Portal hypertension can be caused by a wide variety of conditions.It frequently presents with bleeding from esophageal varices.The approach to acute variceal hemorrhage in children is a stepwise progression from least...Portal hypertension can be caused by a wide variety of conditions.It frequently presents with bleeding from esophageal varices.The approach to acute variceal hemorrhage in children is a stepwise progression from least invasive to most invasive.Management of acute variceal bleeding is straightforward.But data on primary prophylaxis and long term management prevention of recurrent variceal bleeding in children is scarce,therefore prospective multicenter trials are needed to establish best practices.展开更多
Adjacent segment pathology affects 25% of patients within ten years of anterior cervical diskectomy and fusion(ACDF). Laboratory studies demonstrate fused segments increase adjacent level stress including elevated int...Adjacent segment pathology affects 25% of patients within ten years of anterior cervical diskectomy and fusion(ACDF). Laboratory studies demonstrate fused segments increase adjacent level stress including elevated intradiscal pressure and increased range of motion. Radiographic adjacent segment pathology(RASP) has been associated to ACDF in multiple statistically significant studies. Randomized controlled trials(RCTs) comparing anterior cervical discectomy and arthroplasty(ACDA) and ACDF have confirmed ACDF accelerates RASP. The question of greatest clinical interest is whether ACDA, artificial disc surgery, results in fewer adjacent level surgeries than ACDF. Current RCT follow up results reveal only non statistically significant trends favoring ACDA yet the post operative periods are only two to four years. Statistically significant increased RASP in ACDF patients however is already documented. The RCT patients' average ages are in the mid forties with an expected longevity of up to forty more years. Early statistically significant increased RASP in the ACDF patients supports our prediction that given sufficient follow up of ten or more years, fusion will lead to statistically significant higher rate of adjacent level surgery compared to artificial disc surgery.展开更多
Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluor...Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^（？）multidimensional surgical imaging with StealthStation^（？）navigation（Medtronic,Inc.Minneapolis,MN）.Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^（？） integrated with StealthStation^（？） allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage（s） packed with autograft and/or allograft were then placed.O-arm^（？） image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.展开更多
文摘Portal hypertension can be caused by a wide variety of conditions.It frequently presents with bleeding from esophageal varices.The approach to acute variceal hemorrhage in children is a stepwise progression from least invasive to most invasive.Management of acute variceal bleeding is straightforward.But data on primary prophylaxis and long term management prevention of recurrent variceal bleeding in children is scarce,therefore prospective multicenter trials are needed to establish best practices.
文摘Adjacent segment pathology affects 25% of patients within ten years of anterior cervical diskectomy and fusion(ACDF). Laboratory studies demonstrate fused segments increase adjacent level stress including elevated intradiscal pressure and increased range of motion. Radiographic adjacent segment pathology(RASP) has been associated to ACDF in multiple statistically significant studies. Randomized controlled trials(RCTs) comparing anterior cervical discectomy and arthroplasty(ACDA) and ACDF have confirmed ACDF accelerates RASP. The question of greatest clinical interest is whether ACDA, artificial disc surgery, results in fewer adjacent level surgeries than ACDF. Current RCT follow up results reveal only non statistically significant trends favoring ACDA yet the post operative periods are only two to four years. Statistically significant increased RASP in ACDF patients however is already documented. The RCT patients' average ages are in the mid forties with an expected longevity of up to forty more years. Early statistically significant increased RASP in the ACDF patients supports our prediction that given sufficient follow up of ten or more years, fusion will lead to statistically significant higher rate of adjacent level surgery compared to artificial disc surgery.
文摘Arthrodesis of the sacroiliac joint（SIJ） for surgical treatment of SIJ dysfunction has regained interest among spine specialists.Current techniques described in the literature most often utilize intraoperative fluoroscopy to aid in implant placement;however,image guidance for SIJ fusion may allow for minimally invasive percutaneous instrumentation with more precise implant placement.In the following cases,we performed percutaneous stereotactic navigated sacroiliac instrumentation using O-arm^（？）multidimensional surgical imaging with StealthStation^（？）navigation（Medtronic,Inc.Minneapolis,MN）.Patients were positioned prone and an image-guidance reference frame was placed contralateral to the surgical site.O-arm^（？） integrated with StealthStation^（？） allowed immediate autoregistration.The skin incision was planned with an image-guidance probe.An image-guided awl,drill and tap were utilized to choose a starting point and trajectory.Threaded titanium cage（s） packed with autograft and/or allograft were then placed.O-arm^（？） image-guidance allowed for implant placement in the SIJ with a small skin incision.However,we could not track the cage depth position with our current system,and in one patient,the SIJ cage had to be revised secondary to the anterior breach of sacrum.
