Advances in the Use of Prone Cardiopulmonary Resuscitation During Spinal Surgery in the Prone Position

Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is the main complication of prone spine surgery, but the reasons for stress injury in prone spine surgery are not clear, and whether prone cardiopulmonary resuscitation (CPR) can be used needs to be further verified. Supine cardiopulmonary resuscitation is commonly used in posterior spinal surgery, retroperitoneal surgery, and so on, which can effectively improve the patient’s hypoxemia. Such surgeries require a high level of anesthetic management, and cardiopulmonary resuscitation is necessary if a patient in a prone position experiences cardiac arrest. In the process of cardiopulmonary resuscitation, supine cardiopulmonary resuscitation is often used, especially for some obese patients, if they are immediately changed to the supine position, it takes up more time, there may be wound infection, and there is a possibility of missing the optimal rescue and resuscitation time. Based on this, this paper reviews the use of prone-position cardiopulmonary resuscitation for spinal surgery in the prone position.

Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery

BACKGROUND Intracranial hemorrhage after spinal surgery is a rare and devastating complication.AIM To investigate the economic burden,clinical characteristics,risk factors,and mechanisms of intracranial hemorrhage after spinal surgery.METHODS A retrospective cohort study was conducted from January 1,2015,to December 31,2022.Patients aged≥18 years,who had undergone spinal surgery were included.Intracranial hemorrhage patients were selected after spinal surgery during hospitalization.Based on the type of spinal surgery,patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage.The patients'pre-,intra-,and post-operative data and clinical manifestations were recorded.RESULTS A total of 24472 patients underwent spinal surgery.Six patients(3 males and 3 females,average age 71.3 years)developed intracranial hemorrhage after posterior spinal fusion procedures,with an incidence of 0.025%(6/24472).The prevailing type of intracranial hemorrhage was cerebellar hemorrhage.Two patients had a poor clinical outcome.Based on the type of surgery,30 control patients were randomly matched in 1:5 ratio.The intracranial hemorrhage group showed significant differences compared with the control group with regard to age(71.33±7.45 years vs 58.39±8.07 years,P=0.001),previous history of cerebrovascular disease(50%vs 6.7%,P=0.024),spinal dura mater injury(50%vs 3.3%,P=0.010),hospital expenses(RMB 242119.1±87610.0 vs RMB 96290.7±32029.9,P=0.009),and discharge activity daily living score(40.00±25.88 vs 75.40±18.29,P=0.019).CONCLUSION The incidence of intracranial hemorrhage after spinal surgery was extremely low,with poor clinical outcomes.Patient age,previous stroke history,and dura mater damage were possible risk factors.It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

Advances in tissue state recognition in spinal surgery:a review

Spinal disease is an important cause of cervical discomfort,low back pain,radiating pain in the limbs,and neurogenic intermittent claudication,and its incidence is increasing annually.From the etiological viewpoint,these symptoms are directly caused by the compression of the spinal cord,nerve roots,and blood vessels and are most effectively treated with surgery.Spinal surgeries are primarily performed using two different techniques:spinal canal decompression and internal fixation.In the past,tactile sensation was the primary method used by surgeons to understand the state of the tissue within the operating area.However,this method has several disadvantages because of its subjectivity.Therefore,it has become the focus of spinal surgery research so as to strengthen the objectivity of tissue state recognition,improve the accuracy of safe area location,and avoid surgical injury to tissues.Aside from traditional imaging methods,surgical sensing techniques based on force,bioelectrical impedance,and other methods have been gradually developed and tested in the clinical setting.This article reviews the progress of different tissue state recognition methods in spinal surgery and summarizes their advantages and disadvantages.

Acute kidney injury following spinal instrumentation surgery in children

AIM To determine acute kidney in jury （AKI） incidence and potential risk factors of AKI in children undergoing spinal instrumentation surgery. METHODS AKI incidence in children undergoing spinal instru-mentation surgery at British Columbia Children’s Hospital between January 2006 and December 2008 was determined by the Acute Kidney Injury Networ classification using serum creatinine and urine output criteria. During this specific time period, all patients following spinal surgery were monitored in the pediatric intensive care unit and had an indwelling Foley catheter permitting hourly urine output recording. Cases of AKI were identifed from our database. From the remaining cohort, we selected group-matched controls that did not satisfy criteria for AKI. The controls were matched for sex, age and underlying diagnosis （idiopathic vs non-idiopathic scoliosis）. RESULTS Thirty five of 208 patients met criteria for AKI with an incidence of 17% （95%CI： 12%-23%）. Of all children who developed AKI, 17 （49%） developed mild AKI （AKI Stage 1）, 17 （49%） developed moderate AKI （Stage 2） and 1 patient （3%） met criteria for severe AKI （Stage 3）. An inverse relationship was observed with AKI incidence and the amount of fluids received intra-operatively. An inverse relationship was observed with AKI incidence and the amount of fuids received intra-operatively classifed by fluid tertiles： 70% incidence in those that received the least amount of fluids vs 29% that received the most fluids （〉 7.9, P = 0.02）. Patients who developed AKI were more frequently exposed to nephrotoxins （non steroidal anti inflammatory drugs or aminoglycosides） than control patients during their peri-operative course （60% vs 22%, P 〈 0.001）. CONCLUSION We observed a high incidence of AKI following spinal instrumentation surgery in children that is potentially related to the frequent use of nephrotoxins and the amount of fuid administered peri-operatively.

Surgical Outcomes of Spinal Tumour: Experiences of 48 Cases at Referral Neurosurgery Hospital in Bangladesh

Background: Spinal tumour has a great morbidity. Objective: The purpose of the present study was to see the outcome of the spinal tumour surgery. Methodology: Patients with spinal tumor have undergone surgery in neurospine unit of National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from May 2013 to March 2015 for a period of 23(twenty three) months. Plain X-ray and MRI were done in all cases. All patients have undergone surgery through posterior midline approach. They were evaluated preoperatively and at discharge usually on 10th postoperative day after stitch removal and advised to attend in follow up clinic after 2 months of surgery. Result: 50 - 59 years age group was observed as most vulnerable for tumor occurrence (23 cases, 47.9%). The male female ratio was 1:1.3. The highest number (28 cases, 58.4%) of tumor was observed in thoracic region but the highest variety was schwannoma (33 cases, 68.7%). Initial presentation of patients was pain (32 cases, 66.7%), motor disturbances (9 cases 18.7%), sensory disturbances (5 cases 10.4%) and sphincter disturbances (2 cases 4.2%). Symptomatic improvement was in 44 (91.7%) patients whereas improvement in Frankel Scale was observed in 10 (20.8%) patients during follow up. 4 (8.4%) patients deteriorated and there was no death in this series. Conclusion: In conclusion, majority of the spinal tumour patients are presented with schwannoma with good symptomatic improvement.

The Effect of Minimally Invasive Spinal Trauma Surgery on Spinal Trauma

Objective:To study the effect of minimally invasive spinal trauma surgery on spinal trauma.Methods:After 60 patients with spinal trauma were selected,the patients in observation group was treated by minimally invasive spinal trauma surgery,while the patients in control group was given the routine treatment.Results:After treatment,the observation group improved significantly in operation related indexes,complication rate,pain degree,quality of life,JOA score and 0DI score(P<0.05).Conclusion:Minimally invasive spinal trauma surgery is effective in the treatment of spinal trauma.

Impact of surgery on the outcome after spinal cord injury – current concepts and an outlook into the future

Traumatic spinal cord injury（SCI）remains a devastating neurological disorder leading to severe consequences for the affected individual and their families.Further,socioeconomic implications should not be neglected as well.Although life expectancy after SCI increased tremendously,therapeutic treatment options remain limited.

Aspirin interruption before neurosurgical interventions:A controversial problem

Aspirin is widely used for primary or secondary prevention of ischemic events.At the same time,chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood loss.This is especially important for high-risk surgery,including neurosurgery.Current European Society of Cardiology guidelines recommend aspirin interruption for at least 7 d before neurosurgical intervention,but this suggestion is not supported by clinical evidence.This narrative review presents evidence that challenges the necessity for aspirin interruption in neurosurgical patients,describes options for aspirin effect monitoring and the clinical implication of these methods,and summarizes current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients,including brain tumor surgery,cerebrovascular procedures,and spinal surgery.

Delayed neurological dysfunction following posterior laminectomy with lateral mass screw fixation:A case report and review of literature

BACKGROUND While most complications of cervical surgery are reversible,some,such as symptomatic postoperative spinal epidural hematoma(SEH),which generally occurs within 24 h,are associated with increased morbidity and mortality.Delayed neurological dysfunction is diagnosed in cases when symptoms present>3 d postoperatively.Owing to its rarity,the risk factors for delayed neurological dysfunction are unclear.Consequently,this condition can result in irreversible neurological deficits and serious consequences.In this paper,we present a case of postoperative SEH that developed three days after hematoma evacuation.CASE SUMMARY A 68-year-old man with an American Spinal Injury Association(ASIA)grade C injury was admitted to our hospital with neck pain and tetraplegia following a fall.The C3-C7 posterior laminectomy and the lateral mass screw fixation surgery were performed on the tenth day.Postoperatively,the patient showed no changes in muscle strength or ASIA grade.The patient experienced neck pain and subcutaneous swelling on the third day postoperatively,his muscle strength decreased,and his ASIA score was grade A.Magnetic resonance imaging showed hypointense signals on T1 weighted image(T1WI)and T2WI located behind the epidural space,with spinal cord compression.Emergency surgical intervention for the hematoma was performed 12 h after onset.Although hypoproteinemia and pleural effusion did not improve in the perioperative period,the patient recovered to ASIA grade C on day 30 after surgery,and was transferred to a functional rehabilitation exercise unit.CONCLUSION This case shows that amelioration of low blood albumin and pleural effusion is an important aspect of the perioperative management of cervical surgery.Surgery to relieve the pressure on the spinal cord should be performed as soon as possible to decrease neurological disabilities.

Surgical reconstruction of spinal cord circuit provides functional return in humans

This mini review describes the current surgical strategy for restoring function after traumatic spinal nerve root avulsion in brachial or lumbosacral plexus injury in man. As this lesion is a spinal cord or central nervous injury functional return depends on spinal cord nerve cell growth within the central nervous system. Basic science, clinical research and human application has demonstrated good and useful motor function after ventral root avulsion followed by spinal cord reimplantation. Recently, sensory return could be demonstrated following spinal cord surgery bypassing the injured primary sensory neuron. Experimental data showed that most of the recovery depended on new growth reinnervating peripheral receptors. Restored sensory function and the return of spinal reflex was demonstrated by electrophysiology and functional magnetic resonance imaging of human cortex. This spinal cord surgery is a unique treatment of central nervous system injury resulting in useful functional return. Further improvements will not depend on surgical improvements. Adjuvant therapy aiming at ameliorating the activity in retinoic acid elements in dorsal root ganglion neurons could be a new therapeutic avenue in restoring spinal cord circuits after nerve root avulsion injury.

Observation on the Efficacy of Autologous Blood Transfusion Combined with Controlled Hypotension in Patients with Spinal Internal Fixation during the Outbreak of New Coronavirus Pneumonia in Western Guangxi (in Guixi)

Objective: To explore the therapeutic effect of autologous blood reinfusion combined with controlled hypotension in surgical spinal fixation during the outbreak of COVID-19. Methods: 30 patients with spinal internal fixation autologous blood transfusion combined with controlled hypotension were selected as the subjects during the epidemic period from December 2019 to June 2020 in our hospital and during the operation, on the basis of routine blood pressure reduction, the American Haemonetice Corporation autologous blood continuous reinfusion system was used to infuse the blood recovered during the operation to the patient through filtration and other procedures. Results: 30 patients had no complications such as fever and hemolysis;And after the operation, the tube was dialed according to the drainage volume, the cervical thoracic and lumbar brace was customized, and the patient walked on the ground for one week;After no abnormalities, the patient was discharged. Intraoperative comparison of white blood cells (WBC), red blood cells (RBC), red blood cell pressure (HCT), hemoglobin (HGB), and coagulation time (PT) of patients with autologous blood before and after transfusion showed statistically significant differences before and after surgery (P < 0.001). Conclusion: During the new coronavirus pneumonia epidemic, the internal fixation of spinal surgery used a recovery machine to collect intraoperative blood for reinfusion. Intraoperative antihypertensive drugs were used to control blood pressure within a certain safe range. The postoperative clinical observation effect was significant and safe;especially at present the clinical significance during the epidemic was significant.

Clinical Effect of Transforaminal Endoscopic Surgery in the Treatment of Lumbar Disc Herniation

Objective:Objective to explore the curative effect of transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:From October 2018 to October 2020,36 patients with lumbar disc herniation were randomly divided into group A and group B.the curative effect,pain,lumbar function and quality of life were analyzed.Results:The curative effect of group A was 94.44%,better than that of group B 61.11%,P<0.05;The visual analogue scale(VAS)of group A was lower than that of group B on 3D,5D and 7d after operation(P<0.05);The KSS of group A was higher than that of group B(P<0.05);The score of quality of life in group A was better than that in group B(P<0.05).Conclusion:Lumbar disc herniation patients underwent transforaminal endoscopic surgery,the effect is good,can improve lumbar function,relieve pain,improve the quality of life of patients.

Neuroanatomy and clinical analysis of the cervical sympathetic trunk and longus colli

Anterior cervical surgery is commonly used for cervical vertebral body lesions. However, the structure of blood vessels and nerve tissues along the route of anterior cervical surgery is complex. We aimed to measure the data of the longus colli, the sympathetic trunk and the cervical sympathetic trunk （CST） ganglia in Chinese cadaver speci- mens. A total of 32 adult cadavers were studied. We delineated the surgical anatomy of the CST. The superior and inferior/cervicothoracic ganglia of the sympathetic trunk consistently appeared. The middle ganglion was observed in 28.1% of the specimens and there were 2 cases of unilateral double middle cervical ganglia. The inferior ganglion was observed in 25.0% of the specimens and the cervicothoracic ganglion was observed in the remaining speci- mens. The distance between the CST gradually decreased from the top to the bottom, and the distance between the medial edges of the longus colli gradually broadened from the top down. The average angle between the bilat- eral CST and the midline of the vertebra was 11.2°± 1.8° on the left side and 10.3°± 1.4° on the right side. The average angle between the medial margins of longus colli of both sides was 11.1°± 1.9°. The CST is at high risk when LC muscle is cut transversely or is dragged heavily, especially at the levels of C6 and C7. Awareness of the regional anatomy of the CST could help surgeons to identify and preserve it during anterior cervical surgeries.

Safety control strategy for vertebral lamina milling task

Vertebral lamina milling task is one of the high-risk operations in spinal surgeries. The operation is to remove part of vertebral lamina and release the pressure on the spinal nerve. Because many important vessels and nerves are under the vertebral lamina, any incorrect operation may cause irreparable damage to patients. To improve the safety of lamina milling task, a fuzzy force control strategy is proposed in this paper. Primary experiments have been conducted on bone samples from different animals. The results show that, with the fuzzy force control strategy, the bone milling system can recognize all surgery states and halt the tool at the proper location, achieving satisfactory surgery performance.

A Rare Case of Cervical Dumbbell Meningioma with the C2 Spinous Process Preservation

Dumbbell growth is often observed in schwannoma but rarely in meningioma. In particular, the occurrence of dumbbell meningioma at the cervical cord level in Japan is markedly rare. We reported an elderly case with symptomatic meningioma that developed in a dumbbell shape from cervical spine and was treated successfully by surgery.

A Surgery Protocol for Adult Zebrafish Spinal Cord Injury

Adult zebrafish has a remarkable capability to recover from spinal cord injury,providing an excellent model for studying neuro-regeneration. Here we list equipment and reagents,and give a detailed protocol for complete transection of the adult zebrafish spinal cord. In this protocol,potential problems and their solutions are described so that the zebrafish spinal cord injury model can be more easily and reproducibly performed.In addition,two assessments are introduced to monitor the success of the surgery and functional recovery：one test to assess free swimming capability and the other test to assess extent of neuroregeneration by in vivo anterograde axonal tracing.In the swimming behavior test,successful complete spinal cord transection is monitored by the inability of zebrafish to swim freely for 1 week after spinal cord injury,followed by the gradual reacquisition of full locomotor ability within 6 weeks after injury.As a morphometric correlate,anterograde axonal tracing allows the investigator to monitor the ability of regenerated axons to cross the lesion site and increasingly extend into the gray and white matter with time after injury,confirming functional recovery.This zebrafish model provides a paradigm for recovery from spinal cord injury,enabling the identification of pathways and components of neuroregeneration.

Successful outcomes of unilateral vs bilateral pedicle screw fixation for lumbar interbody fusion:A meta-analysis with evidence grading

BACKGROUND Whether it’s better to adopt unilateral pedicle screw(UPS)fixation or to use bilateral pedicle screw(BPS)one for lumbar degenerative diseases is still controversially undetermined.AIM To make a comparison between UPS and BPS fixation as to how they work efficaciously and safely in patients suffering from lumbar degenerative diseases.METHODS We have searched a lot in the databases through 2020 with index terms such as“unilateral pedicle screw fixation”and“bilateral pedicle screw fixation.”Only randomized controlled trials and some prospective cohort studies could be found,yielding 15 studies.The intervention was unilateral pedicle screw fixation;Primarily We’ve got outcomes of complications and fusion rates.Secondarily,we’ve achieved outcomes regarding total blood loss,operative time,as well as length of stay.Softwares were installed and utilized for subgroup analysis,analyzing forest plots,sensitivity,heterogeneity,forest plots,publication bias,and risk of bias.RESULTS Fifteen previous cases of study including 992 participants have been involved in our meta-analysis.UPS had slightly lower effects on fusion rate[relative risk(RR)=0.949,95%CI:0.910 to 0.990,P=0.015],which contributed mostly to this metaanalysis,and similar complication rates(RR=1.140,95%CI:0.792 to 1.640,P=0.481),Δvisual analog scale[standard mean difference(SMD)=0.178,95%CI:-0.021 to 0.378,P=0.080],andΔOswestry disability index(SMD=-0.254,95%CI:-0.820 to 0.329,P=0.402).In contrast,an obvious difference has been observed inΔJapanese Orthopedic Association(JOA)score(SMD=0.305,95%CI:0.046 to 0.563,P=0.021),total blood loss(SMD=-1.586,95%CI:-2.182 to-0.990,P=0.000),operation time(SMD=-2.831,95%CI:-3.753 to-1.909,P=0.000),and length of hospital stay(SMD=-0.614,95%CI:-1.050 to-0.179,P=0.006).CONCLUSION Bilateral fixation is more effective than unilateral fixation regarding fusion rate after lumbar interbody fusion.However,JOA,operation time,total blood loss,as well as length of stay were improved for unilateral fixation.