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  • ISSN: 2373-9479
    Volume 2, Issue 2
    March/April 2014
    Editorial
    Nobuo Kutsuna*
    Neuropsychologic impairments after traumatic brain injury (TBI) involve personality, memory, executive functions, visual spatial functions, language, emotion, and attention [1-4]. Reduced information processing speed is one of the most fundamental cognitive deficits, which may be essential in producing the attentional and memory disturbances [5-7]. This issue is famous in popular contact sports including American football [8-11], boxing [12,13] and rugby [14,15]. Very mild head trauma like heading actions at soccer has no relation to neuropsychological problem [16,17] while more severe brain injury including repeated concussion induces severe cognitive dysfunctions. It is important for not only sports players but also so many other TBI patients to be diagnosed and treated appropriately because the deficits make their and their familial outcome strongly exacerbated [18,19]. However to date there is no effective medication against those symptoms because the mechanism is not entirely clear.
    Short Communication
    Walid Attia*
    The use of intraoperative CT-Quality O-arm and Neuronavigation is still under investigation as aiding tools in complex spine surgeries at different institutes. These systems are still unfamiliar tools to spine surgeons worldwide due to technical and financial limitations as compared to ordinary fluoroscopy [1].
    Review Article
    Jin-Yul Lee*, Stefan Kohler, and Thomas Westermaier
    Abstract: SAH is a severe disease with a high mortality rate, especially within the first few days following hemorrhage. The treatment of SAH remains one of the major challenges, and a specific therapy is still not available. In addition to abrupt increase in intracranial pressure and simultaneous fall in cerebral blood flow leading to cerebral ischemia, extensive accumulation of subarachnoid hemoglobin and iron may play an important role in early brain injury following SAH. Acute therapy with an iron chelator could be a useful adjunct in the treatment of SAH.
    Alp Yurter, Derek G. Ju, and Daniel M. Sciubba*
    Abstract: The incidence of primary cancer increases with each passing year, and patients are living longer as a result of improved therapies and interdisciplinary management. Consequently, long-term complications such as debilitating spinal metastases are becoming more prevalent. In this review, the mechanism of metastasis, clinical presentation, and imaging modalities are briefly summarized. Then, various surgical options, radiotherapies, vertebral augmentation procedures, and systemic therapies are described, including recent, clinically-relevant statistics. Currently, the treatment of spinal metastases is palliative and ideally involves a multidisciplinary approach across various specialties. The number of available treatments continues to grow, resulting in paradigm shifts. Only by determining the niche of each therapy can physicians provide the optimal regimen for patients with metastatic spine disease.
    Research Article
    Hossein Elgafy*, Ali Kiapour, Vijay K Goel, and Tomoya Terai
    Abstract:
    Objective: To biomechanically compare two competing surgical techniques for alleviating spinal stenosis.
    Summary and Background Data: Traditional laminectomy is the long standing surgical gold standard for relief of pain induced to spinal stenosis. However, loss of the posterior tension band due to this technique may result into settling of the motion segment leading to neural foraminal stenosis and recurrence of the symptoms. An alternative technique, which conserves the posterior tension band through the midline sparing bilateral laminotomies, may provide good long term outcomes.
    Methods: An experimentally validated finite element model of the intact L3/S1 segment was used to simulate the laminectomy and bilateral laminotomies across the L4/L5 level. Segmental Motion, intra-discal pressure (IDP), facet load and foramina opening were compared between the intact and surgical models in response to 400N of axial compression and 10Nm moments.
    Results: Segmental motion and IDP after L4 laminectomy increased in flexion, especially at L4/L5 disc level. The laminotomy model had biomechanics close to the intact model, especially in flexion. The distance of L4/L5 foramina in both surgical models decreased in extension, lateral bending and axial rotation compared with the intact model. However in flexion the distance in foramina opening increased in laminectomy model. Facet loads at L4/L5 after both procedures decreased in extension, lateral bending, and axial rotation.
    Conclusion: The midline laminotomy surgery induced much less alterations in biomechanics of spine compared to traditional laminectomy. The increase in IDP and motion for laminectomy model means that the load on the disc is higher as compared to the midline sparing which may lead to long-term disc degeneration. The findings of the current study show that midline sparing laminotomies may prevent disc collapse due to reduced disc loading without sacrificing the opening of formina, as compared to the traditional laminectomy.
    Kevin Mansfield, Kim Meyer, Beatrice Ugiliweneza, Maiying Kong, Kristin Nosova, and Maxwell Boakye*
    Abstract:
    Background context: Literature reports variable incidence rates of concomitant traumatic brain and spinal cord injury.
    Purpose: This study aimed to evaluate and compare in-hospital outcomes among patients with concomitant SCI and TBI diagnosis and patients with isolated SCI.
    Study design/setting: Retrospective cohort study using the National Trauma Data Bank.
    Methods: The National Trauma Databank was queried to identify isolated SCI and concomitant SCI and TBI patient cohorts. Demographics, injury mechanism and severity, complications, and mortality data were obtained. Multivariate comparisons of outcomes and univariate comparisons of unmatched and propensity score matched groups were performed.
    Results: There were 16,577 patients diagnosed with SCI; 5,968 of these patients also had a TBI. The population was 67% white and 25% female; 63% of the patients were treated at level I trauma centers. Unmatched and propensity score matched analyses revealed that the patients with the concomitant SCI+TBI diagnosis had longer ICU days (9.6 days vs. 8.6 days; p-value < 0.0005), increased complications rates (32.6% vs. 27.5%; p-value < 0.0001), higher mortality (1.06% vs. 1.52%; p-value < 0.0001), and were less likely be discharged to a rehab facility (7.39% vs. 8.61%; p-value < 0.0243). Presence of alcohol was associated with the dual SCI+TBI diagnosis (25.60% vs. 20.77%, p-value <.0001), increased risk of complications (OR: 1.282; p-value < 0.0001), and higher mortality (OR: 2.025; p-value < 0.001).
    Conclusion: This large database sample study confirms that patients with concomitant spinal and cranial neurotrauma fared worse in essentially all measured outcome categories than patients with isolated SCI.
    Roland Roelz, Beate Hippchen, Marcia Machein, and Sven Glasker*
    Abstract:
    The anti-VEGF humanized monoclonal antibody bevacizumab is increasingly used, either alone or in combination with chemotherapeutic agents, in cancer therapy. Side-effects of bevacizumab particularly relevant to the surgeon include hemorrhage and delayed wound-healing. Current guidelines are largely empiric and recommend that bevacizumab be discontinued for 4 to 8 weeks before elective surgery. Little is known about the risks of neurosurgical procedures in patients receiving bevacizumab.
    We retrospectively reviewed surgical complications in patients who underwent a neurosurgical intervention following a therapy with bevacizumab 3 month or less prior to surgery or received bevacizumab within 3 months after a surgical intervention at our institution. Ninety-six patients who had received bevacizumab for different malignant diseases were operated at our department between August 2008 and August 2013. Forty-one neurosurgical interventions of any type were performed in 36 patients from this cohort. Nine interventions were performed 28 days or less after the last bevacizumab application (early and emergency surgery group). Twelve patients underwent surgery in an interval ranging from 28 days to 3 months after the last bevacizumab application (elective surgery group). One severe bleeding complication occurred in a patient from the early and emergency surgery group who underwent exchange of a ventriculo-peritoneal shunt 7 days after the last application of bevacizumab. One bacterial meningitis and one delayed wound-healing occurred in the elective surgery group. Two wound-healing complications were noted in 21 patients who were treated with bevacizumab within 3 months after surgery.
    Our data support the notion that preoperative bevacizumab treatment - especially if the interval between bevacizumab therapy and surgery is short - carries a risk for surgical complications. With a delay of 4 weeks, elective neurosurgery seems to be safe following bevacizumab treatment.
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