Spinal Instrumentation Kim, Daniel H; Vaccaro, Alexander R; Fessler, Richard Glenn ...
2017, 20180101
eBook
In the last two decades, spine instrumentation and surgery have undergone many improvements. The second edition benefits from contributions by renowned orthopaedic surgeons and neurosurgeons who ...helped create and refine the systems described in the book, and devoted their careers to educating next generations of spine surgeons. Advancements in instrumentation - plates, cages, rods, screws, disc replacements, spacers, and fusion devices - have led to improved outcomes for patients. The spinal device field has grown exponentially, and surgeons are faced with an increasingly diverse choice of instrumentation options. While the first edition categorized available systems, the new edition is focused on helping clinicians avoid complications and quickly recognize and manage complications when they do occur. Key Features * A concise yet comprehensive reference that educates clinicians on the causes, recognition, and avoidance of instrumentation complications * Organized by anatomical region and condition, the visualization of relevant anatomical landmarks is discussed in context with safe use of spinal instrumentation * Now four-color, with more than 230 new and original illustrations * Easy-to-digest text helps translate classroom knowledge into clinical application This up-to-date book will help orthopaedic surgeons and neurosurgeons learn how to utilize spinal devices more efficaciously and safely. The text is also an excellent reference for radiologists, spine fellows and residents, and physician extenders who are interested in attaining knowledge and experience in spinal instrumentation.
Long-term subdural video/electroencephalographic (EEG) monitoring was performed in a series of patients with medically intractable complex partial seizures, in a study of diagnostic accuracy, to test ...the hypothesis that the time from ictal subdural EEG seizure onset to clinical seizure onset (ECOT) is correlated with temporal lobe epileptogenicity and confirm measures of validity of ECOT for predicting seizure-free outcome following anterior temporal lobectomy and amygdalohippocampectomy (ATL/AH). In 34 patients with refractory temporal lobe epilepsy, subdural EEG monitoring localized the ictal epileptogenic focus to a single temporal lobe. In each patient, ECOT was analysed for correlation with temporal lobe epileptogenicity as measured by seizure interval in hours. Patients in whom ECOT was equal to or less than the mean (i.e. subdural EEG seizure onset preceding clinical seizure onset by at least 11.7 seconds) had a significantly greater likelihood of becoming seizure-free following ATL/AH compared to patients in whom ECOT was greater than the mean (i.e. subdural EEG seizure onset preceding clinical seizure onset by less than 11.7 seconds) (x
2
= 5.78, p<0.05). The validity of ECOT for predicting seizure-free outcome following ATL/AH is confirmed to have sensitivity of 55.0%, specificity of 85.7%, false positive rate of 15.4%, false negative rate of 42.9%, diagnostic value of 84.6% and diagnostic accuracy of 67.6%. In addition, a significant correlation, described by a second order polynomial relationship, was found between the natural exponential function of ECOT and seizure interval f(x=0.415x
2
−25.554x + 267.036, r= 0.731, df= 32, t =6.05, p<0.001, where f(x)=e
ECOT
and x= seizure interval). This result provides the epileptologist with a quantitative tool capable of predicting seizure interval based on ECOT. The capability of ECOT to predict seizure interval may allow the patient and epileptologist to anticipate future seizure onset based on ECOT, potentially facilitating accurate timing of ictal seizure focus localization techniques and clinical intervention to abort seizure onset using various available central and peripheral nervous system stimulation therapeutic strategies. The results suggest a relationship between ECOT and seizure interval. Fundamental pathophysiologic processes involved in the transition from ictal EEG to clinical seizure onset may be responsible for temporal lobe epileptogenicity.
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