This study demonstrates the feasibility of utilizing the 3D 4K-HD EX system and highlights potential technical assets of this novel technology in regard to optics, ergonomics, and maneuverability. Further clinical research is needed to examine the clinical effectiveness of the EX system for different surgical approaches through quantitative methodology.
Study Design:Review article.Objectives:A review of the literature on postoperative spinal infections, their diagnosis, and management.Methods:A systematic computerized Medline literature search was performed using PubMed, Cochrane Database of Systematic Reviews, and EMBASE. The electronic databases were searched for publication dates from the last 10 years. The searches were performed from Medical Subject Headings (MeSH) used by the National Library of Medicine. Specifically, MeSH terms “spine,” “infections,” “management,” and “diagnosis” were used.Results:Currently, the gold standard for diagnosis of postoperative spine infection is positive deep wound culture. Many of the current radiologic and laboratory tests can assist with the initial diagnosis and monitoring treatment response. Currently erythrocyte sedimentation rate, C-reactive protein, computed tomography scan, and magnetic resonance imaging with and without contrast are used in combination to establish diagnosis. Management of postoperative spine infection involves thorough surgical debridement and targeted antibiotic therapy.Conclusions:Postoperative spine infection is a not uncommon complication following surgery that may have devastating consequences for a patient’s short- and long-term health. A high index of suspicion is needed to make an early diagnosis.
It has been clearly demonstrated from both a biochemical and clinical perspective that smoking increases the rate of perioperative complications for patients undergoing spinal fusion surgery, particularly pseudoarthosis. It has also been shown that there are certain approaches that can reduce the risk of morbidity. The most important recommendation is smoking cessation for four weeks after surgery. In addition, patients may be treated with certain surgical techniques, including the use of BMPs, to reduce the risk of pseudoarthrosis. Lastly, nicotine replacement therapy is an area of continued interest in relation to spinal fusion outcomes and more research needs to be done to determine its efficacy moving forward.
Abnormal GTT is a common finding post RYGB. Persistence of diabetes was noted in 50% of patients with diabetes preoperatively. Amongst the nondiabetic patients, reactive hypoglycemia was found to be more common and pronounced than expected. Absence of abnormally high insulin levels does not support nesidioblastosis as an etiology of this hypoglycemia. More than 50% of patients with reactive hypoglycemia had significantly exaggerated MMGR. We believe this may be due to the nonphysiologic transit of food to the small intestine due to lack of a pyloric valve after RYGB. This reactive hypoglycemia may contribute to maladaptive eating behaviors leading to weight regain long term. Our data suggest that GTT is an important part of post-RYGB follow-up and should be incorporated into the routine postoperative screening protocol. Further studies on the impact of pylorus preservation are necessary.
Study Design-Retrospective cohortObjective-To investigate the cervical alignment necessary for the maintenance of horizontal gaze depends on underlying thoracolumbar alignment Summary of Background Data-Cervical curvature (CC) is affected by thoracic and global alignment. Recent studies suggest large variability in normative CC ranging from lordotic to kyphotic alignment. No previous studies have assessed the effect of global spinal alignment on CC in maintenance of horizontal gaze.Methods-Patients without previous history of spinal surgery and were able to maintain their horizontal gaze while undergoing full body imaging were included. Patients were stratified based on thoracic kyphosis (TK) into (<30, 30-40, 40-50 and >50) then by SRS-Schwab sagittal vertical axis (SVA) modifier into (posterior alignment SVA<0, aligned 0-50 and malaligned >50mm). Cervical alignment was assessed among SVA grade in TK groups. Stepwise linear regression analysis was applied on random selection of 60% of the population. A simplified formula was developed and validated on the remaining 40%. each TK group (n=118, 137, 125, 197), lower cervical curvature (C2-C7) was significantly more lordotic by increased Schwab SVA grade. T1 slope and cervical SVA significantly increased with increased thoracolumbar (C7-S1) SVA. Upper cervical curvature (C0-C2) and mismatch between T1 slope and cervical curvature (T1-CL) were similar. Regression analysis revealed LL minus TK (LL-TK) as an independent predictor (r=0.640, r2=0.410) with formula: CC = 10 -(LL-TK)/2. Validation revealed that the absolute difference between the Results-In
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