The significance of direct transportation to a trauma center on survival for severe traumatic brain injury.

Introduction: While timely specialized care can contribute to improved outcomes following traumatic brain injury (TBI), this condition remains the most common cause of post-injury death worldwide. The purpose of this study was to investigate the difference in mortality between regional trauma centers in Sweden (which provide neurosurgical services round the clock) and non-trauma centers, hypothesizing that 1-day and 30-day mortality will be lower at regional trauma centers.

Patients And Methods: This retrospective cohort study used data extracted from the Swedish national trauma registry and included adults admitted with severe TBI between January 2014 and December 2018.

Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index.

Purpose: Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients.

Malpractice claims in spine surgery in Germany: a 5-year analysis.

Study Design: Retrospective analysis of anonymized malpractice claims.

Summary Of Background Data: Spine surgery is considered a high-risk specialty with regards to malpractice claims. However, limited data is available for Germany.

Radiological and Clinical Outcome after Multilevel Anterior Cervical Discectomy and/or Corpectomy and Fixation.

Background: Multilevel anterior cervical decompression and fixation of four and more levels is a common surgical procedure used for several diseases.

Methods: We reviewed the radiological and clinical outcomes after anterior cervical discectomy or corpectomy and fixation of four and more levels in 85 patients (55 men and 30 women) with an average age of 59.6 years.

Persistent Iliosacral Joint Syndrome following Instrumentation to the Sacropelvis in Patients with Adult Spinal Deformity.

Background And Objective:  Persistent sacroiliac joint syndrome (PSIJS) may complicate adult spinal deformity surgery (ASDS). This study assesses the relationship between clinical/morphometric parameters and PSIJS following ASDS including pelvic fixation and the therapeutic efficacy of secondary iliosacral fusion (ISF).

Methods:  Perioperative health-related quality of life (HRQOL) outcomes (Oswestry Disability Index, Short Form 12-item health survey, version 2 scores) at 6, 12, and 24 months, and radiographic studies were analyzed retrospectively in a cohort of 71 consecutive patients undergoing ASDS.

Biomechanical investigation of lumbar hybrid stabilization in two-level posterior instrumentation.

Purpose: Hybrid stabilization with a dynamic implant has been suggested to avoid adjacent segment disease by creating a smoother transition zone from the instrumented segments to the untreated levels above. This study aims to characterize the transition zones of two-level posterior instrumentation strategies for elucidating biomechanical differences between rigid fixation and the hybrid stabilization approach with a pedicle screw-based dynamic implant.

Methods: Eight human lumbar spines (L1-5) were loaded in a spine tester with pure moments of 7.

Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression.

Background: Presenting symptoms, treatment considerations, and outcome are strongly related to the extension of vestibular schwannomas (VS). The aim of the current retrospective study was to analyze the clinical features, microsurgical treatment, and outcome of VS with brainstem compression.

Methods: Forty-nine patients presented with VS (Hannover grading scale T4a or T4b) in our department.

Surgical data and early postoperative outcomes after minimally invasive lumbar interbody fusion: results of a prospective, multicenter, observational data-monitored study.

Unlabelled: Minimally invasive lumbar interbody fusion (MILIF) offers potential for reduced operative morbidity and earlier recovery compared with open procedures for patients with degenerative lumbar disorders (DLD). Firm conclusions about advantages of MILIF over open procedures cannot be made because of limited number of large studies of MILIF in a real-world setting. Clinical effectiveness of MILIF in a large, unselected real-world patient population was assessed in this Prospective, monitored, international, multicenter, observational study.

Comparison of posterior foraminotomy and anterior foraminotomy with fusion for treating spondylotic foraminal stenosis of the cervical spine: study protocol for a randomized controlled trial (ForaC).

Background: Cervical radiculopathy caused by spondylotic foraminal stenosis may require surgical treatment. Surgical options include anterior cervical foraminotomy and fusion or posterior cervical foraminotomy. Controversy remains regarding the preferable surgical approach.

Cortical indocyanine green videography for quantification of acute hypoperfusion after subarachnoid hemorrhage: a feasibility study.

Background: Acute neurological deficits after subarachnoid hemorrhage (SAH) correlate with outcome, and a phase of acute hypoperfusion was characterized recently. Indocyanine green (ICG) videography is an established intraoperative imaging technique with important descriptive potential.

Objective: To analyze whether ICG can be used to analyze and confirm perfusion changes early after SAH.

Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing. Part II: thoracolumbar spine.

Background: Image-guided spinal instrumentation may reduce complications in spinal instrumentation.

Objective: To assess accuracy, time efficiency, and staff radiation exposure during thoracolumbar screw instrumentation guided by intraoperative computed tomography (iCT)-based neuronavigation (iCT-N).

Methods: In 55 patients treated for idiopathic and degenerative deformities, 826 screws were inserted in the thoracic (T2-T12; n = 243) and lumbosacral (L1-S1; n = 545) spine, as well as ilium (n = 38) guided by iCT-N.

Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part I: cervicothoracic spine.

Background: Image-guided spinal instrumentation reduces the incidence of implant misplacement.

Objective: To assess the accuracy of intraoperative computed tomography (iCT)-based neuronavigation (iCT-N).

Methods: In 35 patients (age range, 18-87 years), a total of 248 pedicle screws were placed in the cervical (C1-C7) and upper and midthoracic (T1-T8) spine.

Less invasive surgical correction of adult degenerative scoliosis. Part II: Complications and clinical outcome.

Background: Surgical correction of adult degenerative scoliosis is a technically demanding procedure with a considerable complication rate. Extensive blood loss has been identified as a significant factor linked to unfavorable outcome.

Objective: To report on the complication profile and clinical outcomes obtained with less invasive image-guided surgical correction of degenerative (de novo) scoliosis in a high-risk population.

Less invasive surgical correction of adult degenerative scoliosis, part I: technique and radiographic results.

Background: Adult scoliosis is a condition with increasing prevalence and medical and socioeconomic importance. Surgery is fraught with a significant complication rate in an elderly multimorbid patient population.

Objective: To assess technical feasibility and radiographic results of image-guided less invasive correction of adult degenerative scoliosis.

Technique and clinical results of minimally invasive reconstruction and stabilization of the thoracic and thoracolumbar spine with expandable cages and ventrolateral plate fixation.

Objective: To evaluate the techniques of minimally invasive single- and multilevel corpectomy and reconstruction of the thoracic and thoracolumbar spine using expandable vertebral body replacement (VBR) cages and ventrolateral plate fixation (VPF) via anterolateral retropleural (ALRA) and combined thoracoabdominal approaches.

Methods: 38 patients with spondylitis, traumatic or metastatic lesions of thoracic or thoracolumbar vertebrae T4 to L2 underwent spinal decompression and ventral column reconstruction with correction of spinal deformity by VBR and VPF via ALRA or a combined lateral extrapleural/extraperitoneal (extracoelomic) thoracolumbar approach (CLETA). Overall clinical and neurological outcome, operative time, blood loss, reduction of deformity, and postoperative pain were assessed during a mean follow-up period of 22.

Percutaneous multilevel decompressive laminectomy, foraminotomy, and instrumented fusion for cervical spondylotic radiculopathy and myelopathy: assessment of feasibility and surgical technique.

Object: Extensive muscle dissection associated with conventional dorsal approaches to the cervical spine frequently results in local pain, muscle wasting, and temporarily painful and restricted neck movement. The utility of a percutaneous muscle-sparing access technique and specifically modified instrumentation for multilevel posterior cervical decompression and fusion were evaluated.

Methods: Eleven patients (six men, five woman; mean age 72.

Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability.

Objective: Percutaneous spinal instrumentation techniques may be helpful to reduce approach-related morbidity inherent to conventional open surgery. This article reports technique, clinical outcomes, and fusion rates of percutaneous transforaminal lumbar interbody fixation (pTLIF). Results are compared with those of mini-open transforaminal lumbar interbody fixation (oTLIF) using a muscle splitting (Wiltse) approach.

Tako-tsubo cardiomyopathy: reversible heart failure with favorable outcome in patients with intracerebral hemorrhage. Case report.

In patients with intracerebal hemorrhage, cardiac dysfunction is a common phenomenon. Tako-tsubo cardiomyopathy is characterized by complete reversibility and therefore may constitute an entity with a favorable outcome. In this case report the authors describe a previously healthy 23-year-old man with no history of cardiac disease who suffered a severe fourth ventricular hemorrhage due to an angioma of the vermis cerebelli.

Solitary spinal artery aneurysms as a rare source of spinal subarachnoid hemorrhage: potential etiology and treatment strategy.

Solitary aneurysms of spinal arteries lacking associated vascular malformations are rare. We report three patients with spinal subarachnoid hemorrhage (SAH) due to rupture of such aneurysms, which regressed spontaneously, as confirmed on conventional angiography. One patient had spinal SAH with presumed spontaneous dissection of a segmental artery.

Tissue oxygenation and capacity to deliver O2 do the two go together?

Oxidative phosphorylation is the most important source of energy in mammals. Oxygen capture, convective and diffusive oxygen transport as well as the final intracellular oxygen utilization within the mitochondria represent highly refined mechanisms, supervised by a variety of physiological control systems. Any disease process interfering with the delivery of oxygen to tissue will ultimately lead to an impairment of cellular energy production.

Individual value of brain tissue oxygen pressure, microvascular oxygen saturation, cytochrome redox level, and energy metabolites in detecting critically reduced cerebral energy state during acute changes in global cerebral perfusion.

The authors assessed the diagnostic value of brain tissue oxygen tension (PbrO2), microvascular oxygen saturation (SmvO2), cytochrome oxidase redox level (Cyt a+a3 oxidation), and cerebral energy metabolite concentrations in detecting acute critical impairment of cerebral energy homeostasis. Each single parameter as well as derived multimodal indices (arteriovenous difference in oxygen content [AVDO2], cerebral metabolic rate for oxygen [CMRO2], fractional microvascular oxygen extraction [OEF]) were investigated during controlled variation of global cerebral perfusion using a cisternal infusion technique in 16 rabbits. The objective of this study was to determine whether acute changes between normal, moderately, and critically reduced cerebral perfusion as well as frank ischemia defined by local cortical blood flow (lcoBF), brain electrical activity (BEA), and brain stem vasomotor control can be reliably identified by SmvO2, PbrO2, Cyt a+a3 oxidation, or energy metabolites (glutamate, lactate/pyruvate ratio).

Monitoring of cerebral perfusion pressure during intracranial hypertension: a sufficient parameter of adequate cerebral perfusion and oxygenation?

Objective: A cerebral perfusion pressure (CPP) oriented treatment is a widely accepted standard for patients with intracranial hypertension. In an animal model of controlled intracranial hypertension we investigated whether CPP is a reliable parameter of sufficient cerebral perfusion and oxygenation. Using near-infrared reflexion spectroscopy the effect of decreasing CPP due to increasing intracranial pressure (ICP) on cerebral tissue oxygenation was studied.

S(+)-ketamine attenuates myogenic motor-evoked potentials at or distal to the spinal alpha-motoneuron.

Unlabelled: We investigated the effect of S(+)-ketamine on spinal cord evoked potentials (ESCPs) and myogenic motor-evoked potentials after electrical stimulation of the motor cortex in a rabbit model. This study was designed to characterize the relationship between ESCP characteristics and corresponding changes in compound muscle action potentials (CMAPs) derived from fore and hind limbs. Direct (D) and indirect (I) corticospinal volleys (ESCP) from the upper and lower thoracic spinal cord, recorded by two bipolar epidural electrodes, were assessed during IV administration of 0.

Implications of vascular endothelial growth factor, sFlt-1, and sTie-2 in plasma, serum and cerebrospinal fluid during cerebral ischemia in man.

The relation between cerebral ischemia and local release of angiogenic factors was investigated after subarachnoid hemorrhage (SAH) in humans. Time-dependent concentration-changes of vascular endothelial growth factor (VEGF), sFlt-1 and sTie-2 extracted from plasma, serum, and cerebrospinal fluid (ventricular, cisternal, and lumbar) were analyzed in 15 patients surgically treated for ruptured aneurysms of the anterior circulation (Hunt and Hess grades I-V). Data were related to brain Po2 (Pbro2) and cerebral energy metabolites (extracellular lactate, pyruvate, glutamate, and glycerin concentrations) as well as clinical and radiologic reference data.

Does tissue oxygen-tension reliably reflect cerebral oxygen delivery and consumption?

We investigated the value of brain oxygen partial pressure (P(br)O(2)) with respect to predicting cerebral energetic failure in a rabbit model of global cerebral ischemia and hypoxia. Local cortical blood flow (l(co)CBF), P(br)O(2), extracellular lactate, pyruvate, and glutamate concentrations, as well as microvascular hemoglobin saturation (S(mv)O(2)), cytochrome oxidase redox level (Cyt a+a(3) oxidation), and brain electrical activity, were assessed during variable degrees of cerebral ischemia and hypoxia, induced by cisternal infusion of artificial cerebrospinal fluid or an admixture of nitrous oxide to inspiratory gas in 10 animals each. Arteriovenous difference in oxygen content, cerebral metabolic rate for oxygen, and oxygen extraction were derived from multimodal data.