ABSTRACT
Background: Hospitals are one of the primary resources for disease transmission, so many guidelines were published, and neuro-surgeons were advised to postpone elective spine surgeries during the COVID-19 pandemic. Objective(s): To avoid pulmonary complications and reduce the risk of spreading the virus and contracting the disease during the COVID-19 era, we operated a group of our patients under spinal anesthesia rather than general anesthesia. Method(s): We retrospectively analyzed all patients who underwent discectomy surgery for lumbar spinal disc herniation under SA between September 2020 and 2021. Result(s): Sixty-four patients diagnosed with lumbar disc herniation underwent lumbar discectomy with SA. All patients except three were male. The mean age was 44.52 +/- 7.95 years (28 to 64 years). The mean procedure time for SA was 10 minutes. The duration of the surgery was 40 to 90 minutes per each level of disc herniation. The mean blood loss was 350 cc (200 to 600 cc). The most common involved level was L4/L5 intervertebral disc (n = 40 patients;63.5%). The mean recovery time was 20 minutes. Only three patients requested more analgesics for relief of their pain postoperatively. All patients with discectomy were discharged a day after surgery, and in the case of fusion, two days after surgery. All the patients were followed up for six months, showing no recurrence symptoms, good pain relief, satisfaction with the surgery, and no bad memory of the surgery. Conclusion(s): Spinal anesthesia is a good alternative or even the main anesthesia route for patients with lumbar disc herniation. More studies are needed to elucidate the best candidate for SA in patients with lumbar pathology.Copyright © 2023, Author(s).
ABSTRACT
Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.
ABSTRACT
Introduction: The advancement of wearable integrated augmented reality (AR) devices has rapidly progressed over recent years. We describe the first use of AR goggles during a revision neuromodulation surgery, which enabled specialist consultant support from remote despite ongoing coronavirus pandemic restrictions. Materials / Methods: This case report describes a revision surgery case in a previously successfully implanted spinal cord stimulator (SCS) patient. The attempt, to revise the existing percutaneous SCS leads failed due to the patient's challenging anatomy, which left the patient without therapy. A further revision via hemi-laminectomy and insertion of a surgical paddle lead was being organised with specialist support due to expected further anatomical challenges. Due to ongoing coronavirus restrictions both in travelling as well as reduced staffing numbers in the operating theatre in particular for visiting staff, the decision was made to use AR goggles to enable an experienced specialist to attend virtually. Result(s): The use of AR googles enabled a specialist colleague to virtually attend the live surgery despite a 200 mile distance. This included being able to see the surgical field on their computer screen as well as all live radiographic imaging displayed on the operating theatre monitors, having live sound, stopping any live images of the surgery to annotate with drawings and writing, speak to the resident surgeon in real time and discuss as if being physically present. Annotated images could be sent back to the lens of the operating surgeon for review as well as live commentary via integrated microphone and speaker in the surgeons AR goggles. The technology enabled remote specialist support and valuable expert input resulting in successful insertion of paddle leads in an anatomically very challenging patient. The patient reported 90% pain reduction after programming of his new paddle leads. Discussion(s): AR technology opens up new exciting avenues in supporting neuromodulation surgeries remotely with expert advice for difficult operations without being locally present. This saves unnecessary travel, reduces the carbon footprint, downtime of the expert in their local institution resulting fewer potential local case cancellations, reduces the risk of spread of infections such as SARS-CoV-2, as well as gives the ability to teach in remote locations. Furthermore, this opens further opportunities for mentoring of novice implanters. Conclusion(s): Augmented reality technology is a new and exciting way of further promoting proctorship and mentoring and might be particularly useful in supporting novice implanters and those who need additional specialist input in selected cases. Supplemental Data: [Formula presented] [Formula presented] [Formula presented] Learning Objectives: 1. Advances in augmented reality technology - raise awareness of available technology and its use 2. Ability to delivery intraoperative live teaching remotely - opening new avenues for teaching opportunities and training in neuromodulation 3. Proctorship - assistance of a specialist without being physically present. Keywords: Augmented Reality, SCS, Teaching, Training, Paddle leads, Surgical paddle leads Copyright © 2022
ABSTRACT
BACKGROUND: Patient-reported outcome measures (PROMs) are traditionally used to track recovery of patients after spine surgery. Wearable accelerometers have adjunctive value because of the continuous, granular, and objective data they provide. We conducted a prospective study of lumbar laminectomy patients to determine if time-series data from wearable accelerometers could delineate phases of recovery and compare accelerometry data to PROMs during recovery tracking. METHODS: Patients with lumbar stenosis for whom lumbar laminectomy was indicated were prospectively recruited. Subjects wore accelerometers that recorded their daily step counts from at least 1 week preoperatively to 6 months postoperatively. Subjects completed the Oswestry Disability Index and the 12-Item Short Form Health Survey preoperatively and at 2 weeks, 1 month, 3 months, and 6 months postoperatively. Daily aggregate median steps and individual visit-specific median steps were calculated. The Pruned Linear Exact Time method was used to segment aggregate median steps into distinct phases. Associations between visit-specific median steps and PROMs were identified using Spearman rank correlation. RESULTS: Segmentation analysis revealed 3 distinct postoperative phases: step counts rapidly increased for the first 40 days postoperatively (acute healing), then gained more slowly for the next 90 days (recovery), and finally plateaued at preoperative levels (stabilization). Visit-specific median steps were significantly correlated with PROMs throughout the postoperative period. PROMs significantly exceeded baseline at 6 months postoperatively, while step counts did not (all P < 0.05). CONCLUSIONS: Continuous data from accelerometers allowed for identification of 3 distinct stages of postoperative recovery after lumbar laminectomy. PROMs remain necessary to capture subjective elements of recovery.