Małoinwazyjne (przezskórne) techniki stabilizacji przeznasadowej jako postępowanie z wyboru w złamaniach kręgosłupa piersiowego i lędźwiowego

Introduction. Minimally invasive techniques of transpedicular fusion have become very common and seem to displace classical open techniques. Pedicle screws fusion is the procedure of choice in unstable traumatic lumbar and thoracic spine fractures of.Aim. The aim of the study was to answer whether open techniques are still used in injuries or whether they have been completely replaced by MISS.Material and Methods. The manuscript presents an analysis of patients treated in 2017–2021 in the Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery of Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University.Results. Based on the analysis of medical documentation, it was found that every case of traumatic thoracolumbar spine fracture in 2017–2021 was treated using minimally invasive techniques. According to the documentation, the last case of using open surgical technique in the case of trauma was in 2016. It was noted that percutaneous techniques dominated the surgical treatment of thoracolumbar spine fractures and replaced the classic techniques in our department, which are used only, in some cases, in treatment of non-traumatic spondylolisthesis.Conclusions. Therefore, percutaneous techniques are currently the procedure of choice in spine injuries fusion in our hospital. The use of percutaneous techniques reduces the surgical traumatization of tissues (it is important to avoid additional traumatization and blood loss in traumatic patients). It has been pointed out that these procedures are performed by neurosurgeons who, in teaching process, used percutaneous techniques often and now prefer this method. The use of percutaneous techniques has important aspect in the field of neurosurgical nursing, because care of the operated area consists in observing few (4–16) smaller wounds, not one long wound (as in classic techniques), and these wounds are located directly above the titanium screw tips, which must under neurosurgical nurse care. (JNNN 2022;11(1):3–7)Wstęp. Techniki minimalnie inwazyjne stabilizacji przeznasadowej stały się bardzo powszechne i wydają się wypierać klasyczne techniki otwarte. Stabilizacja śrubami przeznasadowymi jest postępowaniem z wyboru w przypadku niestabilnych złamań pourazowych kręgosłupa lędźwiowego i piersiowego.Cel. Celem badania była odpowiedź, czy techniki otwarte są nadal stosowane w kontuzjach, czy też zostały całkowicie zastąpione przez MISS.Materiał i metody. W pracy przedstawiona została analiza chorych leczonych w latach 2017–2021 w Klinice Neurochirurgii, Neurotraumatologii i Neurochirurgii Dziecięcej w Collegium Medicum w Bydgoszczy Uniwersytetu Mikołaja Kopernika.Wyniki. Na podstawie dokumentacji medycznej stwierdzono, że w każdym przypadku złamania urazowego w tym okresie zastosowano system małoinwazyjny. Według dokumentacji, ostatni przypadek zastosowania otwartej, klastycznej techniki operacyjnej w przypadku urazu miał miejsce w 2016 r. Zwrócono uwagę, że techniki przezskórne zdominowały leczenie operacyjne złamań kręgosłupa piersiowo-lędźwiowego i wyparły w naszym ośrodku techniki klasyczne, które stosowane są jedynie, w niektórych przypadkach w leczeniu nieurazowych kręgozmyków.Wnioski. Techniki przezskórne są więc obecnie postępowaniem z wyboru w stabilizacji urazów kręgosłupa w naszym ośrodku. Zastosowanie technik przezskórnych zmniejsza chirurgiczną traumatyzację tkanek (a jest to istotne aby nie powodować dodatkowej traumatyzacji i utraty krwi u chorych po urazach). Zwrócono uwagę, że zabiegi te wykonywane są przez neurochirurgów, którzy w procesie swojego nauczania stykali się częściej z technikami przezskórnymi i obecnie preferują tą metodę. Zastosowanie technik przezskórnych w urazach kręgosłupa ma istotny aspekt w zakresie pielęgniarstwa neurochirurgicznego, ponieważ pielęgnacja skóry okolicy operowanej polega na obserwacji kilku mniejszych ran (4–16), a nie jednej długiej rany (tak jak w technikach klasycznych), zaś rany te położone są bezpośrednio nad tytanowymi wierzchołkami śrub, co musi budzi czujność z punktu widzenia pielęgniarstwa neurochirurgicznego. (PNN 2022;11(1):3–7

Injuries related to taekwondo training - short report based on experiences from Primary School No. 31 with sports championship classes in Bydgoszcz (Poland)

Taekwondo has become a very popular sport in Poland and around the world, and training in this martial art begins with young children. Taekwondo trainings are organized in kindergartens and schools, clubs and master classes are organized in sports schools, and children take part in competitions. Taekwondo, like any martial art, carries a potential risk of injury. According to the literature, lower limb injuries are the most common, as in taekwondo the lower limbs are mainly used. Head and spine injuries as a result of falls are also described. The author emphasizes that despite the injuries described in the literature and the frequency of occurrence defined as about 2.5 - 8%, injuries in the sports school in Bydgoszcz are significantly less frequent. The author also points out that there are also injuries (fractures) of the upper limbs, which are ignored by numerous international publications. Despite this, it should be emphasized that taekwondo is a safe sport discipline. Its prevalence among school children is a favorable phenomenon

Neurosurgical departments functioning during the COVID-19 pandemic - report

We present a short article on the actual state of functioning of neurosurgical departments, performing neurosurgical procedures during the COVID-19 pandemic on the example of our department - Department of Neurosurgery, Neurotraumatology and Pediatric Neurosurgery of Ludwik Rydygier Collegium Medicum of Nicolaus Copernicus University. The pandemic disrupted so far, proper work of neurosurgical departments and put neurosurgeons in a new reality. Despite the widespread exacerbation of spine diseases, they were pushed to the background. Many neurosurgical departments have been converted into COVID-19 isolation departments. We present a brief report on the actual state of the work of neurosurgeons and that a year after the pandemic began, the work of neurosurgical departments is still disrupted and the prospect of performing non-urgent neurosurgical procedures is uncertain

Neurosurgery education of medical students in Nicolaus Copernicus University during the COVID-19 pandemic

We present a short article on the actual state of education and didactics in the Department of Neurosurgery during the COVID-19 pandemic. The pandemic disrupted the education of students in the 2019/2020 and 2020/2020 academic years. From March 2020, there are no traditional classes with students and they have been deprived the possibility of patients examining and participating in surgical procedures. Only on-line classes are conducted by the use of Microsoft Teams and by e-mail contact. We emphasize that this is unprecedented situation in history of clinical medicine education. We also affirm difficulty of surgical medical specializations training by e-learning. Due to the practical nature of neurosurgery, we provide numerous neuroimaging and videos of surgical procedures using Microsoft Teams. The effects of on-line education of surgical sciences, including neurosurgery, can be assessed after a longer period of time. Currently, in the new reality that surprised unexpectedly medical academics in 2020, we are unable to interpret it

Insidious enemy - phaeochromocytoma. Can diabetes be cured?

We present the case of a 54-year-old patient with long-term type 2 diabetes, treated with intensive insulin therapy, who was considered to be ordinary diabetes. In a random imaging examination it turned out to be a phaeochromocytoma. The patient underwent surgical treatment. It turned out that after the surgery, the diabetes resolved. It is a casuistic curiosity that the patient was "cured" of the disease after diagnosis and treatment for pheochromocytoma, and on the second day after the surgery. It is also a valuable guide when looking for all possible causes of "secondary" diabetes

Cranioplasty as neurosurgical procedure with potential risk of legal claims

We present the current state of affairs regarding the legal claims of patients after cranioplasty operations who are dissatisfied with the treatment effect and have claims that the perioperative course is unfavorable. In the period of 11 years (2010-2020), 2 legal claims were submitted in our neurosurgical center after cranioplasty. Both are civil claims. One of them about purulent infection of the bone prosthesis was found by the judgment to be unfounded. The second one concerning the alleged general condition deterioration as a consequence of cranioplasty has been declared obsolete. A cranioplasty is a surgical procedure used to correct a defect in a bone of the skull. It is not urgent sugery and is performed in patients who had been previously in serious condition. The same medical staff who previously saved the live of patients by performing brain decompression may be subject of legal claims in the case of cranioplasty. Thus, according to authors, claims of patients regarding the alleged negative effects of cranioplasty is an interesting psychological phenomenon.  Authors epmhasized that cranioplasty should be considered as a procedure of increased risk of potential legal claims for medical staff

Analysis of patient with cervical discopathy treated surgically on the own material of neurosurgical department

Cervical discopathy is an important medical problem widespread in society. Symptoms are often upper limbs radicular pain, local pain in the cervical spine, and vetrebrobasilar cerebrovascular insufficiency. In the case of ineffective conservative treatment and severe pressure on nerve structures, surgical treatment is indicated. Cervical discopathy is most common at the age of 30 - 60 with a predominance of women. The authors of this manuscript analyzed the medical data of patients operated on due to cervical discopathy on their own material. Cervical discopathy was found to be more common in women, which is consistent with world references. A relationship was found between cervical myelopathy and critical spinal canal stenosis and C4-C5 stenosis. Stenosis on C3-C4 has also been rare in female patients and more common in men. Obtained data on own material are generally consistent with reports from world literature and constitute its complement in reference to the region of the Kuyavian-Pomeranian Voivodeship

Overload pain but root differentiation discomfort in the lumbar spine

Lumbar pain syndromes of the spine can also be referred to as the pain of the cross. These ailments have now become epidemics of our time. In literature, these pain are referred to as localized ailments that are located in the lumbar, lumbosacral, and cross-iliac areas. Cross pains are a very general term because there are a multitude of factors that cause lumbar disc herniation. This problem poses great diagnostic difficulties. [4]. The nature of these ailments is often difficult to pinpoint by the patient, but it can be the pain that describes patients from blunt, piercing, biting, baking, to those that are termed cold feeling. Keep in mind that the location of the lumbar pain symptoms varies. Patients report pain that is located throughout the lumbar-sacral area or only on one side of the spine, or occurs only in the area of the hip joints. These complaints often radiate along the lower limb. They are often the result of a lack of proper spine prevention: they contribute to this poor body posture, improper sleep positioning, as well as lack of coping skills, as well as a bad diet. In daily life, it is important to remember to do your daily activities in the correct position as well as to use prevention to avoid pain in the lumbar area

Vacuum – assisted closure in neurosurgery as treatment option for purulent wounds after spinal implants procedures – short preliminary report

We present a short preliminary report about the use of vacuum - assisted closure in infected and purulent wounds treatment after neurosurgical spinal procedures. Our report is based on the currently treated patients and points out to other neurosurgeons this therapeutic possibility. We are currently treating two severely injured patients in bad functional state. These patients had severe spine injuries and were therefore treated surgically by decompression and fusion. Patient No. 1 had C5 burst fracture treated by anterior and posterior stabilization, while patient No. 2 had Th4 burst fracture treated with posterior transpedicular stabilization. The patients developed purulent surgical site infection. Revision and wounds irrigation were ineffective. Desire to leave titanium implants in patient’s spines (which is important for future rehabilitation), it was decided to use V.A.C® in wounds healing. We find that vacuum - assisted closure appears to be of significant benefit in such treatment. It is a good therapeutic option in the management of such patients; however, this issue requires more extensive research in the future

Neurochirurgiczne implanty kręgosłupowe u chorych w wieku podeszłym leczonych operacyjnie z powodu stenozy lędźwiowej

Introduction. The incidence of degenerative lumbar spine stenosis increases with age. While young people tend tohave simple disc herniations with root compression, older people develop degenerative stenosis: facet joint hypertrophy,osteophytes, and ligamentum flavum hypertrophy. A typical for senility is neurogenic claudication caused by lumbarforaminal stenosis. Its symptoms decrease in spine flexion.Aim. The study consisted of a retrospective evaluation of medical data: analysis of the patient’s age, description ofthe surgical procedure and a list of spine implants.Material and Methods. The analysis included patients treated surgically for lumbar stenosis in 2020 in NeurosurgicalDepartment of Collegium Medicum in Nicolaus Copernicus University (Bydgoszcz, Poland).Results. The perioperative risk increases with the age of patients, therefore procedures in elderly patients shouldusually be less invasive, ephemeral, and even under local anesthesia. Therefore, neurosurgeons tend to insert spinalimplants in senility to support the surgical effect and optimize the time of the procedure. Interspinous spacers areimplants for neurogenic claudication. Interspinous spacers causes foraminal distraction and thus can theoreticallyinduce nerve roots decompression in indirect mechanism, less invasive, with less tissue damage. We notice significantlymore frequent use of interspinous spacers in patients over seventy.Conclusions. This observation requires further research and analysis; however, it is consistent with the availableliterature and the actual state of clinical practice. This has potentially important implications for neurosurgicalnursing — in geriatric patients after lumbar spine surgery, implants are significantly more common — interspinousspacers, which should be considered in nursing perioperative recommendations. (JNNN 2021;10(3):91–95)Wstęp. Częstość występowania stenozy zwyrodnieniowej kręgosłupa lędźwiowego wzrasta wraz z wiekiem. O ileu chorych młodszych kompresję struktur nerwowych wywołują przepukliny dyskowe, o tyle w wieku podeszłym przyczyną stenozy są zmiany zwyrodnieniowe: przerost stawów międzykręgowych, więzadeł żółtych i osteofity. Jednostką chorobową, typową dla osób w wieku podeszłym i spowodowaną stenozą kanału kręgowego i otworów międzykręgowych jest chromanie neurogenne, zaś objawy chromania ulegają remisji w pozycji zgięcia kręgosłupa, co jest jednym z ważnych objawów je różnicujących.Cel. Badanie polegało na retrospektywnej ocenie danych medycznych: analizie wieku pacjenta, opisie zabiegu chirurgicznego oraz wykazie implantów kręgosłupa.Materiał i metody. Analizą objęto pacjentów leczonych operacyjnie z powodu zwężenia odcinka lędźwiowego w 2020 r.w Klinice Neurochirurgii Collegium Medicum UMK (Bydgoszcz).Wyniki. Ryzyko okołooperacyjne wzrasta wraz z wiekiem chorych, dlatego zabiegi w zakresie kręgosłupa w podeszłymwieku powinny być zwykle mniej inwazyjne, mniej obciążające, a nawet w miarę możliwości przeprowadzone w znieczuleniu miejscowym. Mając na względzie specyfikę chorych w wieku podeszłym, zakwalifikowanych do leczenia operacyjnego kręgosłupa lędźwiowego, neurochirurdzy mają tendencję do wszczepiania implantów aby wesprzeć efekt leczenia i skrócić czas zabiegu. Dystraktory międzykolcowe to implanty dedykowane dla chorych z chromaniem neurogennym. Powodują one potencjalną dystrakcję otworów międzykręgowych i tym samym mogą teoretycznie przyczyniać się do dekompresji zawartych w nich korzeni nerwowych w mechanizmie pośrednim, mniej inwazyjnym, z mniejszym uszkodzeniem tkankowym. Zauważamy istotnie częstsze stosowanie dystraktorów międzykolcowych u pacjentów po siedemdziesiątym roku życia.Wnioski. Obserwacja ta wymaga dalszych badań i analiz, jednak naszym zdaniem jest zgodna z dostępną literaturąi stanem praktyki klinicznej. Fakt, że u chorych w wieku podeszłym po operacjach kręgosłupa występują częściej implanty ma potencjalnie istotne implikacje kliniczne z punktu widzenia pielęgniarstwa neurochirurgicznego i zaleceńpielęgniarskich. (PNN 2021;10(3):91–95)Słowa kluczowe: pacjenci w podeszłym wieku, implanty kręgosłupowe, operacja kręgosłup