To investigate the use of SPECT/CT imaging in patients who had postoperative neck pain after cervical fusion procedures and to devise an appropriate treatment strategy for this patient population.
23 ...patients (8 male, 15 female) with postoperative neck pain were included in this study. Average age of patient was 60 ± 2.11 years. All patients underwent prior cervical fusion surgery and after at least 1 year of postoperative observation continue to suffer unremitting and debilitating neck pain with or without non-dermatomal arm pain. All patients underwent postoperative imaging studies including MRI and CT scan. If no clear origin of pain was detected, SPECT/CT imaging was obtained. Average number of years from prior surgery to SPECT/CT scanning was 5.5 ± 1.1 years. Preoperative VAS score averaged 8.39 ± 0.29 for this patient cohort.
Of the 23 patients who underwent SPECT/CT due to inadequacy of diagnosis based on anatomic studies, 15 patients underwent cervical spine surgery. Eight patients were referred to pain management based on SPECT/CT imaging and clinical symptomatology. 6 surgeries were anterior and 9 were posterior. Last follow-up evaluation after revision surgery was at 12 months. Average VAS scores declined after revision surgery to 4.74 ± 0.5.
Identification of postoperative spinal surgery pain is necessary to design the appropriate intervention. Patients seen in our practice suffering from failed cervical spinal surgery syndrome and offered SPECT/CT imaging leading to the identification of a focus of surgical treatment experienced significant reduction in VAS scores after revision surgery.
Accurate identification of spinal pain generators is critical to selecting the optimal treatment strategy for patients with persistent low back pain following instrumented lumbar fusion. Conventional ...diagnostic imaging modalities such as CT and MRI often yield equivocal results in this patient population. The purpose of this study is to assess the utility of Tc-99 SPECT/CT as an adjunct to conventional imaging modalities in the identification of spinal pain generators in patients with persistent low back pain after a lumbar fusion. A retrospective cohort review of 18 patients with a history of at least 1-year of persistent low back pain following a lumbar fusion surgery was conducted. All patients had MRI and/or CT scans that did not definitively identify a spinal pain generator. Tc-99 SPECT/CT imaging was subsequently performed in this cohort and treatment was determined according to imaging results. For patients undergoing revision fusion, pre- and post-operative visual analogue scores (VAS) at last follow-up were analyzed. All pain sites not clearly visualized on CT or MRI were identified by increased uptake of Tc-99 on SPECT/CT. According to anatomic location of uptake, six patients in this cohort underwent revision lumbar fusion. For patients undergoing revision lumbar fusion, preoperative VAS score averaged 8.5 ± 0.29 and declined after surgery to 4.75 ± 0.95. Patients in our series who suffered from failed lumbar spinal surgery syndrome, and subsequently underwent SPECT/CT imaging leading to the identification of pain generators amenable to surgical treatment experienced significant reduction in VAS scores after revision surgery.
Excessive ventilatory volumes and rates during cardiopulmonary resuscitation (CPR) can lead to adverse effects, such as elevated intrathoracic pressure and decreased coronary blood flow. The 2020 ...American Heart Association (AHA) guidelines acknowledge the value of real-time feedback devices in improving CPR performance. In this case series, three out-of-hospital cardiac arrest cases received ventilation feedback during prehospital resuscitation and the initial in-hospital care phase. In each case, a notable increase in ventilation rate and volume was observed following the transfer of care from emergency medical services to hospital staff. This deviation from established ventilation guidelines emphasizes the importance of monitoring and addressing ventilation strategy during the transition to hospital care. Existing evidence supports the importance of maintaining specific ventilation rates and tidal volumes during cardiac arrest to improve outcomes. We believe further research is essential to establish a definitive link between ventilation strategies and patient outcomes, ultimately enhancing resuscitation efforts and patient survival rates. Integrating real-time ventilation feedback devices both in and out of the hospital during cardiac arrest presents an opportunity for quality improvement and adherence to national standards.
The emergency care environment can be confusing and unwelcoming to patients as unfamiliar triage protocols, long wait times, crowded, noisy conditions, and lack of privacy are structural barriers ...that providers need to overcome with their personalities and bed-side manners. 1 Patient and provider factors leading to dissatisfaction Patient factors that contribute to a difficult encounter include personality disorders, a chief complaint with multiple and vaguely described symptoms, a history of non-adherence to medical advice, and self-destructive behaviors 1,2. ...Part C states that physicians should mentally revise and process the information stated by the patient to be able to address the most important medical issues 36. In medicine, equity stands for equal access to health care services, equal use for equal needs, and equal care for all people in need 43. Health care providers must implement such strategies to ensure that equity-oriented care is delivered at the point of care by: creation of spaces that are private, safe and welcoming; making requests for physical examination and conversations regarding sensitive topics (mental health, substance abuse, and violence); considering all patients' concerns to be true even with absence of evident clinical findings; identification of who may be at risk of being stigmatized and receive below standard care; and seeking patient feedback regarding his/her
The advancement of seat belts have been essential to reducing morbidity and mortality related to motor vehicle collisions (MVCs). The "seat belt sign" (SBS) is an important physical exam finding that ...has guided management for decades. This study, comprising a systematic review and random-effects meta-analysis, asses the current literature for the likelihood of the SBS relating to intra-abdominal injury and surgical intervention.
PubMed and Scopus databases were searched from their beginnings through August 4, 2023 for eligible studies. Outcomes included the prevalence of intra-abdominal injury and need for surgical intervention. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I
values were used to assess for heterogeneity.
The search yielded nine observational studies involving 3050 patients, 1937 (63.5%) of which had a positive SBS. The pooled prevalence of any intra-abdominal injury was 0.42, (95% CI 0.28-0.58, I
= 96%) The presence of a SBS was significantly associated with increased odds of intra-abdominal injury (OR 3.62, 95% CI 1.12-11.6, P = 0.03; I
= 89%), and an increased likelihood of surgical intervention (OR 7.34, 95% CI 2.03-26.54, P < 0.001; I
= 29%). The measurement for any intra-abdominal injury was associated with high heterogeneity, I
= 89%.
This meta-analysis suggests that the presence of a SBS was associated with a statistically significant higher likelihood of intra-abdominal injury and need for surgical intervention. The study had high heterogeneity, likely due to the technological advancements over the course of this study, including seat belt design and diagnostic imaging sensitivity. Further studies with more recent data are needed to confirm these results.
Excessive ventilatory volumes and rates during cardiopulmonary resuscitation (CPR) can lead to adverse effects, such as elevated intrathoracic pressure and decreased coronary blood flow. The 2020 ...American Heart Association (AHA) guidelines acknowledge the value of real-time feedback devices in improving CPR performance. In this case series, three out-of-hospital cardiac arrest cases received ventilation feedback during prehospital resuscitation and the initial in-hospital care phase. In each case, a notable increase in ventilation rate and volume was observed following the transfer of care from emergency medical services to hospital staff. This deviation from established ventilation guidelines emphasizes the importance of monitoring and addressing ventilation strategy during the transition to hospital care. Existing evidence supports the importance of maintaining specific ventilation rates and tidal volumes during cardiac arrest to improve outcomes. We believe further research is essential to establish a definitive link between ventilation strategies and patient outcomes, ultimately enhancing resuscitation efforts and patient survival rates. Integrating real-time ventilation feedback devices both in and out of the hospital during cardiac arrest presents an opportunity for quality improvement and adherence to national standards.
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