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Early Management of Adult Head Injury
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
M. Karthigeyan, Pravin Salunke, Sunil K Gupta
Every HI patient should be presumed to have a cervical spine injury until proven otherwise. This is specifically for those in comatose state or under alcohol influence/drug intoxication. Therefore, a cervical collar has to be applied until the time a spine injury is ruled out by clinical examination and imaging. While securing the airway, perform manual in-line stabilization and avoid excessive spinal movements (hyperextension/hyperflexion).
The safe transfer of acutely ill patients
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
For all patients, changes in blood flow related to acceleration can compromise neurological status, especially if blood rushes to the patient’s head during a manoeuvre. A patient with raised intracranial pressure would not be able to tolerate this haemodynamic instability and changes to intracranial blood flow could precipitate cerebral oedema, risking further neuronal injury. To reduce the chance of this occurring, patients should be positioned in a 20° ‘head-up’ position, which will limit the effect of positive and negative acceleratory forces (Handy and van Zwanenberg 2007). Cervical fracture (a particular risk for trauma patients) must be excluded before moving the patient from a supine position. A protective rigid cervical collar should be worn at all times, until radiological investigation confirms that neck immobilisation is no longer necessary. A spinal cord injury may be sustained if the patient’s neck is moved prematurely (Walters et al. 2013).
How to dissect the plane between the scar of a laminectomy defect in the posterior cervical spine
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Patients who have undergone prolonged prone surgery may benefit from delayed extubation once facial swelling has decreased. This decision should be made in conjunction with the anesthesia team. Postoperative immobilization is at the discretion of the individual surgeon and depends on the relative stability of the bone and hardware and the degree of deformity correction preformed. For patients undergoing large corrections or with poor bone quality, a hard cervical collar should be used for 6–8 weeks postoperatively. X-rays should be obtained at regular intervals to evaluate for maintenance of correction, as well as for signs of fusion. Patients generally may return to all activities at 3 months postoperatively.
Safety and feasibility of an early telephone-supported home exercise program after anterior cervical discectomy and fusion: a case series
Published in Physiotherapy Theory and Practice, 2021
Rogelio A. Coronado, Clinton J. Devin, Jacquelyn S. Pennings, Oran S. Aaronson, Christine M. Haug, Erin E. Van Hoy, Susan W. Vanston, Kristin R. Archer
Over the 6-month period, 29 consecutive patients were screened for inclusion into the case series. Twenty-one (72.4%) patients were excluded due to exclusion criteria (n = 7), declining participation (n = 1), canceling surgery (n = 1), incomplete baseline assessment (n = 1), not responding to study invitation (n = 8), and being unavailable during their preoperative clinic visit (n = 3). Eight (27.6%) patients were eligible, consented, and enrolled. These patients were predominantly female (63%), ranged in age from 35 to 77 years, were all married, and were mostly white (88%) (Table 2). Most patients (88%) had a diagnosis of cervical spondylosis (Table 3). The surgical indication included signs and symptoms of radiculopathy, myeloradiculopathy, or myelopathy. The number of cervical levels fused ranged from 1 to 3. Standard postoperative instructions from the treating surgeons included lifting restrictions (<15 lbs. for 6 weeks), no exercise or stretching involving sudden or extreme neck motion, advice to walk daily, and no driving for 2 weeks after surgery or within 24 hours after taking opioid pain medication. Recommendations for a cervical collar varied (Table 3). Valid physical activity data were obtained from seven (88%) patients at 6 weeks and 6 months.
Cervicogenic dizziness alleviation after coblation discoplasty: a retrospective study
Published in Annals of Medicine, 2021
Liang-liang He, Ru-jing Lai, Jacqueline Leff, Rong Yuan, Jian-ning Yue, Jia-xiang Ni, Li-qiang Yang
In group S, the coblation discoplasty procedure was performed under fluoroscopic guidance with anterior-posterior and lateral views in an operating room under sterile conditions. Patients were placed in a supine position with slight hyperextension of the neck. A puncture was performed using the right or left anterior approach. The ablation wand tip was inserted into the disc and guided to the opposite posterior target lesion and annular outer margin, but not beyond the vertebral body posterior edge (Figure 2(b,e)). After confirming the tip was in a secure position without paresthaesia or abnormal movement following ½ sec of coagulation stimuli, ablation was conducted by rotating the wand 360° with level 2–3 of ablation power. Subsequently, during the withdrawal process along the puncture route, we continued to ablate two more regions: one boundary was between the annulus and nucleus (the midpoint of line linking the midpoint and posterior margin of disc lateral view) (Figure 2(c,f)), the other was the mid-nucleus (the midpoint of the disc lateral view) (Figure 2(d,g)). Following the procedures, all patients were advised to avoid long-term lowering of the head and to wear a cervical collar for 4 weeks. In group C, conservative treatment included physical therapy (TENS therapy), nonsteroidal anti-inflammatory drugs, muscle relaxants or nerve block injections.
Dysphagia following C1 laminectomy and posterior atlantoaxial fixation for retro-odontoid pseudotumor: a case report
Published in British Journal of Neurosurgery, 2020
Satoru Tanioka, Keita Kuraishi, Masaki Mizuno, Fujimaro Ishida, Ikuko Fuse, Ken Umehara, Hidenori Suzuki
A 79-year-old man with a medical history of hypertension and hyperuricemia was admitted to our hospital because of progressive tetraparesis. On admission, the patient exhibited moderate paresthesia and paresis of upper limbs, and mild paresthesia and paresis of lower limbs, inability to walk unaided and bladder and bowel dysfunction. He was able to eat minced food with help without aspiration. Sagittal T2-weighted spine magnetic resonance imaging (MRI) revealed a mass posterior to the odontoid process and a high signal intense legion in the spinal cord at C1 level (Figure 1). Considering that there was no evidence of inflammatory diseases, we made the diagnosis of non-inflammatory retro-odontoid pseudotumor. A Philadelphia cervical collar was used to limit neck motion and to prevent additional cervical cord injury. The patient underwent C1 laminectomy and atlantoaxial fixation consisting of insertion of poly-axial screws (Medtronic, Memphis, TN, USA) into the lateral masses of C1 (4.0 × 36 mm) and the pedicles of C2 (4.0 × 22 mm). Computed tomography on postoperative day (POD) 1 revealed that the differences in the O-C2 angle and the C2-C7 angle were 1° and –12°, respectively, compared with the preoperative status (Figure 2). Although the presenting neurology gradually improved postoperatively, dysphagia and aspiration developed on POD 2. T2-weighted