Vertebroplasty Performance on Simulator for 19 Surgeons Using Hierarchical Task Analysis.

By London Spine
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Vertebroplasty Performance on Simulator for 19 Surgeons Using Hierarchical Task Analysis.

IEEE Trans Med Imaging. 2015 Jan 8;

Authors: Wucherer P, Stefan P, Abhari K, Fallavollita P, Lazarovici M, Weidert S, Peters TM, Ribaupierre S, Eagleson R, Navab N

Abstract
We present a unique simulator-based methodology for assessing both technical and non-technical (cognitive) skills for surgical trainees while immersed in a complete medical simulation environment. Further, we have included two crisis scenarios which allow for the evaluation of the effect of cognitive strategy selection on the low-level surgical skills. Training these mixed-mode scenarios can thereby be evaluated on our platform, allowing for improved assessment and a stronger foundation for credentialing, with the potential to reduce the occurrence of adverse events in the OR. Scientific evaluation and validation of our work is conducted together with 19 junior surgeons in order to achieve the following goals: (i) to provide a qualitative measure of usability, (ii) to assess vertebroplasty technical performance of the surgeon, and (iii) to explore the relationship between mental workload and surgical performance during crisis. Our results indicate that: (a) the surgeons scored the face validity of our modeled simulation environment very highly (4.68 ± 0.48, using a 5-pt Likert scale), (ii) surgeon training enabled completion of tasks more quickly, and (iii) the introduction of crisis scenarios negatively affected the surgeons’ objective performance. Taken together, our results underscore the need to develop realistic simulation environments that prepare young residents to respond to emergent events in the operating room.

PMID: 25585414 [PubMed – as supplied by publisher]

Autologous bone marrow concentrate combined with platelet-rich plasma enhance bone allograft potential to induce spinal fusion.

By Kamruz Zaman
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Autologous bone marrow concentrate combined with platelet-rich plasma enhance bone allograft potential to induce spinal fusion.

J Biol Regul Homeost Agents. 2016 Oct-Dec;30(4 Suppl 1):165-172

Authors: Vadalà G, Di Martino A, Russo F, Tirindelli MC, De Felice L, Agostini F, Papalia R, Denaro V

Abstract
Bone marrow cells concentrate (BMCs) is a source of osteoprogenitor cells and platelet-rich plasma (PRP) is a source of growth factors. The objective of the study was to determine whether BMC and PRP could increase the potential of bone allograft to induce posterolateral-lumbar spinal fusion compared to the bone allograft alone. A prospective nonrandomized radiographic study has been conduced on 10 patients with posterolateral instrumented fusion for degenerative lumbar disease with 1-year follow-up using CT scan. A fresh frozen bone allograft alone and bone allograft with a mixture of autologous BMC and PRP blended with thrombin were apposed in the right and left posterolateral side, respectively. CT showed good right fusion masses (allograft alone) in 4 patients and poor in 6; good left masses (BMC and PRP plus allograft) in 9 patients and poor in 1. The differences detected between right-side and left-side masses show an advantage in adding BMC and PRP to the bone allograft to increase spinal fusion rate.

PMID: 28002915 [PubMed – in process]

Effect of pulsed radiofrequency in treatment of facet-joint origin back pain in patients with degenerative spondylolisthesis.

By London Spine
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Effect of pulsed radiofrequency in treatment of facet-joint origin back pain in patients with degenerative spondylolisthesis.

Eur Spine J. 2014 Jul 6;

Authors: Hashemi M, Hashemian M, Mohajerani SA, Sharifi G

Abstract
BACKGROUND: Degenerative spondylolisthesis is a well-recognized source of low back pain mainly induced by facet joint pain. Pulsed radiofrequency (PRF) allows heat dissipation, thus producing a temporary injury that affects only type C fibers responsible for pain conduction.
OBJECTIVES: We attempted to test whether PRF is a better choice for facet pain due to spondylolisthesis compared to routine steroid injection.
METHODS: Patients were randomly assigned to one of two groups: group one received pulsed RF, and group 2 received injection by steroids (triamcinolone) and bupivacaine.
OUTCOMES ASSESSMENT: Multiple outcome measures were utilized which included the numeric rating scale (NRS), the Oswestry Disability Index (ODI), satisfaction status, and analgesic intake with assessment at 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50 % or more, whereas significant improvement in disability score was defined as reduction of 40 % or more.
RESULTS: Eighty patients were enrolled in the study and were divided into the two groups of study. PRF significantly reduced NRS at 6-month follow-up compared to steroid + bupivacaine. 75.6 ± 14.3 % at pre-treatment and 19.3 ± 9.5 % at 6 months (p = 0.001) in PRF group. The mean ODI is depicted in two groups of study (Fig. 1). Interestingly, ODI% was significantly lower in PRF group at 12 weeks and 6 months compare to steroid + bupivacaine group (p = 0.022 and 0.03, respectively), but it was not significantly different at 6 weeks (p = 0.31). Proportion of patients who did not require analgesics were significantly higher in PRF group compared to other group (p = 0.001) in Log-rank (Mantel-Cox) test.
CONCLUSION: Our results demonstrated that the application of PRF might be more effective than steroid and bupivacaine injection in decreasing back pain due to degenerative facet pain and improvement in function of patients.

PMID: 24997616 [PubMed – as supplied by publisher]

Assessment of the effectiveness of head only and back-of-the-head electrical stunning of chickens.

By London Spine
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Assessment of the effectiveness of head only and back-of-the-head electrical stunning of chickens.

Br Poult Sci. 2016 Jun;57(3):295-305

Authors: Gibson TJ, Taylor AH, Gregory NG

Abstract
The study assesses the effectiveness of reversible head-only and back-of-the-head electrical stunning of chickens using 130-950 mA per bird at 50 Hz AC. Three trials were conducted to compare both stunning systems: (a) behavioural assessment of return of consciousness, (b) insensibility to thermal pain, and (c) assessment of return of brain activity with visually evoked potentials (VEPs). Assessment of behaviour suggested that the period of unconsciousness following head-only electrical stunning was shorter in hens compared to broilers. Stunning across the back-of-the-head delayed the time to return of brainstem function compared to stunning with standard head-only electrodes. Additionally, back-of-the-head stunning produced a more prolonged period of electroanalgesia compared to head-only. Based on examination of return of brain function with VEPs in hens, back-of-the-head stunning produced a shorter-lasting stun than standard head-only. However, even for standard head-only, the stun was notably shorter than previously reported. In some birds, brain function had returned within 9 s after the end of stunning. The results suggest that some birds may recover consciousness prior to or during the neck cut. Based on these findings, back-of-the-head stunning and standard head-only stunning of hens should not be recommended without further development.

PMID: 27023411 [PubMed – indexed for MEDLINE]

Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine; evaluation of a new MRI staging classification and imaging findings as indicators of surgical management: a retrospective study of 37 patients.

By London Spine
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Epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine; evaluation of a new MRI staging classification and imaging findings as indicators of surgical management: a retrospective study of 37 patients.

Arch Orthop Trauma Surg. 2010 Jan;130(1):111-8

Authors: Uchida K, Nakajima H, Yayama T, Sato R, Kobayashi S, Chen KB, Mwaka ES, Baba H

Abstract
INTRODUCTION: The aim of this study was to review the patients with lumbar epidural abscess in terms of neurological morbidity, therapeutic outcome, and prognosis, while assessing the usefulness of a new MRI staging classification and specific imaging findings as indicators for surgical management.
MATERIALS AND METHODS: We reviewed 37 patients who sustained epidural abscess associated with pyogenic spondylodiscitis of the lumbar spine. Ten patients were treated conservatively, while 27 required urgent or elective surgical drainage. We studied patients with respect to symptomatology, Frankel-American Spinal Injury Association (ASIA) scale evaluation and a new proposed system of MRI staging of pyogenic spondylodiscitis (stages I–V).
RESULTS: Of the 37 patients with stage IV and V MRI lesions, 13 (35%) had septicemia and 8 (22%) presented with Frankel-ASIA scale C-D neurological status. All cases with ringlike enhancement on gadolinium-enhanced MRI in the epidural abscess lesions were treated surgically. Progression of local kyphosis and loss of intervertebral disk height were significantly prevented in the surgical group (P < 0.05). Improvements of neurological status and laboratory data were better in the surgical group than the conservative group (P < 0.05), with significantly short hospital stay (P < 0.05).
DISCUSSION: Epidural abscess associated with pyogenic spondylodiscitis presents with various neurological symptoms. In addition to assessment of progression by clinical symptomatology, modified neurological Frankel-ASIA scaling and the currently proposed MRI staging regimen may help to consider the timing of surgical intervention. In the acute, subacute or acute-on-chronic phase and the ringlike enhancement pattern of epidural abscess on gadolinium-enhanced MRI may be an indicator for surgery.

PMID: 19565251 [PubMed – indexed for MEDLINE]