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  • Journal of Neurosurgery Publishing Group (JNSPG)  (4)
  • Vaccaro, Alexander R.  (4)
  • 2000-2004  (4)
Material
Publisher
  • Journal of Neurosurgery Publishing Group (JNSPG)  (4)
Person/Organisation
Language
Years
  • 2000-2004  (4)
Year
Subjects(RVK)
  • 1
    Online Resource
    Online Resource
    Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2004
    In:  Journal of Neurosurgery: Spine Vol. 100, No. 1 ( 2004-01), p. 20-23
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 100, No. 1 ( 2004-01), p. 20-23
    Abstract: Object. The authors sought to identify variables that predispose patients with acute American Spinal Injury Association (ASIA) Grade A cervical spinal cord injury (SCI) to require tracheostomies for ventilator support or airway protection. Methods. A retrospective analysis was performed of 178 consecutive patients with a cervical ASIA Grade A SCI who were admitted through the Delaware Valley SCI Center at Thomas Jefferson Hospital during a 6-year period. Exclusion criteria included injury occurring more than 48 hours prior to admission, death within 14 days of admission or nontraumatic SCI. Twenty-two patients were excluded based on these criteria. Parameters evaluated in the remaining population (156 patients) included demographics, cervical vertebral ASIA level, tracheostomy placement, pneumonia, premorbid pulmonary disease, smoking history, evidence of direct thoracic/lung trauma, operative intervention, associated appendicular trauma, and preexisting medical comorbidities. The ASIA classification of the 156 patients included in this analysis were C-2 (eight), C-3 (11), C-4 (64), C-5 (36), C-6 (20), C-7 (13), and C-8 (four). Tracheostomies were performed in 107 of these 156 patients. Statistical analysis revealed a significant relationship between tracheostomy and patient age (p = 0.0048), preexisting medical conditions (p = 0.0417), premorbid lung disease (p = 0.0177), higher cervical ASIA level (p 〈 0.0001), and the presence of pneumonia (p 〈 0.0001). No patient with a C-8 ASIA A injury required tracheostomy, whereas all C-2 and C-3 ASIA A—injured patients underwent tracheostomies. Patients older than 45 years of age with ASIA A levels between C-4 and C-7 more commonly required tracheostomy (p 〈 0.005) than patients younger than 45 years of age. Conclusions. Several risk factors were identified that corresponded to the frequent tracheostomy placement in the acute injury phase after complete cervical SCI. Early tracheostomy may be considered in patients with multiple risk factors to reduce duration of stay in the intensive care unit and facilitate ventilatory weaning.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/spi.2004.100.1.0020
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2004
    Location Call Number Limitation Availability
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Closed management of displaced Type II odontoid fractures: more frequent respiratory compromise with posteriorly displaced fractures
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2000
    In:  Neurosurgical Focus Vol. 8, No. 6 ( 2000-06), p. 1-3
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 8, No. 6 ( 2000-06), p. 1-3
    Abstract: Acute respiratory failure has been observed in patients after external immobilization for displaced odontoid fractures. The authors studied the frequency of respiratory deterioration in the acute management of displaced Type II odontoid fractures to identify patients at risk for respiratory failure. Methods The authors conducted a retrospective review of a consecutive series of 89 patients with odontoid fractures who were treated over a 5-year period to identify 53 patients with displaced Type II odontoid fractures. Patient demographics, degree of displacement, respiratory status, treatment method, and outcome were examined. Of the 32 patients with posteriorly displaced fractures, 13 experienced acute respiratory compromise, whereas only one of 21 patients with anteriorly displaced fractures had respiratory difficulties (p = 0.0032). The average posterior displacement was 6.9 mm. All 13 were initially managed using flexion traction for reduction of these fractures. Two of these patients died because of failure to emergently secure an airway during closed treatment of the fracture. Conclusions Frequent respiratory deterioration during acute closed reduction of posteriorly displaced Type II odontoid fractures was observed, whereas respiratory failure in patients with anteriorly displaced fractures was rare. The use of the flexed cervical position in the setting of retropharyngeal edema rather than the direction of the displacement may substantially increase the risk of respiratory failure. This may prompt early elective nasotracheal intubation during closed reduction of posteriorly displaced Type II odontoid fractures that require a flexed posture.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/foc.2000.8.6.6
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2000
    detail.hit.zdb_id: 2026589-X
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    Online Resource
  • 3
    Online Resource
    Online Resource
    Efficacy of anterior odontoid screw fixation in elderly patients with Type II odontoid fractures
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2000
    In:  Neurosurgical Focus Vol. 8, No. 6 ( 2000-06), p. 1-4
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 8, No. 6 ( 2000-06), p. 1-4
    Abstract: Type II odontoid fractures are the most common trauma-related dens fracture. Although Type III odontoid fractures have a high union rate when external immobilization is applied, Type II fractures are associated with high rates of nonunion, particularly in elderly patients and those with posteriorly displaced fractures or fractures displaced by more than 6 mm. Because elderly patients may not also tolerate external immobilization in a halo vest, alternative techniques should be explored to identify a method for managing these higher-risk patients. In this study the authors examine the efficacy of anterior odontoid screw fixation in a high-risk group of 10 elderly patients ( 〉 65 years of age) treated for Type II odontoid fractures. Methods A retrospective review of all patients with Type II odontoid fractures treated at two institutions between September 1997 and March 2000 was performed. Demographic data, neurological examination, fracture type and degree of displacement, treatment method, and outcome data were examined at discharge. Ten patients older than 65 years who had sustained a trauma-related odontoid fracture and had undergone an anterior odontoid screw placement procedure were retrospectively reviewed. Fracture displacement (mean 6.6 mm) was observed in all but one patient, and in seven there were posteriorly displaced fractures. Seven were successfully treated with anterior screw fixation and external orthosis alone; in one patient in whom poor intraoperative screw purchase had been observed, the fracture healed after undergoing halo vest therapy. Only one patient was shown to develop a nonunion requiring a subsequent posterior fusion procedure. Conclusions Odontoid screw fixation can be safely performed in elderly patients, and frequent bone union is demonstrated. However, osteopenia may preclude adequate screw fixation in some patients.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/foc.2000.8.6.7
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2000
    detail.hit.zdb_id: 2026589-X
    Location Call Number Limitation Availability
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    Online Resource
  • 4
    Online Resource
    Online Resource
    Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2004
    In:  Neurosurgical Focus Vol. 16, No. 6 ( 2004-06), p. 1-23
    Details
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 16, No. 6 ( 2004-06), p. 1-23
    Abstract: Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are complex neurological disorders that can be manifested through a variety of symptoms. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. Although patients typically present with acute disc herniations, traumatic injuries at the thoracolumbar junction at the terminal portion of the spinal cord and cauda equina are also common. Unfortunately, a precise understanding of the pathophysiology and optimal treatments, including the best timing of surgery, has yet to be elucidated for either traumatic CES or CMS. In this paper the authors review the current literature on traumatic conus medullaris and cauda equina injuries and available treatment options.
    Type of Medium: Online Resource
    ISSN: 1092-0684
    URL: Article
    DOI: 10.3171/foc.2004.16.6.4
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2004
    detail.hit.zdb_id: 2026589-X
    Location Call Number Limitation Availability
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