Background Surgical Tray Rationalization (STR) consists of a systematic reduction in the number of surgical instruments to perform specific procedures without compromising patient safety while reducing losses in the sterilization and assembly of trays. STR is one example of initiatives to improve process performance that have been widely reported in industrial settings but only recently have gained popularity in healthcare organizations. Methods We conduct a scoping review of the literature to identify and map available evidence on surgical tray management. Five methodological stages are implemented and reported; they are: identifying research questions, identifying relevant studies, study selection, charting the data, and collating, summarizing and reporting the results. Results We reviewed forty-eight articles on STR, which were grouped according to their main proposed approaches: expert analysis, lean practices, and mathematical programming. We identify the most frequently used techniques within each approach and point to their potential contributions to operational and economic dimensions of STR. We also consolidate our findings, proposing a roadmap to STR with four generic steps (prepare, rationalize, implement, and consolidate) and recommended associated techniques. Conclusions To the best of our knowledge, ours is the first study that reviews and systematizes the existing literature on the subject of STR. Our study closes with the proposition of future research directions, which are presented as nine research questions associated with the four generic steps proposed in the STR roadmap.

ResumoA protrusão do disco intervertebral pode provocar compressão progressiva crônica da medula espinhal e os sinais neurológicos associados variam de acordo com a localização anatômica, duração e força dinâmica da compressão. A doença do disco tipo II não é totalmente compreendida, havendo muitas controvérsias sobre seu significado clínico e melhor forma de tratamento. O aspecto mais importante do tratamento conservador refere-se ao repouso associado à fisioterapia e exercícios leves, além de uso de corticoesteróides para diminuir o edema vasogênico. A descompressão medular por meio de cirurgia para remoção de material do disco do interior do canal medular é o tratamento cirúrgico de eleição na doença do disco tipo I, mas apresenta limitações quanto à técnica e ao resultado na doença do disco do tipo II. O objetivo deste trabalho é revisar a fisiopatologia e o tratamento da doença do disco intervertebral crônica e discutir as controvérsias existentes no tratamento médico bem como o uso de técnicas cirúrgicas tradicionais e novas técnicas. Palavras-chave: Degeneração do disco intervertebral, medula espinhal, descompressão AbstractProtrusion of the intervertebral disc can cause chronic progressive compression of the spinal cord, and the neurological associated signs vary according to anatomical location, duration and dynamic force of compression. The type II disc disease is not fully understood, and there are many controversies about is clinical significance and best form of treatment. The most important aspect of conservative treatment is rest and physiotherapy associated with mild exercise, and use of corticosteroids to reduce vasogenic edema. The spinal decompression by surgery for removal of disc material from within the medullary canal is the surgical treatment of choice in type I disc disease, but has technical limitations in the type II disc disease. The purpose of this paper is to review the pathophysiology and treatment of chronic intervertebral disc disease and discuss the controversies in medical treatment and the use of some traditional and new surgical techniques.

Business Process Management (BPM) is an approach to analyze and improve main activities of a company continuously. It seeks consistent results aligned with the strategic objectives. There are several approaches to the application of BPM, which focus on specific aspects of the company, not meeting all their needs. The Strategy, Indicators and Operations Model (MEIO), developed by Müller (2003), compiles the fundamental points of each isolated approach, creating a single model. The objective of this work is to provide a step-by-step application of the BPM aspects of MEIO in a practical case: a reference company that provides health services. Also, it provides a framework for organizing and connecting the various components of a product or service to its value chain. Through MEIO, a general analyze of the Company under study was made and the process “payment of invoices from providers” was detailed. Improvements were suggested based on a deeper investigation of the activities involved. The results include: (i) creation of rules engine to validate the procedures to be launched according to coverage, shortage, and contract; (ii) receiving procedure and cost audits separately and; (iii) digitalization and automatization of repetitive and manual activities.

Traumatic events such as a motor vehicle accident or falling from heights are very common in veterinary medicine and often lead to vertebral fracture-luxation with concomitant spinal cord injuries, mostly in the thoracolumbar spine. The purpose of this cadaveric biomechanical study was to determine the feasibility of the three-column concept in canine thoracolumbar segments with induced fractures. Eighteen Functional Spinal Units (FSU) of the thoracolumbar segments (T12-L2) were collected from 18 medium-sized adult dog cadavers and were subjected to flexion-extension and lateral bending tests so that range of motion (ROM) was recorded with a goniometer. Fractures were induced by compressive loads applied by a universal testing machine (EMIC®). After this, specimens were screened using computed tomography (CT) and the fractures were graded as affecting one, two or three columns, and divided into groups A, B, and C, respectively. Post-fracture range of motion (ROM) was compared with the previous results. Groups B and C (with fractures in two or three columns) had instability in the two axes evaluated (P<0.05). The outcomes of this study support the applicability of the three-column theory to thoracolumbar spines of dogs, as the FSUs that suffered fractures in two or more columns showed axial instability.

An adult male crossbred dog was referred with a history of a road traffic accident that took place 1 month earlier. Neurological examination revealed paraplegia with absent nociception in the pelvic limbs. On epaxial palpation, significant curvature of the anatomical axis of the spine between the third and fourth lumbar vertebrae was observed, with the presence of a bone end almost piercing the dog's skin. Survey radiographs of the lumbar spine revealed severe dislocation between L3 and L4 vertebrae. During surgery, the spinal cord was not visible between the dislocated segments. Because of difficulties in reducing the lumbar luxation during surgery, vertebrectomy and vertebral shortening were performed. After alignment between vertebrae L3 and L5, eight cortical orthopaedic screws and bone cement were used for fixation. After 30 days, the dog started to use a wheelchair and was considered by its owner to have a good quality of life with no evidence of pain. To the authors' knowledge, this is the first case of severe luxation treated by total vertebrectomy and spine shortening in a dog. This surgery can be considered as an option in the management of severe spine luxation when the spinal cord is physically transected.

This study aimed to describe in detail the surgical technique of partial lateral corpectomy (PLC) associated with pediculectomy to treat an in vitro extradural chondroma. A 12-year old female Cocker Spaniel was seen in the hospital with proprioceptive ataxia of hind limbs associated with extradural compression between the 1st and 2nd lumbar vertebrae. The owner opted for euthanasia since the patient's condition changed due to simultaneous illnesses that culminated in a poor prognosis. The patient's body was formally ceded to perform experimental spinal decompression. The technique was effective to completely remove the epidural mass with minimal manipulation of the spinal cord. Palavras-chave: cão, compressão medular, neoplasias extradurais, neurocirurgia

Universidade Estadual Paulista -Unesp-Jaboticabal  Jaboticabal, SP ABSTRACTFracture nonunions represent important complications in orthopedic surgeries. Nonunion repairs or bone defects are surgically challenging. Our aim was to describe a nonunion case, which was repaired with rapid bone recovery. An 8-month-old male mixed breed dog that has been previously operated was presented to the Veterinary Medical Teaching Hospital of São Paulo State University, with a right radiusulna nonunion and an amputated contralateral forelimb. A cancellous bone graft was collected from a partially amputated limb, in order to correct the nonunion, and used in association with a locking plate. After four weeks, the bone graft had been incorporated into the original bone. Clinical union with good weight bearing was achieved after eight weeks.Keywords: fracture, complication, orthopaedics, surgery, humerus RESUMO As não uniões ósseas representam uma importante complicação nas cirurgias ortopédicas. Não uniões ósseas ou defeitos ósseos são um desafio na cirurgia. O objetivo do presente trabalho foi descrever um

ResumoA extrusão do disco toracolombar é a causa mais comum de compressão extradural da medula espinhal em cães. A mielografia é uma das técnicas mais comumente realizadas para o diagnóstico desta afecção. Objetivou-se avaliar a aplicabilidade e efetividade da técnica de mielografia lombar no diagnóstico de extrusão do disco intervertebral toracolombar em cães, bem como suas principais complicações. Foram utilizados 20 animais que ao exame neurológico apresentaram localização da lesão na região toracolombar e que tiveram indicação de mielografia como método diagnóstico complementar e confirmação do diagnóstico de extrusão do disco no trans-operatório. Avaliou-se a precisão do exame na localização e lateralização da lesão, e as complicações associadas ao procedimento. A mielografia lombar teve acurácia de 95% e 60% para a localização e a lateralização da lesão respectivamente, com complicações mínimas. Palavras-chave: Diagnóstico, medula espinhal, punção lombar AbstractThoracolumbar disk extrusion is the most common cause of extradural compression of the spinal cord in dogs. Myelography is one of the most commonly performed techniques for the diagnosis of this affection. This study aimed to evaluate the applicability and effectiveness of lumbar myelography in the diagnosis of thoracolumbar intervertebral disk extrusion in dogs, as well as its major complications. Twenty dogs were used in this study. Animals were included when neurological examination suggested thoracolumbar spine lesion, myelography was used as a complementary diagnostic method, and diagnosis of disk extrusion was surgically confirmed. The accuracy of the exam to predict location and lateralization of extruded disk material were evaluated, as well as complications associated to the procedure. Lumbar myelography exhibited 95% and 60% accuracy for location and lateralization of the lesion, respectively, with minimal complications.