Prospective cohort study.
We performed a prospective cohort study with standardized postoperative lumbar imaging every 3 months for a year then annually to assess the incidence and factors associated ...with same-level recurrent disc herniation.
The true incidence of same-level recurrent disc herniation after lumbar discectomy is unclear. Retrospective studies have reported widely varying incidences between 3% and 18%. Prospective controlled studies are lacking.
A total of 108 patients undergoing first-time lumbar discectomy for refractory radiculopathy were enrolled. Baseline lumbar CT and MRI and standardized clinical data were assessed before surgery, and CT and MRI scans repeated 6 weeks, 3, 6, 9, 12, and 24-months after surgery and at the time of recurrent sciatica. Age, weight, preoperative disc volume, and height, volume of disc removed, and size of anular defect were compared with postoperative disc height loss and recurrent disc herniation using regression analysis.
One hundred patients (41 +/- 10 years old) were available for 1-year (93%) and 76 (70%) for 2-year follow-up (mean follow-up: 25 +/- 12 months). Improvement in all outcome measures was observed by 6 weeks after surgery (P < 0.005). An 18% loss of disc height was observed 3 months after surgery, progressing to 26% by 2 years. Eleven (10.2%) patients experienced recurrent disc herniation requiring revision discectomy a mean 10.5 months after surgery. Subjects with larger anular defects (P = 0.019) and with smaller percentage of disc volume removed (P = 0.028) were associated with an increased risk of recurrent disc herniation. Conversely, those from whom greater disc volumes were removed (P = 0.024) had more progressive disc height loss by 6 months after surgery.
Larger anular defects and less disc removal increased the risk of reherniation. Greater volumes of disc removal were associated with accelerated disc height loss. In the setting of larger anular defects or less aggressive disc removal, concern for recurrent herniation should be increased during outpatient follow-up. In this situation effective anular repair may be helpful.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralježnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Prvi dio se odnosi na dijagnostiku, a drugi, njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke procedure. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and ...overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. Part 1 relates to diagnosis, while the complementary Part 2 relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community.
A prospective, randomized study.
To compare the incidence of perioperative and early postoperative complications of surgical tracheostomy (ST) vs. ultrasound-guided percutaneous dilational ...tracheostomy (PDT) in patients with anterior cervical spine fixation (ACSF).
The patients with ACSF after acute spinal cord injury often require tracheostomy. Surgical tracheostomy is burdened with relatively high incidence of peristomal infections, and, recently, ultrasound-guided PDT is proposed in patients with ACSF.
Sixteen adult patients who underwent tracheostomy after acute spinal cord injury and ACSF were analyzed. The patients were randomly assigned to two groups: eight patients (six males; age range, 24-59 years) who underwent ST and eight patients (seven males; age range, 19-47 years) who underwent ultrasound-guided PDT with dilational forceps technique. The incidence of peri- and early postoperative complications was followed up, as well as the stoma infections and the duration of the procedure.
Not one patient from either group had any major perioperative complication of tracheostomy. In each group, there was one case of prolonged bleeding, which stopped spontaneously inside 24 hours. In two patients (25%) from the ST group, purulent infection of the stoma was verified during subsequent treatment at an intensive care unit. The average time of ST was 21 +/- 7 minutes; the average time of ultrasound-guided PDT was 8 +/- 6 minutes (P < 0.05).
Our preliminary data demonstrate that ultrasound-guided PDT as regards to complications is at least equally safe as ST; at the same time, it is much quicker method, probably with less late infections of the stoma, which could be an important advantage in patients with ACSF.
Decompressive craniectomy (DC), an auxiliary neurosurgical invasive procedure, has been a part of the treatment
regimen for severe brain injury (SBI). Today DC is the standard of care in patients ...with middle cerebral artery infarction.
Our previous positive research results about effectiveness of DC procedure when applied to a specifi c group of SBI patients
have made a solid base for a clinical evaluation of DC technique application to patients with isolated SBI with traumatic
subdural hematoma (TSDH), despite controversies regarding clinical benefi t of DC technique when applied to STBI
patients. A matched-pair analysis has been performed to compare long-term clinical outcomes in patients with and without
the DC technique applied. This study has encompassed 150 consecutive STBI patients with TSDH, aged between 18
and 82 years. One hundred patients had required application of DC procedure, while remaining 50 patients represented
a matched control group in which the DC procedure had not been applied. The control group match was conducted on
the basis of epidemiological and potential prognostic factors, such as age, gender, DC surface area and Glasgow Coma
Score (GCS). The main reason for occurrence of STBI with TSDH was traffi c accidents, with sex ration 2:1 (male/female),
while 2/3 of patients were aged between 26 and 40 years. Mortality rate of 18% had occurred in the group of patients in
which DC procedure was applied early in the fi rst 24 hours after the injury, while mortality rate of 54% had occurred in
the group of patients in which DC procedure was applied later than 24 hours after the injury, in comparison to mortality
rate of 35% that had occurred in the control matched group of patients. Also, better control of intracranial pressure (ICP)
had occurred in patients in which a DC surface was made larger than 40ccm. In addition, less computed tomography
(CT) scans were made as a follow up care procedure in patients in which DC procedure was performed and especially if
DC procedure had been performed within 24 hours after the injury. However, regardless of many positive results that an
early application of DC procedure has had on SBI patients with TSDH, an expected increase in immediate or delayed
complications had occurred, for example we had recorded an increased number of encefalocele. Signifi cantly better outcome
of clinical recovery with less cases of morbidity and deaths had occurred in patients in which TSDH was removed with
the DC technique within 24 hours after the time of injury and also if a DC surface had had size over 40 ccm, in comparison
to the group of patients that had TSDH removed with DC technique within longer period of time than 24 hours after
the time of injury and also better than the control group.
Neck pain is one of the most prevalent musculoskeletal diseases which results in considerable pain and disability, and has a great impact on individual level, as well as on health-care system, and ...overall society. Causes of neck pain are different, and prevailing aetiology are mechanical reasons associated with degenerative changes of cervical spine. We are witnessing various diagnostic and therapeutic approaches for these patients. The Croatian Society for Vertebrology of the Croatian Medical Association is presenting a comprehensive narrative review and guidelines for the diagnosis and treatment of neck pain, focusing on the most prevalent causes. The guidelines are the result of consensus of experts of different background, based on the best available evidence. This part (Part 1) relates to diagnosis, while the complementary part (Part 2) relates to treatment. For the diagnostic part (Part 1) the guidelines encompass: clinical features and evaluation (including questionnaires), laboratory tests, imaging, neurophysiology tests, and minimally invasive diagnostic procedures. The management part (Part 2) includes: pharmacology treatment, physical exercise, traction, manual therapies, physical therapy modalities, orthotics, minimally invasive therapeutic interventions, surgical treatment, rehabilitation after surgical procedures, and psychiatric approach. These are the first Croatian guidelines for neck pain intended in the first place for the physicians’ professional community.
Traumatic brain injuries represent a major cause of death and disability. We present a case of a 47-year-old patient who sustained a severe brain injury after being assaulted with a handle of an axe. ...The patient underwent numerous surgeries by various specialists during several months. Following a few failed attempts to cover the skull defects, the vacuum-assisted closure system had been utilized with great success in healing of her complex head wound. Traumatic brain injury requires great effort and collaboration in order to rehabilitate people to the most independent level of functioning possible.
Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. ...Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralješnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Ovaj prvi dio odnosi se na dijagnostiku, a drugi njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke postupke. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici.
Annular Reinforcement Device represents a modification of operative treatment of intervertebral disk herniation. It is a prosthesis that is anchored into the body of the vertebra. The intradiscal ...part of the implant is placed in the inner part of the annulus fibrosus defect. The aim of this technique is to reduce the incidence of reherniation and the degree of intervertebral space collapse, which is the most frequent adverse effect of diskectomy. Clinical outcomes of the treatment group indicated a statistically significant improvement with respect to the control group. Furthermore, over the period of two years, no cases of symptomatic reherniation were recorded. Considering that no serious complications occurred during the procedures, it would appear that this is an implant that, given its encouraging results, should be further verified in carefully designed future studies.
In the elderly, a larger proportion of the intracranial bleeds is related to non-traumatic causes or is caused by slight trauma--such that in a younger patient would not be expected to cause a bleed. ...In clinical practice, there is a prevailing impression that these bleeds, especially subdural hematomas of chronic and sub-chronic duration with or without acutization (evidence of "fresh" bleeding) are in many cases related directly to the use of anticoagulant therapy. A retrospective survey of medical documentation was performed for patients treated at the Neurosurgery Clinic of KBC Rijeka during the period of 2011 and 2012. Statistical analysis showed a significantly greater incidence of spontaneous SDH (subdural hematoma) in patients taking oral anticoagulation therapy (Fisher exact test, p < 0.01). In the article 3 typical cases of such patients are also presented. This survey confirmed the existence of a relationship between oral anticoagulant therapy and SDH, in particular the subgroup of "spontaneous" SDH. A larger study is planned.
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