The Adam Williams initiative: collaborating with community resources to improve care for traumatic brain injury.

Background: The Brain Trauma Foundation has developed treatment guidelines for the care of patients with acute traumatic brain injury. However, a method to provide broad acceptance and application of these guidelines has not been published.

Objective: To describe methods for the development, funding, and continued educational efforts of the Adam Williams Initiative; the experiences from the first 10 years may serve as a template for hospitals and nurses that seek to engage in long-term quality improvement collaborations with foundations and/or industry.

Minimally invasive surgical treatment of lumbar spinal stenosis: Two-year follow-up in 54 patients.

Objective: Minimally invasive surgery has seen increasing application in the treatment of spinal disorders. Treatment of degenerative spinal stenosis, with or without spondylolisthesis, with minimally invasive technique preserves stabilizing ligaments, bone, and muscle. Satisfactory results can be achieved without the need for fusion in most cases.

Device for intervertebral assisted motion: technique and initial results.

Object: The DIAM is a polyester-encased silicone interspinous dynamic stabilization device that can unload the anterior column and reestablish the functional integrity of the posterior column.

Methods: The DIAM was implanted in 104 patients between May 1, 2001 and October 30, 2001. A retrospective evaluation was performed based on chart review and patient questionnaire at a median follow-up interval of 18.

Biomechanical and radiographic analysis of a novel, minimally invasive, extension-limiting device for the lumbar spine.

Object: Biomechanical testing and fluoroscopic imaging were used to study an extension-limiting device that has been developed to support and cushion the facet complex. It is a titanium screw-based system with a polycarbonate-urethane bumper that lies against the inferior articular process and is anchored into the pedicle by the screw for posterior dynamic stabilization (PDS).

Methods: Six human cadaveric spines were dissected from L-2 to L-5, leaving all ligamentous structures intact.

What's the "hyper" in hyperacute stroke? Strategies to improve outcomes in ischemic stroke patients presenting within 6 hours.

Ischemic stroke patients presenting to acute care hospitals require an organized response from multiple disciplines and clinical areas. Patients presenting within 6 hours of stroke onset constitute a category of stroke patient known as the "hyperacute stroke patient." This category of stroke patients is eligible for treatment using intravenous recombinant tissue plasminogen activator when treated within 3 hours, or interventional treatment options when treated within 6 hours of stroke onset.

Refractory increased intracranial pressure in severe traumatic brain injury: barbiturate coma and bispectral index monitoring.

Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative.

Brain tissue oxygenation in brain death.

Introduction: The value of brain tissue oxygenation (PbtO2) measurements in determining brain death is unknown.

Methods: Eleven of 72 patients who had brain tissue oxygen monitors placed experienced brain death. Admission diagnoses included six severe traumatic brain injuries, one multiple trauma with cardiac arrest, one brain tumor, one subarachnoid hemorrhage, one intracerebral hemorrhage, and one cerebral stroke.

Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system.

Object: The objective of this study was to assess the feasibility and efficacy of treating spondylolisthesis-related spinal stenosis via unilateral approach bilateral decompression in which METRx-MD instrumentation is placed.

Methods: Eight consecutive patients with spinal stenosis underwent bilateral decompressions via a unilateral approach in which METRx-MD instrumentation was placed. The procedures were performed on an outpatient basis after induction of general anesthesia.

Use of a tubular retractor system in microscopic lumbar discectomy: 1 year prospective results in 135 patients.

Object: Application of minimally invasive techniques to lumbar disc surgery has led to the development of the Microscopic Endoscopic Tubular Retractor System (METRx-MD). A prospective evaluation of results and complications was undertaken.

Methods: One hundred thirty-five patients underwent surgery in which the METRx-MD system was used; most procedures were performed on an outpatient basis, and general anesthesia was induced in all cases.

Retrospective analysis and modifications of retractor systems for anterior odontoid screw fixation.

The authors present an in-depth retrospective analysis of retractor systems for anterior odontoid screw fixation. They discuss various modifications and innovations of such systems and describe their own tubular retractor system, in which a beveled end conformal to the ventral surface of the vertebral column at the C2-3 level is introduced together with an incorporated light source. This new retractor system allows optimal anatomical exposure for controlled odontoid screw placement with improved protection of surrounding vital structures.

Minimally invasive surgical treatment of lumbar synovial cysts.

Objective: Synovial cysts are a rare cause of lumbar radiculopathy and back pain. Surgical treatment is directed at complete excision of the cyst. We used minimally invasive surgical techniques for a series of patients, to assess the effectiveness of this approach for resection of synovial cysts.

Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system.

Object: The authors studied a consecutive series of patients with spinal stenosis in whom surgery was performed by a single surgeon who used a microscopic tubular retractor system (METRx-MD); patients underwent prospective evaluation involving radiography and magnetic resonance (MR) imaging. The objective was to assess the feasibility and surgery-related efficacy of performing unilateral-approach bilateral decompression and utilization of METRx-MD instrumentation in patients with spinal stenosis.

Methods: Seventeen consecutive patients with spinal stenosis underwent bilateral decompression; surgery was performed via a unilateral approach using METRx-MD instrumentation.

Minimally invasive percutaneous posterior lumbar interbody fusion.

Objective: The wide exposure required for a standard posterior lumbar interbody fusion (PLIF) can cause unnecessary trauma to the lumbar musculoligamentous complex. By combining existing microendoscopic, percutaneous instrumentation and interbody technologies, a novel, minimally invasive, percutaneous PLIF technique was developed to minimize such iatrogenic tissue injury (MIP-PLIF).

Methods: The MIP-PLIF technique was validated in three cadaveric torsos with six motion segments decompressed and fused.