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Current trend in kyphoplasty for osteoporotic vertebral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Kalliopi Alpantaki, Georgios Vastardis, Alexander G. Hadjipavlou
A postprocedural CT scan is the most sensitive way to detect cement leakage. Plain x-ray films revealed only 66% of the leaks that were identified by CT scan. On lateral radiographs, 93% of leakage that occurred via the basivertebral veins and 86% of leakage through the segmental veins were either missed or underestimated (Figure 30.16). Only 7% of the leaks into the spinal canal were correctly identified on radiographs. Therefore, cement leakage is more common than may be detected on plain radiographs (160). It seems that cement leakage occurs more frequently when cement is injected above the T7 level (159).
Complications of Intestinal Surgery
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
During APRs, there are a number of potential sites for bleeding. These include the pelvic sidewalls, iliac veins, and the middle sacral artery. Presacral hemorrhage can sometimes be unpreventable and difficult to control. Methods of control include packing, suture ligation, cautery, and clips. A bleeding basivertebral vein can be controlled with sterile thumbtacks.
Anatomy of the Rectum and Anus
Published in Laurence R. Sands, Dana R. Sands, Ambulatory Colorectal Surgery, 2008
José Marcio Neves Jorge, Newton Luiz T. Gasparetti
The presacral fascia is a thickened part of the parietal endopelvic fascia that covers the concavity of the sacrum and coccyx, nerves, the middle sacral artery, and presacral veins. Intraoperative rupture of the presacral fascia may cause troublesome hemorrhage, related to the underlying presacral veins, in 4.6% to 7% of cases after surgery for rectal neoplasms (14,15). These veins are avalvular and communicate, via basivertebral veins, with the internal vertebral venous system. This system can attain hydrostatic pressures of 17 to 23 cm H2O, about two to three times the normal pressure of the inferior vena cava, in the lithotomy position (14). In addition, the adventitia of the basivertebral veins adheres firmly, by structures “in anchor,” to the sacral periosteum at the level of the ostia of the sacral foramina found mainly at the level of S3–S4 (14). Consequently, despite its venous nature, presacral hemorrhage can be life-threatening due to the high hydrostatic pressure and difficult to control due to retraction of the vascular stump into the sacral foramen.
Perioperative outcomes and hospital costs associated with flowable gelatin hemostatic matrix for lumbar surgeries in real world hospital setting
Published in Journal of Medical Economics, 2019
Bing Wu, Kai Song, Qianyi Gong, Huan Zhan, Wendong Chen, Zheng Wang
Bleeding of epidural and basivertebral veins during spinal surgery can be managed by varied hemostatic agent5. However, the anatomy of spinal epidural space, characterized by a deep, narrow area outside the dura mater, which contains the spinal cord, greatly limits the utilization of conventional hemostatic techniques in LS. For example, it is difficult to compress the epidural bleeding surface by the oxidized cellulose and collagen sponge6. In addition, swelling of the sponge-type hemostatic agent could lead to neurological compression, and several products are contraindicated for that reason7. Flowable gelatin hemostatic matrix (FGHM), mixing gelatin granules and saline, can conform and reach the narrow surgical fields by the flexible applicator8. FGHM has been shown to be safe and effective on stopping epidural bleeding9. SURGIFLO was the first FGHM launched in China in 2015. However, the real-world clinical and economic impact of FGHM for hemostasis in LS remained unclear in the Chinese hospital setting.
COVID-19 vaccines and thrombosis with thrombocytopenia syndrome
Published in Expert Review of Vaccines, 2021
Chih-Cheng Lai, Wen-Chien Ko, Chih-Jung Chen, Po-Yen Chen, Yhu-Chering Huang, Ping-Ing Lee, Po-Ren Hsueh
To better understand the clinical characteristics of COVID-19 vaccine-associated thrombosis, we summarized the findings of case reports or series that provided detailed data regarding this issue (Table 1) [32–36,38–40]. Most of the cases, which mainly comprised women and patients aged < 55 years. Most of them became symptomatic within two weeks of COVID-19 vaccination and only three cases of TTS presented after more than two weeks. Among 53 patients, 41 and nine patients had CVST and splanchnic vein thrombosis, respectively. The sites of CVST included the transverse, sigmoid, straight, sagittal, cortical, azygos, hemiazygos, and basivertebral veins and the veins of Galen [33–36,39,40]. In addition, some patients had concomitant thrombosis of the portal, mesenteric, splenic, hepatic, iliofemoral, or superior ophthalmic vein; lower extremity veins; internal jugular vein or inferior vena cava; or pulmonary or aortoiliac artery [32,34–36,39,40]. Furthermore, cerebral hemorrhage (n = 15) was a common complication observed, while headache was the most common symptom. Other symptoms included lethargy, vomiting, fever, chills, myalgia, dyspnea, back pain, bruising, hemiparesis, aphasia, gaze deviation, visual disturbance, abdominal pain, change of consciousness, and leg swelling [32–36,39]. Common laboratory abnormalities included thrombocytopenia, elevation of D-dimer levels, prolonged prothrombin time (PT) and/or activated partial thromboplastin time (aPTT), and decreased fibrinogen [32–36,39]. Among 50 patients with available data, all had thrombocytopenia (<150 x 109/L) and their mean value of platelet count was 2 5 x 109/L (range from 7 x 109/L to 127 x 109/L).
An independent inter- and intra-observer agreement assessment of Yeom classification for bone cement leakage following vertebroplasty/kyphoplasty
Published in British Journal of Neurosurgery, 2023
Meng Shi, Yuwei Cai, Chongqing Xu, Yisha Guo, Mengchen Yin
In 2003, Yeom et al.11 proposed a classification system based on channels of leakage which divided BCL into three types as follows: type B (leakage via the basivertebral vein), type S (leakage via the segmental vein) and type C (leakage through a cortical defect), indicating the anatomical localization and the cause of BCL, and pointed out that it is very important to reduce the BCL via venous channel due to the significantly higher incidence of type B and type S. So far, there is no unified classification standard for BCL, and Yeom classification is most commonly used (Figure 1).