Postoperative delirium in spine surgery.

BACKGROUND CONTEXT: Postoperative delirium is a great concern in the treatment of hip fracture. However, there have been no reports regarding the postoperative delirium in spine surgery. PURPOSE: To determine the incidence and risk factors for postoperative delirium in the patients who have had spine surgery. STUDY DESIGN/SETTING: The incidence and intraoperative risk factors of postoperative delirium were retrospectively examined in patients who had spine surgery during a 3-year period. PATIENT SAMPLE: Three hundred forty-one patients who underwent spine surgery from 2000 to 2002 were included. METHODS: The presence of delirium was determened by the Confusion Assessment Method. Laboratory data were checked preoperatively, at 1 day and 1 week postoperatively. The prognosis of postoperative delirium was evaluated. RESULTS: Postoperative delirium was found in 13 patients; all of them were in their 70's or 80's. The incidence of delirium was 12.5% in the patients over 70 years old. Hemoglobin and hematocrit levels at 1 day after surgery in the delirium group were significantly lower than those in the control group. One patient had persistent cognitive dysfunction after surgery. Two patients who developed postoperative delirium died during the follow-up period. CONCLUSION: Low concentrations of hemoglobin and hematocrit 1 day after surgery were risk factors for postoperative delirium. As delirium is thought to represent not only brain dysfunction, but also impaired general physical condition, careful observation is necessary for the management of patients with postoperative delirium.

Giant cell tumor of the sternum: a case report.

We report a rare case of giant cell tumor (GCT) of the sternum in a 55-year-old man. He presented with a bony mass in the body of the sternum that had been slowly growing over 6 months. The patient was treated by surgical curettage and cementation. Histological study showed typical GCT findings with cytogenetic abnormalities of many telomeric associations of chromosomes, predominantly the 19q arm.

Preventive measures for axial symptoms following cervical laminoplasty.

We have modified the operative procedure of laminoplasty and changed the postoperative therapy since 1997. In the modified group, several modifications were incorporated. The open door type of cervical en bloc laminoplasty was performed. 1) Bone grafts in the open gap were placed at three levels only. 2) Bone grafting in the hinged side was not performed. 3) The neck collar was worn for only 1 month. 4) The doctors explained the importance of the neck muscle and advised patients to perform early exercise of the posterior neck muscle. The patients who had the original operation and postoperative therapy served as the control (control group). The original operation and postoperative therapy were as follows: Bone grafts from dissected spinous processes were put in the opened laminae and fixed with braided wires or nylon threads. Bone grafts in the open gap were placed to extend from three to five levels. Bone chips were also placed in the hinged side. The orthosis was applied for up to 1 months after surgery, and a neck collar was recommended for 1 additional month. Postoperative neurologic recovery and axial symptoms after cervical laminoplasty were compared between the two groups. There was no statistical difference in postoperative neurologic recovery. However, the incidence of axial symptoms was much lower in the modified group compared with the control group. Radiologic examination showed that postoperative range of motion of the cervical spine in the modified group was significantly well preserved and the number of postoperative fused laminae in the modified group was less than that in the control group. Based on these results, we concluded that the modified method is beneficial for the postoperative status of cervical laminoplasty patients.