Perioperative outcome and cost-effectiveness of spinal versus general anesthesia for lumbar spine surgery

Background and aim General anesthesia (GA) is the most commonly used anesthetic technique for spinal surgery. This study aimed to compare spinal anesthesia (SA) and GA in patients undergoing spinal surgery, in terms of perioperative outcome and cost effectiveness. Materials and methods The study included 80 patients with ASA (American Society of Anesthesiologists) physical status I–II. The patients were randomized to receive SA (n=40) or GA (n=40). Heart rate (HR), mean arterial blood pressure (MABP), blood loss, duration of surgery, duration of anesthesia, surgeon satisfaction, and duration in the post-anesthesia care unit (PACU) were recorded. Postoperative analgesic requirement, nausea and vomiting (PONV), perioperative hemodynamic variables, and anesthetic costs were determined. Results HR and MABP were significantly higher in the GA group than in the SA group at the end of surgery and at PACU admission. Duration of anesthesia, surgeon satisfaction, postoperative analgesic requirement, and anesthetic costs were significantly higher in the GA group. Mean blood loss was lower in the SA group than in the GA group, but the difference was not significant. Duration of surgery, duration in the PACU, perioperative hemodynamic variables, and complications were similar in both groups. Conclusions SA could be considered a reliable alternative to GA in patients undergoing lumber spine surgery, as it is clinically as effective as GA, but more cost effective

Effects of topically applied contractubex® on epidural fibrosis and axonal regeneration in injured rat sciatic nerve

AIM: To investigate the effects of Contractubex (R) (Cx) on peripheral nerve regeneration and scar formation. MATERIAL and METHODS: A surgical procedure involving sciatic nerve incision in 24 adult male Sprague-Dawley rats followed by epineural suturing was performed. In weeks 4 and 12 following surgery, macroscopic, histological, functional, and electromyographic examinations of the sciatic nerve were conducted. RESULTS: No significant difference was found between the Cx group and the control group in terms of sciatic function index (SFI) and distal latency results at week 4 (p>0.05). However, significant improvements in the Cx group were observed in SFI amplitudes and nerve action potentials at week 12 (p<0.001 and p<0.001, respectively). Significant improvements were found in the amplitudes of nerve action potentials in the treatment group after weeks 4 and 12 (p<0.05 and p<0.001, respectively). Macroscopically and histopathologically, epidural fibrosis decreased (p<0.05 and p<0.001, respectively). For both measurement times, the treatment group had significantly higher numbers of axons (week 4, p<0.05; week 12, p<0.001), and the treatment group had better results regarding its axon area (weeks 4 and 12, p<0.001) and myelin thickness (weeks 4 and 12, p<0.05). CONCLUSION: Cx, which is applied topically in peripheral nerve injury, affects axonal regeneration and axonal maturation positively and reduces the functional loss

Footdrop: An Unexpected Complication After Anterior Cervical Discectomy and Fusion Operation

Among the various postoperative complications of anterior cervical discectomy and fusion (ACDF) operation, common peroneal nerve (CPN) palsy is a rare one. In this report we present a 47 years old, female patient who suffered from foot drop postoperatively after an ACDF operation performed in supine position and discuss the medicolegal implications of intraoperative nerve injuries in the light of the foregoing literature. CPN palsy due to intraoperative positioning in neurosurgical practice is very seldomly reported. CPN palsy occurrence should be anticipated and prevented espacially in the presence of the risk factors. There is still a serious need for a more comprehensive understanding of these risk factors. On the other hand intraoperative nerve injuries are becoming a subject of litigation more frequently. The interdisciplinary responsibilities concerning the positioning must be clearly defined and it is essential that the documentation of positioning is carried out as accurately as possible. [Cukurova Med J 2015; 40(1.000): 147-150

Cervico-medullary compression ratio: A novel radiological parameter correlating with clinical severity in Chiari type 1 malformation

WOS: 000450134600021PubMed ID: 30236638Objectives: Chiari malformation type 1 (CM-1) is associated with cough headache, intracranial hypertension, cerebellar and spinal cord symptoms/signs. Herniated cerebellar tonsil length (HCTL) is widely used radiological parameter to determine the severity of CM-1, but with limited utility due to its weak correlation with some clinico-radiological findings. In this study, we aimed to evaluate a novel, practical parameter (cervico-medullary compression ratio; "CMCR") for its relationship with clinico-radiological findings in CM-1. Patients and methods: Thirty-five adult patients (17 F, 18 M) with CM-1 were included in this retrospective study. Head CT and craniospinal MR images were assessed. CMCR was calculated as the ratio of herniated cerebellar tonsil surface area to foramen magnum surface area, and HCTL was measured. These two parameters were correlated with clinical and radiological findings. Results: The mean CMCR was 0.60 +/- 0.15 and mean HCTL was 8.91 +/- 3.4 mm with no significant difference between gender and age groups for both parameters. For cough headache (0.64 +/- 0.14 vs 0.52 +/- 0.15, p = 0.043) and syringomyelia (0.67 +/- 0.11 vs 0.56 +/- 0.16, p = 0.039), only CMCR; for intracranial hypertension (CMCR: 0.64 +/- 0.14 vs 0.55 +/- 0.16, p = 0.049; HCTL: 9.66 +/- 3.59 mm vs 7.79 +/- 3.03 mm; p = 0.045) and cerebellar symptoms (CMCR: 0.65 +/- 0.14 vs 0.54 +/- 0.16, p = 0.048; HCTL: 10.4 +/- 3.5 mm vs 7.4 +/- 2.8 mm, p = 0.041), both CMCR and HTCL were significantly different between patients with and without respective findings. However, neither CMCR nor HTCL was different between patients with and without spinal cord symptoms and hydrocephalus. Conclusion: CMCR is a superior numerical parameter than HCTL for the assessment of clinical severity in CM-1 cases and needs further validation with larger studies

Modified Inside-outside Occipito-Cervical Plate System: Preliminary Results.

CONTEXT: Internal rigid fixation provides immediate stability of the occipito-cervical (OC) junction for treatment of instability; however, in current practice, the optimal OC junction stabilization method is debatable. AIMS: The aim of this study to test the safety and efficacy of a newly designed modified inside-outside occipito-cervical (MIOOC) plate system for the treatment of instability. SETTINGS AND DESIGN: This was a feasibility study of MIOCC plate system. SUBJECTS AND METHODS: Five male and four female patients with OC instability were treated using MIOOC plate system. Stabilization rate, safety, and efficacy were evaluated radiologically and clinically. RESULTS: Mean age of the patients was 35 ± 11 (range: 22-58) years. Etiology of OC instability included trauma, neoplasm, congenital abnormalities, and iatrogenic. The fusion levels ranged from occiput-C3 to occiput-C6. Mean follow-up duration was 22 ± 10 (range: 6-46) months. There were neither complication nor was there any need for plate revision or screw pullout. Mortality occurred in one patient due to primary malignancy at 6 months; otherwise, no morbidity was observed. During the follow-up, no recurrent subluxation or newly developed instability at adjacent levels occurred. All patients showed a satisfactory union at the most recent follow-up examination. CONCLUSIONS: These preliminary results suggest that the MIOCC plate system is a useful and safe method for providing immediate internal stability of the OC junction. Using a multi-piece plate design in this plate system provided easy implantation and a better interface between plate and OC bones. Further, clinical studies and long-term results are needed to determine the reliability of the MIOOC plate system

The effects of ankaferd blood stopper and microporous polysaccharide hemospheres on epidural fibrosis in rat laminectomy model

PURPOSE: To investigate whether topically administered hemostatic agents ankaferd blood stopper and microporous polysaccharide hemospheres can decrease epidural fibrosis after laminectomy in rats