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Incomplete Spinal Cord Injury
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
Scrutiny of the imaging would be required to identify the compressive level. Surgical decompression would be required to prevent further worsening of symptoms but is associated with significant risks and would need careful counselling with the patient. Supportive multidisciplinary care and rehabilitation in the context of cord injury would also be required. Nonetheless, the prognosis is very good in terms of functional outcome.
Neurosurgery: Minimally invasive neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar
This is another minimally invasive decompression surgery that helps to relieve the pressure on the spinal cord or nerve roots. Compared to open cervical foraminotomy, it is associated with lower blood loss, less pain, and shorter duration of hospital stay. These procedures are usually carried out under general endotracheal anesthesia. The intraoperative evoked potential monitoring requires total intravenous-based anesthesia with omission of muscle relaxants. The anterior cervical foraminotomy helps to treat ventral radiculopathy without the need for discectomy, obviating the need for any arthrodesis or neck collar. Injury may occur to nerve root, blood vessels, or to sympathetic chain, resulting in Horner syndrome. Posterior cervical microforaminotomy is used to treat foraminal stenosis due to degenerative changes such as osteophytes or lateral disc herniation (29). It may be carried out in the prone or sitting position. Injury to dura, nerve root, or blood vessels may occur. Vertebral artery injury is a dreaded complication and requires control with gelfoam packing. In an uneventful case, patients are woken and trachea extubated at the end of surgery.
Thoracic outlet syndromes
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Hugh A. Gelabert, Erdogan Atasoy
Initial management of neurogenic TOS relies on physi- cal therapy and risk-factor modification (most commonly workplace ergonomic assessment and correction). This is often supplemented with medication to manage pain. If this fails to relieve symptoms, scalene muscle block testing is used to provide relief of symptoms and to confirm the diagnosis. Surgical decompression is then the best alternative to achieve symptomatic relief when the conservative management has failed.
Spinal reperfusion syndrome. A literature review and medicolegal implications
Published in British Journal of Neurosurgery, 2021
Persistent spinal cord compression, inadequate decompression, has been reported to be the cause of immediate and delayed spinal cord deficits in ACDF surgery and in a patient with thoracic laminectomies;6,11,25 revisional surgery was performed. The mechanism(s) of injury in patients who have an inadequate decompression is not well understood. One potential explanation is soft tissue oedema/swelling (which occurs with all surgical procedures). If there is soft tissue swelling/oedema and there is persistent compression of the spinal cord the additional swelling/oedema can exacerbate the extent of spinal cord compression. Another potential cause is axonal or vascular stretching. At the levels of decompression the dura and the spinal cord move into the area of decompression (which is exactly what the operation is designed to achieve). However if there is a part of the spinal cord that is not decompressed the spinal cord can kink across the unresected compressive pathology causing stretching of axons and/or stretching of the blood vessels that supply the spinal cord. Mechanical deformation of axons and/or ischaemia (caused by stretching of the blood vessels) is a potential mechanism of spinal cord injury following incomplete decompression. Emergency revisional surgery in patients with an inadequate decompression usually leads to recovery of cord function.6,11,17,25
Short-Term Outcomes of Self-Expandable Metallic Stent versus Decompression Tube for Malignant Colorectal Obstruction: A Meta-Analysis of Clinical Data
Published in Journal of Investigative Surgery, 2020
Fu-Gang Wang, Ri-Xing Bai, Ming Yan, Mao-Min Song, Wen-Mao Yan
Our study was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist [12]. The PRISMA flow chart of study inclusion was shown in Figure 1. Comprehensive checks of the references from the eligible studies and related reviews revealed no additional eligible study, which indicated that our search strategy was satisfactory. Totally, 7 cohort studies [5,9,10,13–16] were enrolled in our meta-analysis. The basic characteristics of eligible studies and the procedure-related outcomes were shown in Table 1. A total of 312 patients were included in the 7 eligible studies (147 patients in SEMS group and 165 patients in the DT group). The sample size of each group for single study ranged from 12 to 45. Two eligible studies [10,14] limited their patients to left side colon (rectum, sigmoid colon, descending colon, and splenic flexure). The remaining 5 studies [5,9,13,15,16] limited their patients to total colon. The duration of decompression ranged from 6 to 17 days. All the 7 eligible studies proved to be high quality according to the NOS scale. The surgery-related outcomes and NOS scores were shown in Table 2.
Pituitary apoplexy mimicking meningoencephalitis: case report and scoping study
Published in Hospital Practice, 2020
Chun Chu, Gretchen A. Perilli, Casey Judge, Sen Sheng, Hussam A. Yacoub
The main treatment of PA includes HRT and surgical decompression. Corticotropic deficiency may be life-threatening if left untreated, and corticosteroids should be initiated as soon as the diagnosis is confirmed. Intravenous fluids are indicated for hemodynamic-compromised cases. Previously, surgical decompression was recommended for all patients. Optimal management of PA is currently controversial due to the growing data that favors conservative treatment and lack of randomized prospective studies. Certain authors advocate surgical decompression for all cases while others suggest a conservative approach in patients without visual impairments and with appropriate level of consciousness [33–36]. Guidelines published in 2011 in the United Kingdom provided a practical algorithm to aid clinicians in treating PA with conservative or surgical treatment [37]. Significant neuro-ophthalmic signs or reduced level of consciousness appear to be strong indications for surgical decompression. The guidelines also propose a scoring system that could serve as a uniform tool to monitor conservatively-managed patients. The scoring system helps quantify the neuro-ophthalmic deficits and audits the outcome in surgically- and conservatively-managed patients.