Assessment of malpractice litigation following spine surgery

Medical litigation in spine surgery is a serious concern today, with a high volume of clinical negligence claims, substantial financial cost and significant burden, who is threatening the future of this surgery. Classical spinal surgery should be performed with very well documented indication, in order to improve the expected results, with clear aims: decompression of the neural elements of the spine from tightness, stabilizing the spine to protect the nerves, eliminate the pain resulting from abnormal loading from the different movements. Spinal surgery today means a wide analysis, understanding and realization of spinal decompression, also osteosynthesis and fusions, using high-performance gestures, with increased addressability especially in the elderly, for a varied pathology, which involves anaesthetic-surgical risks, complications. In such a context, surgical damage does not necessarily result from an error or from surgical misconduct and the surgeon is not always responsible for the damage in the absence of a proven fault in the legal sense. The paper aims to briefly review the main problems, but also useful recommendations to meet various challenges, expectations, maintaining the quality of life of each patient, reducing risks of getting sued, also to increase the odds of a successful defence. In conclusion: education, vigilance, improved patient-safety strategies, investigation, implementation and sharing of lessons learned from litigation claims remain important components of spinal surgeons training, to reduce future cases of negligence and improve patient care, quality of life, as many of the cases of successful litigation had a preventable cause

Psychotherapy of hospitalized patients - between option and necessity

The existence of reciprocal psyche-soma influence requires a double relationship, medical and psychological; the consequences of poor communication include noncompliance to treatment and malpractice legal actions. This paper provides explanations which necessarily require psychosomatic approach of each patient, the patient reacting massively in psychological plan. Delimitation of competence of various specialties is only for the benefit of the patient, who will be investigated and treated according to custom issues (“There are no diseases, only ill people”), imposing thus the integration of the psychologist in the therapeutic team

Romanian neurosurgery at European standards: The 45th Congress of the “Romanian Society of Neurosurgery”

Sibiu, 201

Historical vignette: The first brain surgery performed by the first woman neurosurgeon in Romania, Dr. Sofia Ionescu-Ogrezeanu

Introduction. Sofia Ionescu-Ogrezeanu (b. April 25, 1920, F?lticeni - d. March 21, 2008, Bucharest), also known as the Lady of Romanian Neurosurgery, became the first woman neurosurgeon in the world after performing a brain surgery during World War II, a fact recognized as a world premiere during the 13th World Congress of the World Federation of Neurosurgical Societies (WFNS) in Morocco, in 2005. [1] Materials and methods. Sofia Ionescu is the first woman neurosurgeon. She was born on the fields of Bucovina, in F?lticeni, and became part of the "golden team" of the Romanian neurosurgery of the pioneering period. The decisive moment of her career took place in 1944, during the war when she was forced to perform an emergency operation on a child, a victim of the bombing. The article coagulates the reports regarding the description of the first brain surgery performed by the first woman neurosurgeon with the continuous activity integrated with the field of neurosurgery. Both specialized articles, biographical books, and television interviews were used as references. Results. The operation performed in the fifth year of faculty was the first step of a journey of 47 years of neurosurgical career, practised with high morality and devotion. The sacrifice of the pioneer of the first woman neurosurgeon was recognized in the press in the country and abroad, as well as by the recognition of different titles and distinctions

Differential diagnostic problems in elderly chronic subdural hematoma patients

Chronic subdural hematomas (CSDH) are recognized as common in older people (over 70 years). They are produced in minor injuries (falls on the same level). These CSDH have minor symptoms (headache, memory disorders, balance disorders, cognitive disorders, etc. and are classified as signs for the onset of dementia, circulatory failure - basilar vertebra, Alzheimer, etc. A simple brain CT scan can highlight these hematomas and a neurosurgical intervention will achieve extremely favorable prognosis. There are many pitfalls in the differential diagnosis of CSH especially with strokes being so common at this age

Steps towards neuro-excellence

Between September 28 and October 1, 2022, took place the 47th National Congress of the Romanian Society of Neurosurgery. It was organized in Iasi, at the Palace of Culture. On this occasion, the 26th Francophone Course and the 4th National Congress of Modern Neuroscience were held. These three events represent the quintessence of all current modern neurosurgical problems. Extremely important topics were disputed which helped to grow the passion in the hearts of young enthusiasts and their mentors

Subarachnoid haemorrhage. A critical neurosurgical emergency

Subarachnoid haemorrhage (SAH) accounts for 3% of all strokes and is the cause of 5% of stroke mortality. SAH by rupture of cerebral aneurysm or arterial-venous malformation (AVM) remains the most devastating cerebrovascular disease. During admission for SAH, about 30-70% of patients suffer a rebleed, and from all rebleeds, about 90% lead to death no matter the treatment. Available current scales help predict the prognosis and guide the therapy. Considering that the lifestyle risk factors for SAH are of increasing prevalence, it is expected that it will affect even more people in the future. SAH should not be regarded as a disease but rather a set of events with devastating complications requiring adequate management from debut extending long after patient discharge

Postoperative lumbar spondylodiscitis: A systematic review

Background. Several causes that can trigger POD can be incriminated: the patient's immune status, surgical technical errors, intra-operative contamination, foreign materials microfilm. Extensive analysis is required to eradicate the limited or diffuse infection and manage the optimal therapeutic attitude conservative or by surgery to get: faster recovery time, to improve symptoms, to allow mobilization, to offer a good quality of life and to reduce the average length of hospital stay. Objectives. To perform a systematic review of POD outcomes via retrospective analysis of current studies based on the mechanism, the pathogenesis, the management of patient's immunological status, aetiology (microorganism involved, foreign material applied for hemostasis, application of spinal instrumentation, cement, screws, spinal devices), laboratory (TLC, ESR, CRP), MRI/CT-scan, antibiotherapy guidelines and the type of surgery performed: classical or minim-invasive, length of procedure, intraoperative accidents, the experience of the neurosurgeon, post-operative stay in ICU, etc. Methods. Several data were taken into account regarding lumbar infections using a comprehensive review of the literature published studies from 1998 to 2021. Demographic data, clinical variables, length of hospital stay, duration of antibiotic treatment, and post-treatment complications were assessed. Results. We performed a systematic review concerning 31 studies regarding clinical status, diagnosis and treatment. Conclusions. Based on our systematic analysis, training and continuous education in spine surgery are necessary to prevent POD. The diagnosis of lumbar POD is based on history and physical examination, biochemical markers, neuroradiologic studies, using appropriate MRI imaging. Most cases of lumbar POD can be managed by conservative treatment with antibiotics after causative germ isolation and antibiogram. Surgery is performed on patients with conservative treatment failure - resistant to antibiotic therapy, as those with neurological complications: acute paraplegia, pain resistance to analgetics, acute sepsis, abscesses, spinal instability, severe kyphosis. Early surgery with wound irrigation/debridement is more readily able to disrupt biofilm formation and facilitate penetration of systemic antimicrobials to allow for resolution of the infection, vacuum-assisted closure facilitates wound healing and eradicates spinal infections, decrease the rate of complications, permit rapid pain relief while preserving the instrumentation/stability, better clinical outcomes, infection control before extensive destruction of the vertebrae, spinal instability and kyphotic deformity appear. Instrumentation can usually be preserved in patients with early infections (e.g., <6 weeks), but instrumentation removal should be considered for infections presenting in a delayed fashion (e.g., >6 weeks to even years) PSII. Patients should be adequately followed for one postoperative year, to ensure that the infection has been fully eradicated. Implant sonication provides cultures for direct identification of active and/or persistent biofilm, while the introduction of enzymes that dissolve the biofilm matrix (e.g., DNase and alginate lyase) and quorum-sensing inhibitors that increase biofilm susceptibility to antibiotics may further help manage postoperative infection (2)(27-31)