Reactivation of herpes simplex labialis following adult spine deformity correction surgery

Background: A depressed host defense is a major contributor to the oral shedding of herpes simplex virus (HSV) type 1. Here, we present an instance in which herpes simplex labialis was reactivated following major spinal deformity surgery. Case Description: A 59-year-old female underwent spinal deformity correction for lumbar degenerative scoliosis. On postoperative days 2–3, she presented with pyrexia (38°C) and tachycardia (94/min); by day 5 she had multiple ulcers around her lips and was HSV IgG positive. She had a remote history of herpes simplex I infection 7 years previously. Once started on oral acyclovir, the lesions improved, and by day 15 postoperative, her pyrexia and all lesions completely resolved. Conclusion: HSV-1 should be suspected in patients with a previous history of HSV and postoperative pyrexia. Adequate prophylactic administration of acyclovir should result in resolution of these outbreaks, in this case, attributed to overly extensive spinal deformity surgery.

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Neuromonitoring During Surgery for Paediatric Spinal Deformity in Canada (2007)

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100006302 ◽

2009 ◽

Vol 36 (1) ◽

pp. 47-50 ◽

Cited By ~ 4

Author(s):

Jonathan Norton ◽

Douglas Hedden

Keyword(s):

Spinal Deformity ◽

Motor Evoked Potentials ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Standard Of Care ◽

National Standards ◽

Spinal Deformity Surgery ◽

Correction Surgery ◽

Training Programmes ◽

Spinal Cord Function

Background:Neuromonitoring during paediatric (and adult) spinal deformity surgery helps to reduce the risk of both permanent and short term neurological damage. A shortage of neurophysiologists and technicians limits the availability of this service. Not all surgeons believe neuromonitoring offers neuroprotection during spinal surgery. This study aimed to document the degree to which paediatric patients undergoing spinal deformity correction surgery have their spinal cord function monitored.Methods:A questionnaire was sent electronically to all of the surgical members of the Canadian Paediatric Spinal Deformity Study Group.Results:Results were received from 9/9 centres indicating that monitoring was performed in 7/9 centres, with one further centre awaiting staffing. Whilst half of those centres that do monitor only monitor sensory and motor evoked potentials, the remaining centres also use EMG and EEG to assess the state of the patient intraoperatively.Conclusions:Despite a shortage of staff, most paediatric spinal deformity surgeons in Canada who wish to, are able to neurophysiologically monitor their surgical cases. Neuromonitoring appears to be becoming a standard of care, at least for paediatric spinal deformity surgery. There is an urgent need for the establishment of national standards for both technologists and interpreters, as well as training programmes for both these groups.

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The Accuracy of 3D Printing Assistance in the Spinal Deformity Surgery

BioMed Research International ◽

10.1155/2019/7196528 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9

Author(s):

Po-Chen Chen ◽

Chien-Chun Chang ◽

Hsien-Te Chen ◽

Chia-Yu Lin ◽

Tsung-Yu Ho ◽

...

Keyword(s):

3D Printing ◽

Pedicle Screw ◽

Spinal Deformity ◽

Deformity Correction ◽

Pedicle Screws ◽

Evoke Potential ◽

Printing Technology ◽

3D Printing Technology ◽

Spinal Deformity Surgery ◽

Correction Surgery

Background. The pedicle screw is one of the main tools used in spinal deformity correction surgery. Robotic and navigated surgeries are usually used, and they provide superior accuracy in pedicle screw placement than free-hand and fluoroscopy-guided techniques. However, their high cost and space limitation are problematic. We provide a new solution using 3D printing technology to facilitate spinal deformity surgery. Methods. A workflow was developed to assist spinal deformity surgery using 3D printing technology. The trajectory and profile of pedicle screws were determined on the image system by the surgical team. The engineering team designed drill templates based on the bony surface anatomy and the trajectory of pedicle screws. Their effectiveness and safety were evaluated during a preoperative simulation surgery. The surgery consisted in making a pilot hole through the drill template on a computed tomography- (CT-) based, full-scale 3D spine model for every planned segment. Somatosensory evoke potential (SSEP) and motor evoke potential (MEP) were used for intraoperative neurophysiological monitoring. Postoperative CT was obtained 6 months after the correction surgery to confirm the screw accuracy. Results. From July 2015 to November 2016, we performed 10 spinal deformity surgeries with 3D printing technology assistance. In total, 173 pedicle screws were implanted using drill templates. No notable change in SSEP and MEP or neurologic deficit was noted. Based on postoperative CT scans, the acceptable rate was 97.1% (168/173). We recorded twelve pedicle screws with medial breach, six with lateral breach, and five with inferior breach. Medial breach (12/23) was the main type of penetration. Lateral breach occurred mostly in the concave side (5/6). Most penetrations occurred above the T8 level (69.6%, 16/23). Conclusion. 3D printing technology provides an effective alternative for spinal deformity surgery when expensive medical equipment, such as intraoperative navigation and robotic systems, is unavailable.

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The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery

Global Spine Journal ◽

10.1177/21925682211008830 ◽

2021 ◽

pp. 219256822110088

Author(s):

Aixing Pan ◽

Hongtao Ding ◽

Yong Hai ◽

Yuzeng Liu ◽

Junrui Jonathan Hai ◽

...

Keyword(s):

Spinal Deformity ◽

Deformity Correction ◽

Control Group ◽

Posterior Fixation ◽

Spine Deformity ◽

Good Prospect ◽

Correction Rate ◽

Spine Model ◽

Correction Surgery ◽

Dimensional Printing

Study Design: Retrospective case-control study. Objective: We aimed to evaluate the value of 3-dimensional printing (3DP) spine model in the surgical treatment of severe spinal deformity since the prosperous development of 3DP technology. Methods: Severe scoliosis or hyper-kyphosis patients underwent posterior fixation and fusion surgery using the 3DP spine models were reviewed (3DP group). Spinal deformity surgeries operated by free-hand screw implantation during the same period were selected as the control group after propensity score matching (PSM). The correction rate, pedicle screw accuracy, and complications were analyzed. Class A and B screws were defined as accurate according to Gertzbein and Robbins criteria. Results: 35 patients were enrolled in the 3DP group and 35 matched cases were included in the control group. The perioperative baseline data and deformity correction rate were similar between both groups ( P > .05). However, the operation time and blood loss were significantly less in the 3DP group (296.14 ± 66.18 min vs. 329.43 ± 67.16 min, 711.43 ± 552.28 mL vs. 1322.29 ± 828.23 mL, P < .05). More three-column osteotomies (Grade 3-6) were performed in the 3DP group (30/35, 85.7% vs. 21/35, 60.0%. P = .016). The screw placement accuracy was significantly higher in the 3DP group (422/582, 72.51% vs. 397/575, 69.04%. P = .024). The screw misplacement related complication rate was significantly higher in the free-hand group (6/35 vs. 1/35, P = .046). Conclusions: The study provided solid evidence that 3DP spine models can enhance surgeons’ confidence in performing higher grade osteotomies and improve the safety and efficiency in severe spine deformity correction surgery. 3D printing technology has a good prospect in spinal deformity surgery.

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The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery

10.21203/rs.3.rs-132245/v1 ◽

2020 ◽

Author(s):

Aixing Pan ◽

Hongtao Ding ◽

Yong Hai ◽

Junrui Jonathan Hai ◽

Peng Yin ◽

...

Keyword(s):

Spinal Deformity ◽

Deformity Correction ◽

Control Group ◽

Posterior Fixation ◽

Spine Deformity ◽

Good Prospect ◽

Correction Rate ◽

Spine Model ◽

Correction Surgery ◽

Dimensional Printing

Abstract Objective. We aimed to evaluate the value of 3-dimensional printing (3DP) spine model in the surgical treatment of severe spinal deformity since the prosperous development of 3DP technology.Materials and Methods. Severe scoliosis or hyper-kyphosis patients underwent posterior fixation and fusion surgery using the 3DP spine models were reviewed (3DP group). Spinal deformity surgeries operated by free-hand screw implantation during the same period were selected as the control group after propensity score matching (PSM). The correction rate, pedicle screw accuracy, and complications were analyzed. Class A and B screws were defined as accurate according to Gertzbein and Robbins criteria.Results. 35 patients were enrolled in the 3DP group and 35 matched cases were included in the control group. The perioperative baseline data and deformity correction rate were similar between both groups (P>0.05). However, the operation time and blood loss were significantly less in the 3DP group (296.14±66.18 min vs. 329.43±67.16 min, 711.43±552.28 mL vs. 1322.29±828.23 mL, P<0.05). More three-column osteotomies (Grade 3-6) were performed in the 3DP group (30/35, 85.7% vs. 21/35, 60.0%. P=0.016). The screw placement accuracy was significantly higher in the 3DP group (422/582, 72.51% vs. 397/575, 69.04%. P=0.024). The screw misplacement related complication rate was significantly higher in the free-hand group (6/35 vs. 1/35, P=0.046).Conclusion. The study provided solid evidence that 3DP spine models can enhance surgeons' confidence in performing higher grade osteotomies and improve the safety and efficiency in severe spine deformity correction surgery. 3D printing technology has a good prospect in spinal deformity surgery.

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The Role of C21orf91 in Herpes Simplex Virus Keratitis

Medicina ◽

10.3390/medicina55120753 ◽

2019 ◽

Vol 55 (12) ◽

pp. 753

Author(s):

Vilija Danileviciene ◽

Reda Zemaitiene ◽

Vilte Marija Gintauskiene ◽

Irena Nedzelskiene ◽

Dalia Zaliuniene

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Real Time ◽

Previous History ◽

Herpetic Keratitis ◽

Eye Disease ◽

Ophthalmological Examination ◽

Healthy Controls ◽

History Of ◽

Simplex Virus

Background and Objectives: This paper aims to describe the single nucleotide polymorphisms (SNPs) of C21orf91 rs1062202 and rs10446073 in patients with herpetic keratitis by evaluating corneal sub-basal nerves, as well as the density of Langerhans cells (LC) and endothelium cells (EC) during the acute phase of the disease. Materials and Methods: A prospective clinical study included 260 subjects: 70 with herpetic eye disease, 101 with previous history of herpes labialis—but no history of herpetic eye disease—and 89 with no history of any herpes simplex virus (HSV) diseases. All subjects underwent a complete ophthalmological examination including in vivo laser scanning confocal microscopy (LSCM) of the central cornea. C21orf91 rs1062202 and rs10446073 were genotyped using the real-time polymerase chain reaction (PCR) method with the Rotor-Gene Q real-time PCR quantification system. SNPs were determined using TaqMan genotyping assay, according to the manufacturer’s manual. Results: The C21orf91 rs10446073 genotype GT was more frequent in the HSV keratitis group, compared with healthy controls (20.0% vs. 7.9%), OR 2.929[1.11–7.716] (p < 0.05). The rs10446073 genotype TT was more frequent in healthy controls (12.4% vs. 1.4%), OR 22.0[2.344–260.48] (p < 0.05). The rs10446073 genotype GT increased the risk of EC density being less than 2551.5 cell/mm2, OR 2.852[1.248–6.515] (p < 0.05). None of the SNPs and their genotypes influenced the LC density and corneal sub-basal nerve parameters (p > 0.05). Conclusions: Our study reports a new association between herpetic keratitis and human gene C21orf91, with the rs10446073 genotype GT being more common in herpetic keratitis patients and increasing the risk for the disease by a factor of 2.9.

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Neuromonitoring changes in pediatric spinal deformity surgery: a single-institution experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.12.peds13188 ◽

2014 ◽

Vol 13 (3) ◽

pp. 247-254 ◽

Cited By ~ 25

Author(s):

Joseph Ferguson ◽

Steven W. Hwang ◽

Zachary Tataryn ◽

Amer F. Samdani

Keyword(s):

Spinal Cord ◽

Evoked Potentials ◽

Spinal Deformity ◽

Pediatric Patients ◽

Motor Evoked Potentials ◽

Deformity Correction ◽

Cord Injury ◽

Spinal Deformity Surgery ◽

Correction Surgery

Object Intraoperative monitoring of the spinal cord has become the standard of care during surgery for pediatric spinal deformity correction. The use of both somatosensory and motor evoked potentials has dramatically increased the sensitivity and specificity of detecting intraoperative neurophysiological changes to the spinal cord, which assists in the intraoperative decision-making process. The authors report on a large, single-center experience with neuromonitoring changes and outline the surgical management of patients who experience significant neuromonitoring changes during spinal deformity correction surgery. Methods The authors conducted a retrospective review of all cases involving pediatric patients who underwent spinal deformity correction surgery at Shriners Hospital for Children, Philadelphia, between January 2007 and March 2010. Five hundred nineteen consecutive cases were reviewed in which neuromonitoring was used, with 47 cases being identified as having significant changes in somatosensory evoked potentials, motor evoked potentials, or both. These cases were reviewed for patient demographic data and surgical characteristics. Results The incidence of significant neuromonitoring changes was 9.1% (47 of 519 cases), including 6 cases of abnormal Stagnara wake-up tests, of which 4 had corroborated postoperative neurological deficits (8.5% of 47 cases, 0.8% of 519). In response to neuromonitoring changes, wake-up tests were performed in 37 (79%) of 47 cases, hardware was adjusted in 15 (32%), anesthesiology interventions were reported in 5 (11%), hardware was removed in 5 (11%), the patient was successfully repositioned in 3 (6%), and the procedure was aborted in 13 (28%). In 1 of the 4 patients with new postoperative deficits, the deficit had fully resolved by the last follow-up; the other 3 patients had persistent neurological impairment as of the most recent follow-up examination. The authors observed a sensitivity of 100% for intraoperative neuromonitoring. Conclusions Due to the profound risks associated with spinal deformity surgery, intraoperative neurophysiological monitoring is an integral tool to warn of impending spinal cord injury. Intraoperative neuromonitoring appears to provide a safe and useful warning mechanism to minimize spinal cord injury that may arise during scoliosis correction surgery in pediatric patients.

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Machine learning approach for differentiating cytomegalovirus esophagitis from herpes simplex virus esophagitis

Scientific Reports ◽

10.1038/s41598-020-78556-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jung Su Lee ◽

Jihye Yun ◽

Sungwon Ham ◽

Hyunjung Park ◽

Hyunsu Lee ◽

...

Keyword(s):

Machine Learning ◽

Differential Diagnosis ◽

Herpes Simplex Virus ◽

Herpes Simplex ◽

Predictive Value ◽

Characteristic Curve ◽

Previous History ◽

Clinical Factor ◽

Endoscopic Images ◽

Simplex Virus

AbstractThe endoscopic features between herpes simplex virus (HSV) and cytomegalovirus (CMV) esophagitis overlap significantly, and hence the differential diagnosis between HSV and CMV esophagitis is sometimes difficult. Therefore, we developed a machine-learning-based classifier to discriminate between CMV and HSV esophagitis. We analyzed 87 patients with HSV esophagitis and 63 patients with CMV esophagitis and developed a machine-learning-based artificial intelligence (AI) system using a total of 666 endoscopic images with HSV esophagitis and 416 endoscopic images with CMV esophagitis. In the five repeated five-fold cross-validations based on the hue–saturation–brightness color model, logistic regression with a least absolute shrinkage and selection operation showed the best performance (sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the receiver operating characteristic curve: 100%, 100%, 100%, 100%, 100%, and 1.0, respectively). Previous history of transplantation was included in classifiers as a clinical factor; the lower the performance of these classifiers, the greater the effect of including this clinical factor. Our machine-learning-based AI system for differential diagnosis between HSV and CMV esophagitis showed high accuracy, which could help clinicians with diagnoses.

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Asymptomatic shedding of herpes simplex virus from the genital tract: uncertainty and its consequences for patient management

International Journal of STD & AIDS ◽

10.1258/0956462961917799 ◽

1996 ◽

Vol 7 (4) ◽

pp. 229-232 ◽

Cited By ~ 12

Author(s):

S E Barton ◽

P E Munday ◽

R J Patel

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Genital Herpes ◽

Genital Tract ◽

Patient Management ◽

Sexual Transmission ◽

Supportive Counselling ◽

History Of ◽

Simplex Virus ◽

The Relationship

A frequent component of the management of patients with genital herpes concerns the possibility of asymptomatic shedding and potential sexual transmission of the virus. Approaches intended to provide supportive counselling and reassurance of patients about these issues need now to be modified in the light of increasing data of the frequency of asymptomatic detection of virus and the effects of antiviral therapy on this phenomenon. Further studies to delineate the relationship between asymptomatic detection of HSV in the genital tract and the mechanism of sexual transmission of this virus need to be conducted before clinicians instigate antiviral suppressive treatment primarily to prevent sexual transmission of HSV. However, it is important that the new data and our greater understanding of the natural history of genital herpes is translated into accurate and comprehensible information for our patients.

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Herpes Simplex Virus Infections

Pediatrics in Review ◽

10.1542/pir.17.12.415 ◽

1996 ◽

Vol 17 (12) ◽

pp. 415-423

Author(s):

Paula W. Annunziato

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Hepatitis B Surface Antigen ◽

Liver Function Tests ◽

Virus Infections ◽

Sexually Transmitted ◽

The Third ◽

Intravenous Acyclovir ◽

History Of ◽

Simplex Virus

Case Report A term female developed fever and tachypnea and had a transient episode of poor color and tone on the third day of life. She was delivered by cesarean section 5 hours after rupture of membranes to a 19-year-old, gravida 4, para 0 mother whose serology was negative for syphilis, human immunodeficiency virus (HIV), and hepatitis B surface antigen. The mother had no history of sexually transmitted diseases. Apgar scores were 8 at 1 minute and 9 at 10 minutes. When the infant was admitted to the nursery, scalp abrasions were noticed by the nurse. On the third day of life, a sepsis evaluation was initiated, and the infant received ampicillin and gentamicin intravenously: no bacterial infection was found. On the fifth day of life, vesicular lesions were noticed on her scalp. Bilateral interstitial infiltrates were present On chest radiograph and laboratory studies revealed mild elevations in liver function tests. There were no cerebrospinal fluid (CSF) abnormalities. She was started on intravenous acyclovir, and herpes simplex virus (HSV)-2 subsequently was isolated from both her pharynx and scalp lesions. After receiving intravenous acyclovir for 3 weeks, she was discharged with no evidence of residual sequelae. Four days after acyclovir was discontinued, new scalp vesicles appeared and the infant developed a temperature of 38.8°C (102°F).

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Comparison of Radiographic And Clinical Outcomes Observed After Adult Spinal Deformity Correction Using Iliac Screw Versus S2-Alar-Iliac Screw

10.21203/rs.3.rs-492643/v1 ◽

2021 ◽

Author(s):

Qiang Luo ◽

Yong-Chan Kim ◽

Ki-Tack Kim ◽

Kee-Yong Ha ◽

Joonghyun Ahn ◽

...

Keyword(s):

Clinical Outcomes ◽

Spinal Deformity ◽

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Postoperative Change ◽

Iliac Screw ◽

Vas Scores ◽

Correction Surgery

Abstract Background: To date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation.Methods: A retrospective review of consecutive patients underwent deformity correction surgery for ASD between 2013 and 2017 was performed. Patients were divided into two groups based on whether IS or S2AI fixation was performed. All radiographic parameters were measured preoperatively, immediately postoperatively, and the last follow-up. Demographics, intraoperative and clinical data were analyzed between the two groups. Additionally, the cohort was subdivided according to the postoperative change in pelvic incidence (PI): subgroup (C) was defined as change in PI ≥5° and subgroup (NC) with change <5°. In subgroup analyses, the 2 different types of postoperative change of PI were directly compared.Results: A total of 142 patients met inclusion criteria: 111 who received IS and 31 received S2AI fixation. The IS group (65.6 ± 26, 39.8 ± 13.8) showed a significantly higher change in lumbar lordosis (LL) and upper lumbar lordosis (ULL) than the S2AI group (54.4 ± 17.9, 30.3 ± 9.9) (p<0.05). In subgroup (C), PI significantly increased from 53° preoperatively to 59° postoperatively at least 50% of IS cohort, with a mean change of 5.8° (p<0.05). The clinical outcomes at the last follow-up were significantly better in IS group than in S2AI group in terms of VAS scores for back and leg. The occurrence of sacroiliac joint pain and pelvic screw fracture were significantly greater in S2AI group than in IS group (25.8% vs 9%, p<0.05) and (16.1% vs 3.6%, p<0.05).Conclusions: IS fixation showed a greater change in LL and ULL than S2AI fixation in ASD surgery. PI may be changed under certain circumstances.

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