Incidence Of Neurological Deficits Research Articles

Novel biomarkers of preterm brain injury from blood transcriptome in sheep model of intrauterine asphyxia.

Infants born preterm have a higher incidence of neurological deficits. A key step in finding effective treatments is to identify biomarkers that reliably predict outcome. Following umbilical cord occlusion (UCO) in pregnant sheep, whole fetal blood RNA was sequenced pre- and post-UCO, brain injury outcome was determined by battery of neuropathology scoring and the transcriptome signature correlated to the degree of brain injury. Additionally, we developed a novel analytical procedure to deduce cell blood composition over time. Sixty-one genes were identified with significant altered expression after UCO. In pre-UCO blood, the level of three mRNAs (Trex2, Znf280b, novel miRNA) and in post-UCO, four mRNAs (Fam184a, Angptl2, novel lincRNA and an unknown protein-coding gene) were associated to brain injury (FDR < 0.01). Several of these mRNAs are related to inflammation and angiogenesis. Pathway analysis highlighted genes playing a role in perinatal death and growth failure. Results also indicate that several leukocyte populations undergo significant changes after UCO. We have used a whole transcriptomic approach to uncover novel biomarkers in fetal blood that correlate to neuropathology in the preterm sheep brain. The current data forms a basis for future studies to investigate mechanisms of these mRNAs in the injury progression. Trend analysis of genes following asphyxia reveal a group of genes associated with perinatal death and growth failure. Several pre-asphyxia transcripts were associated to brain injury severity suggesting genomic susceptibility to injury. Several post-asphyxia transcripts were correlated to brain injury severity, thus, serve as potential novel biomarkers of injury outcome. Successfully adaptation of cell profiling algorithms suggests significant changes in blood cell composition following asphyxia.

Upper Extremity Nerve Transfers for Treatment of Nerve Injury After Cervical Spine Surgery: A Single-Center Retrospective Review.

Nerve transfers to restore or augment function after spinal cord injury is an expanding field. There is a paucity of information, however, on the use of nerve transfers for patients having undergone spine surgery. The incidence of neurologic deficit after spine surgery is rare but extremely debilitating. The purpose of this study was to describe the functional benefit after upper extremity nerve transfers in the setting of nerve injury after cervical spine surgery. A single-center retrospective review of all patients who underwent nerve transfers after cervical spine surgery was completed. Patient demographics, injury features, spine surgery procedure, nerve conduction and electromyography study results, time to referral to nerve surgeon, time to surgery, surgical technique and number of nerve transfers performed, complications, postoperative muscle testing, and subjective outcomes were reviewed. Fourteen nerve transfers were performed in 6 patients after cervical spine surgery. Nerve transfer procedures consisted of a transfer between a median nerve branch of flexor digitorum superficialis into a biceps nerve branch, an ulnar nerve branch of flexor carpi ulnaris into a brachialis nerve branch, a radial nerve branch of triceps muscle into the axillary nerve, and the anterior interosseous nerve into the ulnar motor nerve. Average patient age was 55 years; all patients were male and underwent surgery on their left upper extremity. Average referral time was 7 months, average time to nerve transfer was 9 months, and average follow-up was 21 months. Average preoperative muscle grading was 0.9 of 5, and average postoperative muscle grading was 4.1 of 5 ( P < 0.00001). Upper extremity peripheral nerve transfers can significantly help patients regain muscle function from deficits secondary to cervical spine procedures. The morbidity of the nerve transfers is minimal with measurable improvements in muscle function.

Epidemiology of Spinal Trauma and Related Complication.

Traumatic spinal injury is leading cause of mortality and morbidity among the people of productive age group. This study aim to find the cause of spinal injury, site ,and mode of injury, treatment option given so that a preventive measures and create awareness among people of this region. This is a prospective observation study done in Karnali Academy of Health Sciences from December 2021 to January 2023. Performa was filled to collect data. Data were entered in excel sheet and transported to SPSS 16.0 and statistical analysis was done . Out of 117 patients male population had higher incidence of spinal trauma (69.2%) with average age 43.9 years . Fall injury was the commonest mode of injury. 65.8% had injury at the thoracolumbar junction followed by lumbar, thoracic and cervical respectively. Cervical injury patients had higher incidence of neurological deficit. The average duration of trauma to hospital presentation was 10.9±11.2 hours. 19.7 % were operated and 6.8 % of patients were referred to other center. Fall injury being the commonest mode of injury in this art of world, prevention and awareness should be raised about the spinal trauma and its consequences. Adequate equipment with health facilities to the distant hospital may reduce the referral rate and duration of presentation to the hospital which ultimately prevent the further damage to the cord.

Does Magnetic Resonance Imaging Predict Neurological Deficit in Patients with Traumatic Lower Lumbar Fractures?

A retrospective cohort study. This study aimed to understand the role of magnetic resonance imaging (MRI) in predicting neurological deficits in traumatic lower lumbar fractures (LLFs; L3-L5). Despite studies on the radiological risk factors for neurological deficits in thoracolumbar fractures, very few have focused on LLFs. Moreover, the potential utility of MRI in LLFs has not been evaluated. In total, 108 patients who underwent surgery for traumatic LLFs between January 2010 and January 2020 were reviewed to obtain their demographic details, injury level, and neurology status at the time of presentation (American Spinal Injury Association [ASIA] grade). Preoperative computed tomography scans were used to measure parameters such as anterior vertebral body height, posterior vertebral body height, loss of vertebral body height, local kyphosis, retropulsion of fracture fragment, interpedicular distance, canal compromise, sagittal transverse ratio, and presence of vertical lamina fracture. MRI was used to measure the canal encroachment ratio (CER), cross-sectional area of the thecal sac (CSAT), and presence of an epidural hematoma. Of the 108 patients, 9 (8.3%) had ASIA A, 4 (3.7%) had ASIA B, 17 (15.7%) had ASIA C, 21 (19.4%) had ASIA D, and 57 (52.9%) had ASIA E neurology upon admission. The Thoracolumbar Injury Classification and Severity score (p =0.000), CER (p =0.050), and CSAT (p =0.019) were found to be independently associated with neurological deficits on the multivariate analysis. The receiver operating characteristic curves showed that only CER (area under the curve [AUC], 0.926; 95% confidence interval [CI], 0.860-0.968) and CSAT (AUC, 0.963; 95% CI, 0.908-0.990) had good discriminatory ability, with the optimal cutoff of 50% and 65.3 mm2, respectively. Based on the results, the optimal cutoff values of CER >50% and CSAT >65.3 mm2 can predict the incidence of neurological deficits in LLFs.

Practices of Adult Spine Immobilization During Trauma Resuscitation: Proposal for Improved Guidelines.

This narrative review aims to evaluate the impact of current spinal immobilization practices on clinical outcomes in adult trauma patients with suspected or confirmed spinal injury to direct the creation of improved practice management guidelines. PubMed, ProQuest, Embase, Google Scholar, and Cochrane were searched for studies that evaluated the impact of spine immobilization practices during resuscitation in adult trauma patients and reported associated clinical outcomes. Outcomes included neurological deficits, in-hospital mortality, hospital length of stay (HLOS), ICU length of stay (ICU-LOS), discharge disposition, long-term functional status (modified Rankin scale), vascular injury rate, and respiratory injury rate. Nine studies were included in this review, divided into two groups based on patient immobilization status. Patients compared with and without cervical immobilization had higher mortality, longer ICU-LOS, and a higher incidence of neurological deficits if immobilized. Immobilization only was associated with a higher incidence of indirect neurological injury and poor functional outcomes. Spinal immobilization during resuscitation in adult trauma patients is associated with a higher risk of neurological injury, in-hospital mortality, and longer ICU-LOS. Further research is needed to provide strong evidence for spinal immobilization guidelines and identify the optimal method and timing for immobilization practices in trauma patients.

Dynamic cord compression induced by proximal junctional failure and loose pedicle screws after thoracolumbar fusion surgery: a case report

BackgroundOne of the common mechanical complications following spinal fusion surgery is proximal junctional failure (PJF). The incidence of neurological deficit associated with PJF has been poorly described in the literature. Here, we report a case in which numbness in the lower extremities was recognized as the first symptom, but the discrepancy in the imaging findings made PJF difficult to diagnose.MethodsA 71-year-old female underwent corrective fusion surgery. Three weeks later, she complained of persistent right leg numbness. Standing X-ray showed the back-out of the pedicle screws (PSs) in the upper instrumented vertebra (UIV), but there was no obvious evidence of cord compression on computed tomography (CT), which caused the delay of diagnosis. Five weeks later, magnetic resonance image (MRI) did not show cord compression on an axial view, but there were signal changes in the spinal cord.ResultsThe first reason for the delayed diagnosis was the lack of awareness that leg numbness could occur as the first symptom of PJF. The second problem was the lack of evidence for spinal cord compression in various imaging tests. Loosened PSs were dislocated on standing, but were back to their original position on supine position. In our case, these contradictory images led to a delay in diagnosis.ConclusionLoosened PSs caused dynamic cord compression due to repeated deviation and reduction. Supine and standing radiographs may be an important tool in the diagnosis of PJF induced by dynamic cord compression.

Incidence of neurological deficits of post spinal surgery syndrome

Background: Post spinal surgery syndrome (PSSS) is characterized by chronic discomforts post one or more spine operations. Despite advancements in surgical technology, failure rate of back operations has not decreased. These conditions may occur preoperatively, intraoperatively, and postoperatively. Objectives: The primary purpose of this investigation was to ascertain the incidence and causes of neurological complications in patients who have undergone spinal surgery and subsequently developed PSSS. Methods: Cross sectional research was performed at Mardan Medical Complex, Mardan, comprising 82 patients (50 males and 32 females). X-ray studies, MRI, and electromyography was the tool for initial lumbar surgery to confirm the initial diagnosis. Participants were requested to submit the questionnaire and then, their scores were calculated and analyzed as per standard protocols. Results: The potential causes of PSSS, indicated 16 (19.5%) patients with incorrect diagnosis, 24 (29.3%) of the due to surgical technical errors, 10 (12.2%) due to improper pre-operative patient selection and 20 (24.4%) as a result of recurrent disc herniation after surgery. The frequency of cases of complications was spinal fusion (64.09%), followed by kinesiophobia (47.38%), laminectomy (45.98%), depression (40.3%), numbness in lower limbs (36.9%), myelopathy (14.5%) and other neurological deficits (12.56%).

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State.

Retrospective database analysis. To elucidate trends in the utilization of intraoperative neurophysiological monitoring (IONM) during elective lumbar surgery procedures and to investigate the association between the use of IONM and surgical outcomes. The routine use of IONM in elective lumbar spine procedures has recently been called into question due to longer operative time, higher cost, and other substitute advanced technologies. The Statewide Planning and Research Cooperative System database was accessed to perform this retrospective study. The trends of IONM use for lumbar decompression and fusion procedures were investigated from 2007 to 2018. The association between IONM use and surgical outcomes was investigated from 2017 to 2018. Multivariable logistic regression analyses, as well as propensity score matching (PS-matching), were conducted to assess IONM association in neurological deficits reduction. The utilization of IONM showed an increase in a linear fashion from 79 cases in 2007 to 6201 cases in 2018. A total of 34,592 (12,419 monitored and 22,173 unmonitored) patients were extracted, and 210 patients (0.6%) were reported for postoperative neurological deficits. Unadjusted comparisons demonstrated that the IONM group was associated with significantly fewer neurological complications. However, the multivariable analysis indicated that IONM was not a significant predictor of neurological injuries. After the PS-matching of 23,642 patients, the incidence of neurological deficits was not significantly different between IONM and non-IONM patients. The utilization of IONM for elective lumbar surgeries continues to gain popularity. Our results indicated that IONM use was not associated with a reduction in neurological deficits and will not support the routine use of IONM for all elective lumbar surgery.

BOLD fMRI and DTI fiber tracking for preoperative mapping of eloquent cerebral regions in brain tumor patients: impact on surgical approach and outcome.

Task-based BOLD fMRI and DTI-fiber tracking have become part of the routine presurgical work-up of brain tumor patients in many institutions. However, their potential impact on both surgical treatment and neurologic outcome remains unclear, in despite of the high costs and complex implementation. We retrospectively investigated whether performing fMRI and DTI-ft preoperatively substantially impacted surgical planning and patient outcome in a series of brain tumor patients. We assessed (i) the quality of fMRI and DTI-ft results, by using a scale of 0-2 (0 = failed mapping; 1 = intermediate confidence; 2 = good confidence), (ii) whether functional planning substantially contributed to defining the surgical strategy to be undertaken (i.e., no surgery, biopsy, or resection, with or without ESM), the surgical entry point and extent of resection, and (iii) the incidence of neurological deficits post-operatively. Twenty-seven patients constituted the study population. The mean confidence rating was 1.9/2 for fMRI localization of the eloquent cortex and lateralization of the language function and 1.7/2 for DTI-ft results. Treatment strategy was altered in 33% (9/27) of cases. Surgical entry point was modified in 8% (2/25) of cases. The extent of resection was modified in 40% (10/25). Onepatient (1/25, 4%) developed one new functional deficit post-operatively. Functional MR mapping - which must not be considered an alternative to ESM - has a critical role preoperatively, potentially modifying treatment strategy or increasing the neurosurgeons' confidence in the surgical approach hypothesized based on conventional imaging.

神経学的後遺症を残した電撃型脂肪塞栓症候群の1例～文献レビューと予後調査～(A case of fulminant fat embolism syndrome with neurological deficit: literature review and prognosis research)

要旨電撃型脂肪塞栓症候群（電撃型FES）は外傷後短時間で発症し，致死的転帰をたどり生命予後も不良と報告されているがまとまった報告はない。神経学的後遺症を残した電撃型FESの1例を生命予後・神経学的予後を調査した文献レビューとともに報告する。症例は18歳の男性。交通事故により受傷し，救出後に当院救急搬送となった。来院時ショックはなく，意識レベルはGCS E3V4M6で軽度の不穏を認めた。顔面挫滅創を認めたがCTで頭蓋内損傷はなく，右肘開放性脱臼骨折および右大腿骨骨幹部骨折を認めた。受傷後8時間で骨折に対する緊急手術を行った。術中より血圧低下あり，術後に低酸素状態・意識レベル不良であり，再挿管・人工呼吸器管理となった。直後に行ったCTで肺野のすりガラス影の出現と脳浮腫を認め，翌日には点状出血の出現を認めたため電撃型FESの診断となった。集学的治療を行ったが，けいれんの出現があり，受傷後22日に撮像した頭部MRIでは多発性の陳旧性脳梗塞像を認めた。受傷後35日の転院時E3VTM3と意思疎通は困難であった。受傷後1年の時点で追視は可能だが意思疎通困難で，随意的な四肢運動は不可能である。文献レビューでは電撃型FESは日本語文献26例，英語文献14例の症例報告があり，死亡率は43～50%で，神経学的後遺症発生率は43～56%であった。

Laser Interstitial Thermal Therapy for the Treatment of Primary and Metastatic Brain Tumors: A Systematic Review and Meta-Analysis

Laser interstitial thermal therapy (LITT) is a minimally invasive treatment option for intracranial tumors that are challenging to treat via traditional methods; however, its safety and efficacy are not yet well validated in the literature. The objectives of the study were to assess the available evidence of the indications and adverse events (AEs) of LITT and 1-year progression-free survival and 1-year overall survival in the treatment of primary and secondary brain tumors. A comprehensive literature search was conducted through the databases PubMed, Embase, and the Cochrane Library until October 2021. Comparative and descriptive studies, except for case reports, were included in the meta-analysis. Separate analyses by tumor type (high-grade gliomas, including World Health Organization grade 4 astrocytomas [which include glioblastomas] as a specific subgroup; low-grade gliomas; and brain metastases) were conducted. Pooled effect sizes and their 95% confidence intervals (CI) were generated via random-effects models. Forty-five studies met the inclusion criteria, yielding 826 patients for meta-analysis. There were 829 lesions in total, of which 361 were classified as high-grade gliomas, 116 as low-grade gliomas, 337 as metastatic brain tumors, and 15 as nonglial tumors. Indications for offering LITT included deep/inaccessible tumor (12 studies), salvage therapy after failed radiosurgery (9), failures of ≥2 treatment options (3), in pediatric patients (4), patient preference (1); indications were nonspecific in 12 studies. Pooled incidence of all (minor or major) procedure-related AEs was 30% (95% CI, 27%-40%) for all tumors. Pooled incidence of neurologic deficits (minor or major) was 16% (12%-22%); postprocedural edema 14% (8%-22%); seizure 6% (4%-9%); hematoma 20% (14%-29%); deep vein thrombosis 19% (11%-30%); hydrocephalus 8% (5%-12%); and wound infection 5% (3%-7%). One-year progression-free survival was 18.6% (11.3%-29.0%) in high-grade gliomas, 16.9% (11.6%-24.0%) among the grade 4 astrocytomas; and 51.2% (36.7%-65.5%) in brain metastases. One-year overall survival was 43.0% (36.0%-50.0%) in high-grade glioma, 45.9% (95% CI, 37.9%-54%) in grade 4 astrocytomas; 93.0% (42.3%-100%) in low-grade gliomas, and 56.3% (47.0%-65.3%) in brain metastases. New neurologic deficits and postprocedural edema were the most reported AEs after LITT, albeit mostly transient. This meta-analysis provides the best statistical estimates of progression and survival outcomes based on the available information. LITT is generally a safe procedure for selected patients, and future well-designed comparative studies on its outcomes versus the current standard of care should be performed.

A Mechanistic Based Analysis of Clinicoradiological and Functional Outcome in C7-T1 Translational Injury

C7-T1 translational injuries are relatively rare, unstable, and usually associated with neurological impairment. We aim to analyze the C7-T1 translational injury based on Allen and Ferguson's classification and to highlight the clinicoradiologic and neurologic outcomes in these patients. Patients with C7-T1 translational injury were retrospectively analyzed and demographic data, mechanism, mode of injury, surgery details, and associated injuries were obtained. The initial neurologic status was recorded as American Spinal Injury Association (ASIA) grade. All the injuries were classified as per Allen and Ferguson classification and stage 4 compressive extension (CE) injury was further classified into stage 4a and stage 4b according to Rebich etal. Among 44 patients, the most common mechanism of injury was CE injury seen in 27 patients (61.4%) followed by distractive flexion (DF) in 16 patients (36.4%) and compressive flexion in 1 patient (2.2%). Neurologic deficit was noted in 14 of 27 patients (51.85%) with CE injury, which was less compared to 12 of 16 patients (75%) with DF injury. However, there was no significant difference in terms of neurologic recovery. One patient with standalone anterior fixation had implant loosening and underwent additional posterior fixation. We present the largest series of C7-T1 translational injuries in the literature to our best knowledge. CE injury is nearly 2 times more common than DF injury and is associated with a lower incidence of neurologic deficit and easier fracture reduction techniques. Staging the injury severity aids in better planning in terms of surgical approach and levels of fixation.

Incidence of neurological deficit following road traffic accident with cervical spine immobilization compared to no cervical spine immobilization in patients visiting Taif hospitals

Background: Spinal collars were brought in 1967 into the administration of spinal injury care as it was believed that this procedure of immobilization would forestall any further neurological or spinal harm in high-risk patients. This study was done to assess the incidence of neurological deficit following road traffic accidents with cervical spine immobilization compared to no cervical spine immobilization in patients visiting Taif hospitals. Methods: A cross-sectional investigation of the patients who have encountered street car crashes was done from the time of July 2018 2022. The information was collected through a survey that assess the presence or non-attendance of neurological shortfalls in patients who had the cervical collar (CC) immobilization applied and the people who had not. Results: A total of 322 patients took part in our poll and cross-sectional review. The highest number of people were who did not utilize the CC when they own up to the emergency department (67.1%); accordingly, that significance (p = 0.009) demonstrated the powerlessness of the CC to diminish the deficiencies. Also, its presence did not diminish the complete number of patients in the Intensive care unit (ICU), however, the opposite occurred (p = 0.005). Conclusion: The utilization of a CC did not resist diminishing either the neurological deficiencies or admission to the ICU where most patients did not admit to the ICU unit which might be on the grounds that the greater part of patients did not confront cervical spine injury.

Cognitive Deficits in Pediatric Craniopharyngioma: An Updated Review

AbstractCraniopharyngiomas (CP) are brain tumors that often occur in children and adolescent that results in many neurological and endocrinological disorders. The aim of this systematic review is to provide updated version of studies used to formalize standard tests used for cognitive impairment in pediatric patients with craniopharyngioma. A systematic review was conducted in PubMed, EBSCO, ProQuest, Science Direct, Wiley Online, and Springer to identify studies assessing cognitive impairment in pediatric patients with craniopharyngioma. Academic and learning dysfunctions were reported in seven studies among 41 of 178 patients (23%). Visual–spatial deficits were reported in six studies. Speech and verbal dysfunctions were reported in three studies. Memory deficits were reported in eight studies among 61 of 197 patients (31%). Motor dysfunctions were reported in five studies. Sleep related issues were reported in four studies among 33 of 70 patients (47.1%). Patients with treated pediatric CP demonstrate a high incidence of neurological deficits including cognitive dysfunctions. Academic and learning dysfunctions, visual–spatial deficits, speech and verbal dysfunctions, memory deficits, and sleep-related issues were the most commonly reported cognitive deficits in the present study.

Patterns of neurological deficits in COVID-19 infections: a literature review

Neurologic deficits accompanying SARS-CoV-2 infections are associated with high mortality and morbidity. However, the exact prevalence and underlying pathogenesis of each disease are still unknown and under investigated. That is why this review reports the latest neurologic disorders diagnosed in COVID-19 patients and the possible underlying pathogenesis. We searched PubMed, Medline, Web of science, Embase, Google scholar, and Scopus using the following search terms; severe acute respiratory syndrome of coronavirus-2 or SARS-CoV-2 or COVID-19 or coronavirus and brain or nerve or neuro. Only studies that reported any neurologic deficits accompanying the COVID-19 diagnosis were included. COVID-19 patients had a wide range of neurologic deficits affecting different parts of the nervous systems. Cerebrovascular disorders, seizures, and cranial nerve diseases were reported in many cases. Autoimmune neuropathy was also reported in many patients. The incidence of neurologic deficits was considered high in COVID-19 patients and was associated with high morbidity and mortality.

Neuromonitoring in Cervical Spine Surgery: When Is a Signal Drop Clinically Significant?

Study DesignRetrospective cohort study.PurposeTo identify the clinical significance of different patterns of intraoperative neuromonitoring (IONM) signal alerts.Overview of LiteratureIONM is a long-established valuable adjunct to complex spine surgeries. IONM for cervical spine surgery is in the form of somatosensory evoked potential (SSEP) and motor evoked potential (MEP). The efficacy of both modalities (individually or in combination) to detect clinically significant neurological compromise is constantly being debated and requires conclusive suggestions.MethodsClinical and neuromonitoring data of 207 consecutive adult patients who underwent cervical spine surgeries at multiple surgical centers using bimodal IONM were analyzed. Signal changes were divided into three groups. Group 0 had transient signal changes in either MEPs or SSEPs, group 1 had sustained unimodal changes, and group 2 had sustained changes in both MEPs and SSEPs. The incidences of true neurological deficits in each group were recorded.ResultsA total of 25% (52/207) had IONM signal alerts. Out of these signal drops, 96% (50/52) were considered to be false positives. Groups 0 and 1 had no incidence of neurological deficits, while group 2 had a 29% (2/7) rate of true neurological deficits. The sensitivities of both MEP and SSEP were 100%. SSEP had a specificity of 96.6%, while MEP had a lower specificity at 76.6%. C5 palsy rate was 6%, and there was no correlation with IONM signal alerts (p=0.73).ConclusionsThis study shows that we can better predict its clinical significance by dividing IONM signal drops into three groups. A sustained, bimodal (MEP and SSEP) signal drop had the highest risk of true neurological deficits and warrants a high level of caution. There were no clear risk factors for false-positive alerts but there was a trend toward patients with cervical myelopathy.

202. Hyperlordotic anterior interbody use without superior articulating process resection has an increased risk of Iiatrogenic neurological injury single level circumferential fusion

BACKGROUND CONTEXT Hyperlordotic (>20°) anterior interbody cages (HAI) may be utilized in anterior-posterior fusion (AP-F) in efforts to improve alignment. However, significant increase in segmental lordosis (SL) in HAI without superior articulating process resection (SAP) may result in foraminal stenosis and nerve root compression causing neurological deficits and radiculopathy. Additionally, HAI with SAP may increase SL without concomitant increase in lumbar lordosis (LL). PURPOSE Assess whether HAI without SAP in APF causes increased neurological complications. STUDY DESIGN/SETTING Single-center retrospective cohort study PATIENT SAMPLE A total of 158 patients undergoing single level APF were included, of which 73 had HAI placed and 85 had SAI placed. OUTCOME MEASURES Outcomes measures included radiographic analysis of pre- and postoperative LL and SL. Perioperative neurological complications were measured including new radiculopathy, iatrogenic motor deficit and malpositioned instrumentation or compressive hematoma causing deficit. Returns to OR within 30 or 90 days were measured including return for foraminal decompression, instrumentation revision, hematoma evacuation, and irrigation and debridement. METHODS Patients undergoing primary, single level, APF without SAP resection over a 5-year period were included. Patients were classified as HAI or SAI. Outcomes measures included perioperative neurological complications, returns to OR, pre- and postoperative LL and SL. Demographic, procedural and perioperative outcomes were compared using independent samples t-tests and chi-squared analyses as appropriate with significance set at p RESULTS A total of 158 patients (73 HAI, 85 SAI) were included. Age, gender, BMI and CCI were similar between groups. HAI without SAP resulted in significantly larger change in SL (9.84±5.84 vs 7.32±5.02 deg, p=0.001), without a significantly larger change in LL (8.16±1.11 vs 11.5±1.69 deg; p=0.641) compared with SAI. HAI without SAP increased overall incidence of neurological deficit (13.69% vs 3.53%; p=0.012), iatrogenic new cases of radiculopathy (10.95% vs 3.53%; p=0.045), and iatrogenic neurological motor deficit (13.69% vs 3.53%; p=0.012). Regression analysis demonstrated that increasing cage lordosis greater than 20° is an independent risk factor for neurological complications (p=0.046), as is higher preop SL (p=0.022). There were no significant differences in returns to OR. CONCLUSIONS We caution HAI implantation without SAP resection due to increased neurological complications from iatrogenic nerve root injury without the benefit of significantly improving LL correction. Use of HAI without SAP resection in single level APF should not be standard practice due to risk of neurological complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

A study of operative and non - operative management of dorsolumbar spine fracture (A study OF 40 cases)

In an epidemiological study traumatic injury to the thoracolumbar area constitute of 75% of total back skeletal injuries. Most of these injuries comprises of thoracolumbar segment of the spine (t10 to l2), also high incidence of neurological deficits is associated with thoracolumbar fractures. Numerous classifications were proposed on an anatomical basis to guide the management of TL fractures and define the indications for surgery but none of these classification systems have taken into account the stabilizing effect of para- spinal muscles. The aim of this article is to review the present literature on evidence of management of TL fractures using operative versus conservative techniques. 40 patients with dorsolumbar spine injuries falling into inclusion criteria were managed with conservative and operative intervention between December 2008 to January 2010. 16 patients were treated with operative intervention with short or long segmented fixation & fusion with bone grafts.24 patients were treated non operatively with DLSO brace and kept immobilised for 4-6 weeks. The maximum period of follow up was 18 to 24 months with a minimum period of follow up of 9 to 12 months. At follow up on regular check of neurological status, 50% of operatively treated patients were showing improvement. Patients treated non operatively had no or occasional pain according to pain score. 10 patients had excellent score treated operatively while 12 patients had good score. 8 patients treated non operatively had good to fair score according to grading for neurological improvement by SRS (scoliosis research society). Surgical intervention should be advocated in cases of unstable burst fractures of the dorsolumbar region, irrespective of status of neurological damage, but might be restricted in the patients with incomplete spinal cord injuries.

Tertiary Pediatric Academic Institution's Experience With Intraoperative Neuromonitoring for Nonspinal Surgery in Children With Mucopolysaccharidosis, Based on a Novel Evidence-Based Care Algorithm.

Musculoskeletal deformities in mucopolysaccharidoses (MPSs) patients pose unique challenges when patients present for surgery, especially nonspinal surgery. MPS patients have developed postsurgical neurological deficits after nonspinal surgery. While the incidence of neurological deficits after nonspinal surgery under anesthesia is unknown, accumulating evidence provides impetus to change current practice and increased neurological monitoring in these patients. Intraoperative neurophysiologic monitoring (IONM) with somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) has been implemented at select institutions with varying degree of success. This report describes our experience with IONM in the context of a multidisciplinary evidence-based care algorithm we developed at Cincinnati Children's Hospital Medical Center. We conducted a retrospective chart review of the electronic medical record (EPIC), for data from all MPS patients at our institution undergoing nonspinal surgery between September 2016 and March 2018. Patients were identified from IONM logs, which include procedure and patient comorbidities. Data concerning demographics, morbidities, degree of kyphoscoliosis, intraoperative administered medications and vital signs, surgical procedure, the IONM data, duration of surgery, and blood loss were extracted. Descriptive analyses were generated for all variables in the data collected. In addition, any IONM changes noted during the surgeries were identified and factors contributing to the changes described. Thirty-eight patients with a diagnosis of MPS underwent nonspinal surgery, and of those 38, 21 received IONM based on preoperative decision-making according to our care algorithm. Of the 21 patients who received IONM, we were able to get reliable baseline potentials on all patients. Of the 21 patients, 3 had significant neurophysiologic changes necessitating surgical/anesthetic intervention. All of these changes lasted several minutes, and the real-time IONM monitoring was able to capture them as they arose. None of the patients sustained residual neurological deficits. Thus, children who did not fit the criteria for IONM (n = 13) based on our algorithm had 0% incidence of any untoward neurological deficits after surgery (97.5% confidence interval [CI], 00%-25.5%), while 14% (95% CI, 11.5%-30.1%) of children who did fit criteria for IONM and had IONM had significant IONM changes. Through this case series, we describe our experience with the use of IONM and a novel care algorithm for guiding the anesthetic management of MPS patients undergoing nonspinal surgery. We conclude that they can be useful tools for provision of safe anesthetic care in this high-risk cohort.

Multidisciplinary treatment system for bone metastases for early diagnosis, treatment and prevention of malignant spinal cord compression

Malignant spinal cord compression (MSCC) is a serious complication of cancers. The present study aimed to establish a multidisciplinary treatment system for urgent magnetic resonance imaging (MRI) and referral to orthopedists in order to prevent neurological deficits caused by MSCC. In the present study, the extent to which this system achieved early diagnosis and treatment and prevented MSCC-caused neurological deficits was examined. The records from patients with neurological deficits caused by MSCC before (between April 2007 and March 2012; group A) and after (between April 2012 and March 2017; group B) the establishment of the multidisciplinary system at the Shikoku Cancer Center (Ehime, Japan) were retrospectively evaluated. The numbers of patients with neurological deficits were 38 and 7 in groups A and B, respectively. All patients received radiotherapy. The incidence of neurological deficits was 13.2 and 3.4% in groups A and B, respectively (P<0.001). The proportion of patients with improvement in the severity of neurological deficits was 5.3 and 28.6% in groups A and B, respectively (P<0.001). The interval between physicians' recognition of a neurological deficit and MRI and the start of treatment, the number of cases, and the severity of neurological deficits were evaluated in groups A and B. The median interval between recognition of a neurological deficit by physicians and MRI was 3 and 0 days in groups A and B, respectively (P<0.001). The median interval between physicians' recognition of a neurological deficit and the start of treatment was 3 and 0 days in groups A and B, respectively (P<0.001). By using a multidisciplinary treatment system, the incidence and severity of neurological deficits following treatment were significantly improved. Therefore, the multidisciplinary treatment system used in the present study may be useful for early diagnosis, treatment and prevention of MSCC in patients with bone metastases.