Neurologico Spinale Medico Chirurgico Journal
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Our Surgical Strategy for Thoracic Outlet Syndrome
No full textSurgical treatment for thoracic outlet syndrome (TOS) is a very controversial surgery because objective diagnosis, such as image and electrophysiological examination, is very difficult. Clinical provocation tests including brachial plexus compression tests, such as Morley and Roos, and vascular compression tests, such as Wright and Eden ,are not high in specificity and are likely to be positive even in healthy persons and patients with carpal tunnel syndrome. We place emphasis on the laterality of latency and amplitude in the sensory neural action potential (SNAP) of the medial antebrachial cutaneous nerve and ulnar nerve. After enough stretching exercises of scapular stabilizers and brachial plexus block, we always select surgery. In this presentation, I would like to show our diagnosis method and treatment strategy including surgery.
Bioethics In Neurospinal Patient Care
No full textNeurosurgery is among the newest of surgical disciplines, appearing in its modern incarnation at the dawn of twentieth century with the work of Harvey Cushing and contemporaries. Neurosurgical ethics involves challenges of manipulating anatomical locus of human identity and concerns of surgeons and patients who find themselves bound together in that venture.In recent years, neurosurgery ethics has taken on greater relevance as changes in society and technology have brought novel questions into sharp focus. Change of expanded armamentarium of techniques for interfacing with the human brain and spine— demand that we use philosophical reasoning to assess merits of technical innovations.Bioethics can be defined as systematic study of moral challenges in medicine, including moral vision, decisions, conduct, and policies related to medicine. Every surgeon should still take the Hippocratic Oath seriously and consider it a basic guide to follow good medical ethics in medical practice. It is simple and embodies three of the four modern bioethics principles – Respecting autonomy, beneficence, nonmaleficence, and justice.Spinal cord injury (SCI) is a devastating condition often affecting young and healthy individuals around the world. Currently, scientists are pressured on many fronts to develop an all-encompassing “cure” for paralysis. While scientific understanding of central nervous system (CNS) regeneration has advanced greatly in the past years, there are still many unknowns with regard to inducing successful regeneration. A more realistic approach is required if we are interested in improving the quality of life of a large proportion of the paralyzed population in a more expedient time frame
Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?
No full textUse of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system.
Surgical Treatment for Scoliosis
No full textRecently, patients with spinal deformities, particularly scoliosis, could be handled well through surgical pathways. Generally, surgery is indicated in patients with scoliosis curve exceeding 45 degrees (COBB angle> 45). The ultimate goal is to reduce the curve as optimally as possible without disturbing spinal cord. Whether the result is straight or not, it also depends on the patient's spine flexibility before surgery.Surgical indications are for improving appearance, preventing increasing degrees of the curve, preventing interference to other organs such as the lungs, and preventing neurological deficits. Correction of Cobb angle below 25 degrees had already makes the patient feel more comfortable. The amount of screw and instrumentation length depends on the number of spines involved. After surgery treatment, 2-4 weeks of rest are required before returning to daily activity.Fusion principle states that the spine will be slightly stiff in order to be corrected but it is believed that patient's activity could still be done with the remaining flexibility. Surgical treatment of scoliosis that does meet the indications is imperative and relatively safe with advances in medical technology today
Unilateral Laminotomy for Bilateral Microsurgical Decompression in Treating Multiple Spinal Stenosis
No full textMultiple spinal stenosis with significant signs and symptoms is one of the complex problems in spine pathology. For a simple reason, many spine surgeons do conservative decompressions, such as decompressive laminectomy or bilateral laminotomy and flavectomy, with one incision (preservation of lamina). Unilateral laminotomy in the lumbar area for bilateral access in spinal canal is quite rare and is performed for the treatment of multiple spinal stenosis.With this technique, microsurgical decompression is done with partial resection of the ipsilateral facet, the medial part of the laminar arch, and the partial contralateral facet, with the complete removal of the ligamentum flavum. By this methods, the aim for complete bilateral flavectomy and partial bilateral facetectomy are the key for the success of clinical improvements in treating multiple spinal stenosis.
Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment
No full textSpinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.
RESECTION OF ULNAR NERVE GIANT CELL NEURINOMA
No full textGiant cellular ulnar nerve neurinoma is a very rare condition. According to the literature, the author reports the first case while only two other reports of the cellular neurinoma can be found in English literature in different locations. The author presents the case of large size cellular neurinoma of the ulnar nerve, where the primary tumour was resected using the shelled out technique, without neurolysis and any nerve repair. Histopathologic characteristics, radiological findings and clinical data on these tumours were reviewed, and the proposed chosen surgical technique, which differs from that used in the previous cases and taking into account the rate of recurrence after total resection
Controversies in Managing of Thoracic-Lumbar Upper Burst Fractures
No full textUpper burst fracture of Th12-L1 has unique anatomy because it contains lower spinal cord, medullary cone, and diaphragm which separates between the thoracic and lumbar spine.The presence or absence of neurologic deficit is the single most important factor in the decision making. The presence of profound but incomplete neural deficit in association with canal compromise represents an urgent indication of surgical decompression. Antero-lateral direct decompression with trans-thoracic trans-pleural–retroperitoneal approach given the proximity the cord and conus is the most effective method, with inter-vertebral instrumentation with or without lateral fixation or posterior instrumentation.
A PRELIMINARY STUDY ON THE EXTRAVASATION OF INTRAVENOUS CHEMOTHERAPY IN SANGLAH GENERAL HOSPITAL, BALI – INDONESIA
No full textBackground: Extravasation of intravenous chemotherapeutic agents is one of the most devastating complications, which unacceptable condition neither to patient nor to medical services. Many healthcare providers realize that even one extravasation injury is too many since this injury is preventable. Published incidence rates of chemotherapy extravasation range from 0,01% to 6%, but in our institution, chemotherapy extravasation was not well recorded, so the incidence rate is unclear and the number of injuries is underestimated. Method: We observed chemotherapy extravasation occurrence during a 6 months period in our institution, from September 2013 until March 2014. We recorded the chemotherapy agents, patient’s clinical presentations, and extravasation management.Result: During our observation, 1374 chemotherapies administered, and 10 cases of chemotherapy extravasation occur, particularly doxorubicine was the main chemotherapy agent. Almost all treated conservatively, only 10% handled with surgical management. Eventually, 20% of cases have implanted port placed.Conclusion: Extravasation of cytotoxic agents is a serious problem, it causes tissue damage, prolongs the length of stay, increases hospital cost and psychological damage to cancer patients who under chemotherapy. It preventable but always underestimate by some clinicians, the use of central venous access device is one of the solutions to minimize the damage.
CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016
No full textBackground. Cervical spine disease has the potential to reduce productivity in affected patients because of myelopathy and mood disorder (e.g. depression) which lead to decreasing of the patient’s quality of life. Objective. This study aims to elaborate the most frequent symptoms and pathology of C-spine disease in patients who underwent a surgical procedure over the period time from January 2012 to December 2016. Method. This study is a retrospective, conducted in Spine Division of Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia (FMUI). All patients who underwent surgery for the C-spine disease are included. The data was obtained from the records in our spine database. Result. The total number of surgical procedures for spine disease over the 5 years was 345 procedures, with 127 procedures in the C-spine which are the second most common procedures of spine surgery in Department of Neurosurgery FMUI. The C-spine diseases were more common in males, aged more than 50 years old. The most frequent disease or pathology is degenerative disease, and yet, tumour cases show an increasing number and became the most common pathology in the year of 2016. The most common procedure is anterior cervical discectomy and fusion (ACDF).Conclusion. Our study showed that the most common symptoms and pathology are myelopathies and degenerative disease respectively, which has similarity with another study in the term of the most frequent pathology and surgical procedure. The finding of the more advanced neurological condition by the time of surgery as the most common symptom is found to be contradictory with other studies in western countries