Predicting the Difficulty Score of Spinal Anaesthesia

Background: Spinal anaesthesia is the commonest regional anaesthesia conducted for several surgical procedures. Objectives: This study aims to predict the difficulty score of spinal anaesthesia to scale back the complications and ultimately improve anaesthesia quality. Materials and Methods: Patients undergoing various surgeries involving spinal anaesthesia were taken in this study and several parameters like demographic details, body mass index, spinous process condition were recorded pre operatively to see how they influenced the difficulty of performing spinal anesthesia on them. Results: Out of the 101 patients enrolled in this study, 53 underwent an easy SA by the first attempt in the first space. It was moderate in 36 and difficult in 12 patients. Conclusion: Considering the examination of patients with respect to BMI, lumbar spinous process status and deformities, radiological signs of lumbar vertebrae can be helpful in predicting how difficult the SA procedure is going to be.

Relationship Between C2 Semispinalis Cervicis Preservation and C2 Spinous Process Morphology During Cervical Laminoplasty Involving C3

Study Design Retrospective study Objectives Due to anatomical variations in the semispinalis cervicis insertion in the C2 spinous process, complete preservation is not always possible when the C3 level is included in a cervical laminoplasty. Three-dimensional computed tomography was used to evaluate the relationship between the incidence of semispinalis cervicis injury and the C2 inter-spinous angle. Methods We included 95 patients who underwent a cervical laminoplasty that included a C3 laminectomy for cervical myelopathy. Patients with a C2 inter-spinous angle above and below 60° were classified into wide- and narrow-angled groups, respectively (n = 48 and n = 47). Whether the C2 semispinalis cervicis insertion was preserved, or detached and reattached was reviewed from surgical records. The pre and postoperative C2-C7 lordosis and range of motion (ROM) were measured, and clinical outcomes were obtained from the patient charts. Results The C2 semispinalis cervicis was preserved in 47 patients (97.9%) in the wide-angled group but only in 14 patients (29.8%) in the narrow-angled group ( P < .001). The postoperative C2-C7 lordosis extension and ROM were significantly greater in the wide-angled ( P = .048 and .036). Postoperative neck pain was significantly greater in the narrow-angled ( P = .018). Conclusions The morphology of the C2 spinous process indicates that a C2 semispinalis cervicis insertion preservation is possible during a cervical laminoplasty that includes a C3 laminectomy. A careful surgical procedure should be conducted when the C2 inter-spinous angle is above 60° to increase the likelihood of achieving this preservation and thereby obtaining a more favorable clinical outcomes.

Causes and Management of Neck Pain in Primary Care, Review Article

Neck pain is a prevalent ailment that affects many people around the world. Neck pain is linked to a high level of disability and is usually regarded as a serious public health issue. Pain between the superior nuchal line and the spinous process of the first thoracic vertebra is referred to as neck pain. The pain in the neck might refer to the head, trunk, and upper limbs in some cases. This article seeks to offer a summary of the existing evidence on the prevalence, costs, diagnosis, prognosis, risk factors, prevention, and management of neck pain patients.

Lumbar spinous process-splitting technique for ligamentum flavum cyst removal: the first use in Europe.

Background Laminotomy for lumbar stenosis is a well-defined procedure and represents a routine in every neurosurgical department. It is a common experience that the mono- or bilateral paraspinal muscles detachment together with supra and interspinous ligaments injury can lead to postoperative pain. In literature has been reported the application at the level of the lumbar spine of a minimally invasive technique defined as lumbar spinous process-splitting technique (LSPST). Methods In the current study, we present a case series of 12 patients that underwent LSPSL from September 2019 to April 2020. Two patient suffering from ligamentum flavum cyst, 8 patients with single level lumbar canal stenosis (LCS) and two patients with two-level LCS. The approach was mini-open, with reduced soft tissue dissection and without paraspinal muscles injury. Moreover, a novel morphological classification of postoperative muscle atrophy is proposed as well as a volumetric analysis of the decompression achieved. Conclusion At our knowledge, this is the first description of this surgical technique and the first LSPSL case series in Europe. Furthermore, cases of ligamentum flavum cyst removal using this safe and effective technique are not yet reported. Abbreviations Lumbar canal stenosis (LCS), lumbar spinous process-splitting technique (LSPST), minimally invasive spine surgery (MISS)

Life - History Studies on New Zealand Brachyura (Crustacea, Decapoda)

<p>1. Abbreviated or direct development is described in Pilumnus novaezelandiae Filhol, 1886 and P. lumpinus Bennett, 1964 (Xanthidae, Pilumninae) from New Zealand. Embryonic development is separated into Nauplius, Metanauplius, and embryonic Zoea stages. In P. novaezelandiae, larvae hatch at a Megalopa stage and are retained beneath the pleon of the female crab. The Megalopa larva and first five juvenile crab stages are described. In P. lumpinus emergent larvae are advanced, much-modified, and non-natatory Zoeae which are not retained by the parent. The Zoea and Megalopa larvae of this species are described. Abbreviated development has little phylogenetic significance among Brachyura, and has probably evolved as a response to habitat requirements of adult crabs. 2. A brief account is given of the systematics and distribution of the New Zealand xanthid crabs Heterozius rotundifrons A. Milne Edwards, 1867, Ozius truncatus H. Milne Edwards, 1834, and of Heteropanope (Pilumnopeus) serratifrons (Kinahan, xanthid Brachyura and to the Megalopa larvae of Heterozius rotundifrons and Ozius truncatus. Notes are given on the seasonal breeding cycle of Heterozius rotundifrons, and the pre-Zoea larva, two Zoea larval stages, and the Megalopa larva reared in the laboratory are described. Ozius truncatus possesses a pre-Zoea larva, four Zoea larval stages, and a Megalopa larva. These have been reared and are described. A key is given for the separation of the Zoea larval stages. The pre-Zoea larva and first stage Zoea larva of Heteropanope Pilumnopeus serratifrons are described. There are probably four zoeal stages in the larval development of this species. 3. The characters of Zoea larvae of the family Xanthidae described up of the present time are critically analysed and considered in relation to the status of currently accepted adult genera and species, the generic groupings used by Monod (1956), and the generic composition of the subfamilies proposed by Balss (1957). Xanthid Zoea larvae fall into two natural groups of genera based on larval characters, the most important being the length of the antennal exopod in relation to that of the spinous process. The first group is equivalent to the subfamily Xanthinae as reconstituted by Balss (1957), but there is no larval evidence suggesting that the "Panopean" genera should be separated from the "Xanthian" genera as suggested by Monod (1956). A second natural group is formed by larvae of the subfamily Menippinae as in Balss (1932, 1957), the subfamily Pilumninae of Balss (1957), and the genus Geryon. Larvae of genera in the subfamily Trapeziinae Miers should be removed from the section Hyperolissa and included in this second natural group. Zoea larvae described from the genera Heteropanope and Pilumnopeus form a separate branch of the second group. Zoea larval evidence does not support Monod's (1956) separation of Eriphia from the "Menippian" group of genera. 4. The first stage Zoea larva Hemiplax hirtipes (Jacquinot, 1853) is described, and present knowledge concerning larvae of crabs of the family Ocypodidae is summarized discussed. No diagnostic character is common to all ocypodid Zoea larvae, but affinities are shown with those of the families Hymenosomidae, Pinnotheridae, and Grapsidae. 5. Pre-Zoea and first stage Zoea larvae hatched from the grapsid crabs Leptograpsus variegatus (Fabricius, 1793), Planes marinus Rathbun, 1915, Hemigrapsus crenulatus (H. Milne Edwards, 1837), H. edwardsi (Hilgendorf, 1882), Cyclograpsus lavauxi H. Milne Edwards, 1853, Helice crassa Dana, 1851, and Plagusia chabrus (Linnaeus, 1764) from New Zealand are described. A key is given for the separation of these larvae. Known Zoea larvae of the family Grapsidae show close affinities with those of the brachyrhynchous families Ocypodidae and Gecarcinidae, and fall into four groups based on larval characters. This system of larval classification agrees with the present arrangement of adult genera into subfamilies except for a division among larvae of the subfamilies Varuninae and Sesarminae. The length of larval life and larval dispersal probably has no bearing on the presence or absence of certain New Zealand species at the Chatham Islands.</p>