RESUMO
Many sectors within healthcare have adapted checklists to improve quality control. Notwithstanding the reported successful implementation of surgical checklists in the operating theater, a dearth of literature addresses the specific challenges posed by complex surgery in the craniocervical junction and spine. The authors devised an intraoperative checklist to address the common errors and verify the completion of objectives unique to these surgeries. The data over six years is presented retrospectively; no historical control for comparison is available, as those omissions and surgical errors addressed by the checklist are not generally registered in any morbidity and mortality reports. Through six years and approximately 1200 surgeries, the checklist was implemented with 98% compliance. The checklist eliminated the occurrences of mundane surgical errors, minimized iatrogenic complications, and ensured completion of specific objectives. We discuss that preoperative checklists, now in general use in all hospitals, have not addressed the most common, intraoperative omissions. These technical omissions result in part from the complexity of spine surgery and directly impact the surgical outcome. The Neurosurgical Intraoperative Checklist is a practical, rapid, and comprehensive means to prevent common, avoidable errors and iatrogenic complications inherent to spine surgery.
RESUMO
Proper craniocervical alignment during craniocervical reduction, stabilization, and fusion optimizes cerebrospinal fluid (CSF) flow through the foramen magnum, establishes the appropriate "gaze angle", avoids dysphagia and dyspnea, and, most importantly, normalizes the clival-axial angle (CXA) to reduce ventral brainstem compression. To illustrate the metrics of reduction that include CXA, posterior occipital cervical angle, orbital-axial or "gaze angle", and mandible-axial angle, we present a video illustration of a patient presenting with signs and symptoms of the cervical medullary syndrome along with concordant radiographic findings of craniocervical instability as identified on dynamic imaging and through assessment of the CXA, Harris, and Grabb-Oakes measurements.
RESUMO
Dance involves a high volume of aesthetic, stretch-shortening cycle (SSC) actions, which may cause unique adaptations to performance. The strength dancers possess to withstand such frequency of SSCs remains elusive. The extensive training that dancers experience from a young age, however, yields anatomical and strength development that may contrast with that of untrained individuals. Therefore, the purpose of this study was to investigate differences in musculo-articular stiffness and maximal isometric plantar flexion and knee extension force between dancers and untrained individuals. A total of 16 females volunteered to participate in the study (N = 8 dancers; N = 8 untrained individuals). Dancers had a minimum of 10 years of dance experience and were currently training at the collegiate dance level three or more times per week. Untrained individuals had no dance background, nor were they currently involved in any form of regularized physical activity. All subjects completed a series of lower leg measurements and strength tests. This included a musculo-articular stiffness measurement using a free-oscillation technique, along with maximal isometric plantar flexion (MIP) and maximal isometric knee extension (MIKE) testing. The data indicate that dancers had a significantly greater rate of force development and peak force during MIP and rate of force development during MIKE in comparison to untrained individuals. Dancers also possessed significantly greater musculo-articular stiffness. Hence, the data provide some evidence that involvement in dance can result in greater muscle force generating capacity and musculo-articular stiffness due to the SSC mechanisms involved in dance movements.
