Background:Blood loss in spine surgery is an important issue, even though it has been understudied compared with hip and knee arthroplasty.Objectives:In this study, we evaluated the effect of oral clonidine as premedication on blood loss in lumbar spine fusion surgery under anesthesia with propofol and remifentanil.Patients and Methods:In this double-blind, randomized clinical trial, 30 patients who were undergoing lumbar spine posterior fusion surgery due to traumatic fracture were allocated randomly into 2 groups. The study group (clonidine group) received a 200-μg oral clonidine tablet 60–90 minutes before anesthesia, and the control group received placebo at the same time. Induction and maintenance of anesthesia and the mean target arterial pressure for controlled hypotension with remifentanil were the same in the 2 groups. We compared the amount of intraoperative blood loss, dose of remifentanil/hour administered, need for nitroglycerine to reach the mean target arterial pressure when remifentanil was insufficient, duration of operation, and surgeon’s satisfaction of a bloodless field between groups.Results:There was no statistically significant difference between groups in age (P = 0.115), sex (P = 0.439), weight (P = 0.899), operation time (P = 0.2), or American Society of Anesthesiologists physical status score (P = 0.390).Intraoperative blood loss and remifentanil dose administered per hour in the clonidine group were significantly less than in the control group (P = 0.002 and P = 0.001, respectively), but there was no significant difference in surgeon’s satisfaction between groups (P = 0.169).Conclusions:As an oral premedication, clonidine can reduce surgical blood loss in lumbar spine posterior fusion surgery, even at the same levels of mean arterial pressure (MAP) with the control group. Its use can be studied in more complicated spine surgeries, such as scoliosis and spinal deformity surgeries.
Study Design: This was a prospective clinical study.Purpose: Previous studies have indicated that cervical lordosis is a parameter influenced by segmental and global spinal sagittal balance parameters. However, this correlation still remains unclear. Therefore, a better understanding of the normal values and interdependencies between inter-segmental alignment parameters is needed. This is a preliminary analysis that helps to understand these factors.Overview of Literature: Change in global sagittal alignment is associated with poor health-related quality of life. Questions regarding which parameters play the primary roles in the progression of spinal sagittal imbalance and which might be compensatory factors remain unanswered.Methods: Prospectively, 420 adults (105 asymptomatic, 105 cervical symptomatic, 105 lumbar symptomatic, and 105 post-surgical) were selected. Whole-spine standing lateral radiographs were taken, and spinopelvic, thoracic, and cervical parameters were measured. Then, the data were analyzed using correlation coefficient test and multiple regression analysis.Results: All the parameters showed a normal distribution. The mean values of the cervical parameters are as follows: C<sub>1</sub>C<sub>2</sub> Cobb angle, −27.07°±4.3°; C<sub>2</sub>C<sub>7</sub> Cobb angle, −16.4°±5.6°; O<sub>C</sub>C<sub>2</sub> Cobb angle, −14.5°±3.8°; O<sub>C</sub>C<sub>7</sub> Cobb angle, −29.8°±5.6°; C<sub>2</sub>C<sub>7</sub> Harrison angle, 20.4°±4.3°; and C<sub>7</sub> slope, −25.4°±5.6°. The analysis of these parameters revealed no statistically significant difference between asymptomatic, symptomatic, and post-surgical patients. C<sub>7</sub> sagittal vertical axis (SVA) correlated with the C<sub>2</sub>C<sub>7</sub> Cobb angle (<i>r</i> =0.7) in all groups. No significant correlation was noted between cervical and spinopelvic parameters in asymptomatic patients. However, C<sub>1</sub>C<sub>2</sub> Cobb angle correlated significantly with pelvic incidence (PI, <i>r</i> =−0.2), lumbar lordosis (LL, <i>r</i> =0.2), and pelvic tilt (PT, <i>r</i> =−0.2) in cervical symptomatic patients. Irrespective of the patient symptom sub-group (n=420), C<sub>1</sub>C<sub>2</sub> Cobb angle correlated with LL (<i>r</i> =0.1) and C<sub>2</sub>C<sub>7</sub> Harrison angle correlated with PI and PT (<i>r</i> =0.1).Conclusions: Our results indicate significant interdependence between the spinopelvic and cervical alignment, especially in cervical symptomatic patients. In addition, strong correlation was found between the C<sub>7</sub> SVA and C<sub>2</sub>C<sub>7</sub> Cobb angle. Overall, the results of this study could help to better understand the cervical sagittal alignment and serve as preliminary data for planning surgical reconstruction procedures.
The evidence from the present study suggests that transferring spinal accessory nerve to the suprascapular nerve for restoring shoulder abduction is an effective and reliable treatment with high success rate in patients with brachial plexus palsy, especially in young patients.
Objective:The purpose of this study was to evaluate the disability in patients with spondylolisthesis who assigned either to posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) and to compare it between two groups.Methods:In a prospective observational study, 102 surgical candidates with low-grade degenerative and isthmic spondylolisthesis enrolled from 2012 to 2014, and randomly assigned into two groups: PLF and PLIF. Evaluation of disability has been done by a questionnaire using Oswestry Disability Index (ODI). The questionnaire was completed by all patients before the surgery, the day after surgery, after 6 months and after 1-year.Results:There were no statistically significant differences in terms of age and sex distribution and pre-operation ODI between groups (P > 0.05). Comparison of the mean ODI scores of two groups over the whole study period showed no significant statistical difference (P = 0.074). ODIs also showed no significant differences between two groups the day after surgery, 6th months and 1-year after surgery (P = 0.385, P = 0.093, P = 0.122 and P = 433) respectively. Analyzing the course of ODI over the study period, showed a significant descending pattern for either of groups (P < 0.0001).Conclusion:Both surgical fusion techniques (PLF and PLIF) were efficient to lessen the disability of patients with spondylolisthesis, and none of the fusion techniques were related to a better outcome in terms of disability.
Spontaneous cervical epidural hematoma (SCEH), which is a rare disease, is manifested as by a sudden quadriplegia or paraplegia and other neurological deficits. SCEH can compress the spinal cord resulting in its clinical manifestations. The reported etiological risk factors are anticoagulants, coagulopathies, vascular malformations, infections, and herniated discs. Here, we report a 77-year-old woman with a presenting chief complaint of left hemiparesis and a history of hypertension. The medical drugs in use were aspirin and antihypertensives. The initiating presentations were hemiparesis, in favor of ischemic stroke, so the patient admitted to neurology ward and received anticoagulant therapy with the initial diagnosis of stroke. Although clinical manifestations and examinations are important in these patients due to mimicking stroke picture, imaging evaluation is paramount for a definite diagnosis, which in our case showed a SCEH, who was suspected to have an ischemic stroke during the initial assessment because its initial demonstration mimicked ischemic stroke. This patient underwent laminectomy after 3 days and showed a clinical recovery the day after. Her muscle strength improved gradually, and neurological symptoms were diminished after physiotherapy.
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