadian ice hockey.

Aetioepidemiological profile of spinal injury patients in Eastern Nepal

2005 ◽  
Vol 35 (4) ◽  
pp. 231-233 ◽  
Author(s):  
S Lakhey ◽  
N Jha ◽  
B P Shrestha ◽  
S Niraula
Keyword(s):  
Community Education ◽  
Spinal Injury ◽  
Case Series ◽  
Spinal Injuries ◽  
Retrospective Case ◽  
Target Groups ◽  
Retrospective Case Series ◽  
Adolescents And Adults ◽  
Orthopaedic Ward

This is a retrospective case series of 233 spinal injury patients admitted to the orthopaedic ward of BPKIHS from May 1997 to April 2001. The inpatient records were analysed. In all, 40.3% of spinal injuries resulted from falls from trees while cutting leaves for fodder, and 27.9% resulted from falls from first/second floors. More than 75% of total spinal injuries are largely preventable. Overall, 46.8% of our spinal injury patients had complete cord transection at the level of injury. All adolescents and adults, irrespective of age or sex, should be the target groups for community education and intervention programmes for prevention of spinal injury.

scholarly journals Blind liver biopsy: a 17-year experience

2020 ◽  
Vol 40 (4) ◽  
pp. 322
Author(s):  
Nafiye Urganci ◽  
Tugce Kurtaraner ◽  
Derya Kalyoncu ◽  
Ayse Merve Usta ◽  
Banu Yilmaz Ozguven
Keyword(s):  
Liver Biopsy ◽  
Chronic Active Hepatitis ◽  
Wilson Disease ◽  
Gold Standard ◽  
Liver Diseases ◽  
Liver Enzymes ◽  
Liver Inflammation ◽  
Safe Method ◽  
Biopsy Site ◽  
Histopathological Results

Objectives: Liver biopsy is the gold standard for assessing liver inflammation, necrosis and fibrosis. The aim of the study is to evaluate clinical indications and histopathological results of percutaneus liver biopsy. Materials and methods: A total of 516 children who underwent blind liver biopsy were evaluated retrospectively. Results: Blind liver biopsy was performed for chronic active hepatitis B in 50% of the cases (n=260), neonatal cholestasis in 14% (n=68), autoimmune hepatitis in 7.7% (n=40), Wilson disease in 7.3% (n=38), isolated elevation of the liver enzymes in 5% (n=26), chronic active hepatitis C in 4.2% (n=22), metabolic disease in 3.4% (n=17), malignancies in 2.2% (n=11) and the others in 3.4% (n=17). Major complications were observed in 0.19% of the cases (n=1) and minor complications such as pain at the biopsy site in 13.5% of the cases (n=70), hypotension and tachycardia in 1.9% (n=10). Conclusions: Blind liver biopsy is a safe method in diagnosing liver diseases in childhood.

scholarly journals Features of Experiencing a Spiritual Crisis and Attitudes to Self in Persons with Spinal Injury

2020 ◽  
Vol 28 (3) ◽  
pp. 42-64
Author(s):  
I.V. Vachkov ◽  
M.A. Odintsova ◽  
O.A. Tristan
Keyword(s):  
Fairy Tales ◽  
Fairy Tale ◽  
Spinal Injury ◽  
Age Groups ◽  
Spinal Injuries ◽  
The Past ◽  
Gender And Age ◽  
Spiritual Crisis ◽  
Changing Attitudes ◽  
Real Self

The article presents the results of the study of the specifics of spiritual crisis experience and attitudes to Self in persons with spinal injury (N=65) and conventionally healthy respondents (N=63). The characteristics of spiritual crisis most typical of people with spinal injury were: dissatisfaction and loneliness attributed to the past, present, and future; and suffering attributed to the past. The categories of dissatisfaction, loneliness, and suffering were heterogeneous, as reflected in texts produced by people with spinal injuries and healthy people of different sex and age. Groups distinguished by time elapsed since injury did not differ on quantitative signs of spiritual crises but differed qualitatively in their experiences of dissatisfaction, loneliness, and suffering. People who had lived with the injury longer often experienced uselessness, and a lack of contacts, attention, and support; they were disposed to self-flagellation and guilt. Their attitude to Self reflected in the texts of fairy tales. Healthy controls wrote simple fairy tales describing the interaction of the Real Self and Ideal Self. By contrast, people with spinal injuries focused their stories on emotional experiences of their attitude to Self (complicated fairy tales) or finding meaning, accepting oneself and life in all its fullness and variety (complex fairy tale). Counseling people with a spinal injury, one should take into account both gender and age of the injured person and the potential of the fairy tale itself, which becomes a resource in the experiencing of spiritual crisis and in changing attitudes to Self.

scholarly journals MODERN VIEWS FOR THE TREATMENT OF ACUTE UNCOMPLICATED APPENDICITIS: APPENDECTOMY OR ANTIBIOTICS?

2019 ◽  
pp. 86-94
Author(s):  
V.V. Vashchuk ◽  
V.P. Andrushchenko ◽  
T.V. Khomchenko ◽  
T.P. Kyryk
Keyword(s):  
Gold Standard ◽  
Meta Analysis ◽  
Analysis Data ◽  
The Body ◽  
Controlled Trials ◽  
Safe Method ◽  
Randomized Controlled ◽  
Vital Functions ◽  
Uncomplicated Appendicitis ◽  
Critical Violations

Summary. The paper reviews the results of randomized controlled trials and meta-analysis data from comparisons of antibiotics and appendectomy in the treatment of acute uncomplicated appendicitis ) is carried. It has been shown that appendectomy remains in most cases the gold standard for the treatment of acute uncomplicated appendicitis is proved. At the same time, it is noted that in separate groups of patients with no risk of development of complications and / or with high operational risk in persons with critical violations of vital functions of the body, in case of impossibility to perform an operation, antibiotic therapy can be a highly effective and safe method of treatment is established. Preparations of choice are carbapenems (mepenes), fluoroquinolones III (levofloxacin) and metronidazos/ornizol is indicated.

scholarly journals Osteoblastoma: When the Treatment Is Not Minimally Invasive, an Overview

2021 ◽  
Vol 10 (20) ◽  
pp. 4645
Author(s):  
Carmine Zoccali ◽  
Mariangela Novello ◽  
Francesco Arrigoni ◽  
Alessandra Scotto di Uccio ◽  
Dario Attala ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gold Standard ◽  
Bone Tumors ◽  
Focused Ultrasound ◽  
Surgical Excision ◽  
Late Complications ◽  
High Intensity Focused Ultrasound ◽  
Wide Resection ◽  
Primary Bone Tumors ◽  
Invasive Techniques

Background: osteoblastoma is a bone-forming tumor accounting for about 1% of all primary bone tumors and 3% of benign bone tumors. The gold-standard treatment is surgical excision; nevertheless, minimally invasive radiological techniques such as thermoablation and, more recently, high intensity focused ultrasound are gaining more importance. The aim of the present paper is to analyze surgical indications based on our experience and on the evidences in the literature. Methods: all patients affected by osteoblastoma who underwent surgical excision in January 2009 and December 2018 were reviewed; eleven patients were enrolled in the study. The epidemiological aspects, size of the disease and site of onset, symptoms, surgery type, indications, and results are reported for every case. Results: all treatments were based on a preoperative diagnosis; pain was constant in all cases. Intralesional surgeries were performed in 9 out of 11 cases; the remaining 2 cases underwent wide resection. No early or late complications occurred after the surgical procedure. The indications for surgery were lesions very close to nerves or joints, unclear diagnosis, risk of fracture, lesion too large for radiofrequency thermoablation, or failure of minimally invasive treatments. At a medium follow-up of 88 months, no local recurrences were verified. Conclusions: osteoblastoma is a rare tumor with difficult diagnosis. Identification is based on symptoms, imaging, and histology. When possible, minimally invasive techniques is preferred for treatment but surgery is still considered the gold standard.

scholarly journals iant extradural dermoid cyst in the right parietal-occipital region with obliteration of the transverse sinus

2021 ◽  
Vol 11 (3) ◽  
pp. 115-121
Author(s):  
K. A. Belozerskikh ◽  
G. Yu. Evzikov
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Dermoid Cyst ◽  
Dura Mater ◽  
Transverse Sinus ◽  
Occipital Region ◽  
Resonance Imaging ◽  
Study Objective ◽  
The Right ◽  
Parietal Bones

The study objective – to report a case of giant extradural dermoid cyst in a 48‑year-old woman; the cyst caused extensive erosion of the occipital bone and lower portions of the right parietal bone, which is quite rare.Case report. A 48‑year-old female patient was admitted to the Department of Neurosurgery, A. Ya. Kozhevnikov Clinic of Nervous System Diseases, University Clinical Hospital No. 3, I. M . Sechenov First Moscow State Medical University on 28.07.2020. In 2002, the patient noted the emergence of a 1‑cm subcutaneous formation in the right occipital region. The formation was slowly growing. On 17.12.2015, she underwent magnetic resonance imaging of the brain. It revealed a 2,5 × 4,4 × 4,0 cm extradural formation with clear contours and erosion of the occipital and right parietal bones. On 12.03.2020, she had contrast-enhanced magnetic resonance imaging, which demonstrated that the tumor was growing (its size was 3,0 × 6,4 × 5,5 cm). Magnetic resonance imaging scans also showed extensive erosion (6,4 × 5,4 cm) of the occipital and right parietal bones and obliteration of the right transverse sinus. On 28.07.2020, the patient underwent elective surgery, namely excision of the extradural dermoid cyst in the right parietooccipital region with simultaneous reconstruction of the calvarial bones using a titanium plate. The cyst capsule and its contents were completely removed. The capsule was tightly attached to the dura mater, but did not invade it. To remove small fragments of the capsule that could potentially invade the bone, we performed small marginal resection of the calvarial bones at the depth of 2–3 mm from the defect margin. After the removal of cyst capsule, well-defined furrow could be visualized on the dura mater in the projection of the obliterated transverse sinus. Five days postoperatively, the patient was discharged from hospital in satisfactory condition.Conclusion. Surgical treatment of extradural dermoid cysts implies radical removal of the tumor. Since the cyst capsule gets tightly attached to the edges of the bone defect along with bone erosion, the removal of such cysts as a single block is almost impossible. The risk of severe erosion of the skull bones caused by a dermoid cyst with extradural (and sometimes intradural) growth increases with age. Therefore, it is recommended to remove such tumors as early as possible. Patients with skull bone defects also require cranioplasty.

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