The influence of coagulopathy on outcome after traumatic subdural hematoma: a retrospective single-center analysis of 319 patients.

The aim of this study was to identify the effects of coagulopathy on the outcome of patients with traumatic subdural hematoma (SDH). Based on a retrospective study, the records of all patients admitted between 2001 and 2007 to a large emergency hospital with acute SDH resulting from traumatic brain injury (TBI) were analyzed. An initial Glasgow coma score (GCS), clinical state, and Glasgow outcome score (GOS) were recorded for all patients. All computer assisted tomography and MRI scans obtained from patients were saved on an electronic storage device and were reviewed by a neurosurgeon and a neuroradiologist. The coagulation parameters were analyzed for all patients. Coagulopathy was defined as international normalized ratio more than 1.2 or partial thromboplastin time more than 37 s. One hundred and five women and 214 men aged between 1 and 100 years (mean 59 years) were included in the study. Patients with coagulopathy had a significantly worse outcome. Almost twice as many patients died in the coagulopathy group (mean GOS 3.10 ±â€Š1.46) than in the group without coagulopathy (mean GOS 2.16 ±â€Š1.45), (P < 0.001). In-hospital mortality is twice as frequent in patients with coagulopathy with traumatic SDH compared with noncoagulopathic patients, even if the initial severity of the TBI does not differ.

Spinal manifestation of hydatid disease: a case series of 36 patients.

OBJECTIVE: Vertebral hydatid cysts are found in <1% of all cases of hydatidosis. The pathology has an infiltrative malignant nature, affecting the vertebral body with possible extension in the epidural space. This pathomechnism is associated with a high rate of morbidity, mortality, and relapse. Decompressive surgery combined with antihelminthic therapy is recommended to eradicate the disease and prevent recurrence. METHODS: Between 1990 and 2007, 36 patients with a mean age of 31 years were diagnosed as having spinal hydatid disease and underwent surgery on several occasions for multiple recurrences. Combined chemotherapy with albendazole also was given. RESULTS: Initial surgery and chemotherapy steadied clinical progression and functional deterioration, but with a recurrence rate of 89% and an average time to disease recurrence of 2.5 years, did not improve the known malignant course of disease in comparison to the literature. CONCLUSION: The devastating and malignant course of this disease, which affects mostly young patients, demands continuous development of preventive care in endemic regions, the early detection and screening of the diseased patients, and eventually the advancement of the combined medical and surgical treatment.

Polyetheretherketone (PEEK) Spacers for Anterior Cervical Fusion: A Retrospective Comparative Effectiveness Clinical Trial.

BACKGROUND: Anterior cervical decompression and fusion (ACDF) is the standard surgical treatment for radiculopathy and myelopathy. Polyetheretherketone (PEEK) has an elasticity similar to bone and thus appears well suited for use as the implant in ACDF procedures. The aim of this study is to examine the clinical and radiographic outcome of patients treated with standing alone PEEK spacers without bone morphogenic protein (BMP) or plating and to examine the influence of the different design of the two spacers on the rate of subsidence and dislocation. METHODS: This retrospective comparative study reviewed 335 patients treated by ACDF in a specialized urban hospital for radiculopathy or myelopathy due to degenerative pathologies. The Intromed PEEK spacer was used in 181 patients from 3/2002 to 11/2004, and the AMT SHELL spacer was implanted in 154 patients from 4/2004 to 12/2007. The follow-up rate was 100% at three months post-op and 82.7% (277 patients) at one year. The patients were assessed with the Japanese Orthopedic Association (JOA) questionnaire and radiographically. RESULTS: At the one-year follow-up there were 118/277 patients with an excellent clinical outcome on the JOA, 112/277 with a good outcome, 20/277 with a fair outcome, and 27/277 with a poor outcome. Subsidence was observed in 13.3% of patients with the Intromed spacer vs 8.4% of the patients with the AMT SHELL. Dislocation of the spacer was observed in 10 of the 181 patients with Intromed spacers but in none of the 154 patients with Shell spacers. CONCLUSION: The study demonstrates that ACDF with standing alone PEEK cages leads to excellent and good clinical outcomes. The differences we observed in the subsidence rate between the two spacers were not significant and cannot be related to a single design feature of the spacers.

Minimally invasive spinal surgery using nucleoplasty: a 1-year follow-up study.

BACKGROUND: Nucleoplasty is a minimally invasive percutaneous intradiscal coblation therapy option in patients with chronic discogenic low back pain. The purpose of this prospective study was to assess the effectiveness of nucleoplasty in our patients up to 1 year after treatment. METHOD: All patients included in this study suffered from established back pain and/or radiating pain in the lower extremities. Age, gender, weight, body mass index (BMI) and smoking status were recorded and the clinical status of the patient documented using a visual analogue pain scale (VAS). Additionally, patients were asked to provide details regarding analgesic consumption, disability and ability to work. Nucleoplasty was carried out under fluoroscopic and CT-guidance. All treated patients were reviewed at 6 and 12 months. FINDINGS: Between April 2005 and December 2006, 96 patients underwent nucleoplasty in our department. The 69 patients reported here were followed-up to 12 months while data for eight others is available only up to 6 months. Seven patients were lost to follow-up, while eleven were excluded due to a secondary disc sequestration, either at the treated segment or elsewhere. The mean age of the 27 females (39%) and 42 males in this study was 42 years (range 18-74). The mean duration of symptoms was 30.5 months (range 1-120). Forty-two percent of patients were smokers and the mean BMI was 26.3 (17.4-42.4). 73% of treated patients experienced an improvement of more than 50% in their symptoms in the early post-operative VAS score. This was reduced to 61% at 6 months post-operatively and 58% after 1 year. A statistically significant reduction in analgesic consumption, disability and occupational incapacitation resulted from treatment with nucleoplasty. CONCLUSIONS: Nucleoplasty is an effective therapy for chronic, discogenic back pain which results in significant reductions in levels of disability and incapacity for work as well as decreased analgesic consumption.