摘要:

&NA;To determine the incidence of acute complications of an operation in a large cross‐section of U.S. community hospitals, we developed a method that combines the screening of discharge abstracts with the sampling of medical records. Our target patients were those who underwent discectomy for routine lumbar discogenic radiculopathy. We assembled 39,389 discharge abstracts of patients who underwent lumbar discectomy in the U.S. in 1980. This population contained some nontarget patients with a) errors in principal diagnosis or procedure, b) operations exceeding two levels, c) fusion, d) previous laminectomy, or e) problems of the lumbar spine in excess of routine disc disease. Screening of discharge abstracts allowed us to exclude some of these patients. Those remaining were then divided by the reported hospitalization into three groups: 1) death, 2) nonfatal complication, and 3) normal hospitalization. A sample of patients from each group was selected for detailed study, and questionnaires were mailed to hospital medical records departments to confirm the hospitalization and to obtain other medical information unavailable in the abstract. With this information, we 1) removed the remaining nontarget patients (athrougheabove); 2) categorized reported complications as erroneous, preexistent, trivial or major; 3) calculated the incidence of major complications; and 4) assessed the reliability of the discharge abstract data. Principal diagnosis and procedure were reliably coded in 96.5% of abstracts. No deaths were reported in error and none were excluded in error. Among patients who had complications, 4% of the abstracts incorrectly indicated complications, and 11% omitted one complication while correctly reporting others. Among the abstracts reporting a normal hospitalization, 0.7% omitted a complication. The abstract data had a 62% sensitivity and a 99% specificity for complications. Based on a final clean population of 28,395 patients, the incidence of death (per 10,000) was 5.9, and that of serious complication was 157. (Neurosurgery25:218‐225, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;We determined the incidence of acute, major complications in a population of 28,395 patients who underwent lumbar laminectomy for discogenic radiculopathy in the United States in 1980. This population was drawn from a broad cross‐section of community hospitals and represented 31% of all patients who underwent laminectomy that year for this condition. Our cohort excluded patients with a) operations exceeding two disc levels, b) fusion, c) previous lumbar laminectomy, or d) coexistent discitis, spondylosis, spinal stenosis, myelopathy, or arachnoiditis. The incidence of death was 5.9 per 10,000. The causes of death were septicemia, myocardial infarction, and pulmonary emobolus. The incidence of at least one major complication was 157 per 10,000. The incidences of specific complications were as follows: infection requiring intravenously administered antibiotics, 30.7; major neurological deficit, 29.8; pulmonary embolus, 10.7; and myocardial infarction, 5.6. We studied four additional categories of complication. Patients were counted only when a second operation was required to treat the complication. The categories and incidence per 10,000 were as follows: incisional hematoma, 8.7; cerebrospinal fluid fistula, 10.5; ventral perforation, 1.6; and retention of a foreign body, 0.7. Among the patients whose hospitalizations were otherwise normal, 6.7% received a blood transfusion; of the patients whose hospitalizations were complicated, 24% required transfusion. The demographic characteristics of patients with a normal hospitalization were tabulated separately from those whose hospitalizations were complicated. Neurosurgeons performed 60% of the operations, and orthopedic surgeons performed 40%. The speciality of the surgeon was not a factor in determing the risk involved in surgery. Spinal anesthesia was used in 7% of the cases, and no pattern of complications emerged that was uniquely related to that technique. (Neurosurgery25:226‐231, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A series of 16 patients with symptoms such as pain in the neck, occiput, shoulder and arm; numbness in the hands: and/or difficulty in walking, is described. Neurological examination of the upper extremities disclosed signs of nerve roots dysfunction in 5 patients and long tract signs in 12, whereas examination of the lower extremities disclosed long tract signs in every patient. Positive contrast cervical myelograms suggested mild posterior bulging of one or two intervertebral discs in every patient, but computed tomographic myelograms invariably demonstrated a coincident narrow cervical spinal canal, thus revealing the true compressive potential of the aforementioned mild disc protrusion on the spinal cord. All patients underwent anterior cervical microdiscectomy of the offending disc or discs, which were found to be degenerated. No case of frank rupture of the anulus was identified. Response to treatment was graded as excellent in 12 patients, who had complete relief of symptoms, and good in 4 patients, who had mild residual complaints. This study suggests that incompetence (bulging) of a cervical intervertebral disc may acquire important clinical significance in the presence of a narrow spinal canal by compressing the spinal cord and the corresponding nerve roots. Surgical removal of the diseased disc may result in restoration of neurological function. (Neurosurgery25:232‐239, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A variety of surgical techniques is available for treatment of metastatic disease of the spine. Prior emphasis on the use of these procedures has been on their benefit as a palliative measure to relieve signs and symptoms of spinal cord and nerve root compression not aided by radiation therapy and corticosteroid administration. More recently, development of surgical techniques that combine neural decompression with restoration of spinal stability has brought about consideration of additional indications for surgery in the treatment of metastatic disease of the spine. The present scope of such surgical procedures is reviewed along with identification of the most reliable selection factors for surgical candidates in order to improve functional outcome from surgical treatment of metastatic disease of the spine. Over 70 surgical series with more than 2,000 patients treated were reviewed. (Neurosurgery25:240‐252, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A detailed autopsy and autoradiographic study was performed after the death of a patient undergoing intrathecal, antibody‐guided irradiation for carcinomatous meningitis. The results demonstrated tumor cells infiltrating the surface meninges and a severe astrocytic reaction associated with oedema in the periventricular and brain stem subpial white matter. This was not seen in cortical or other gray matter structures. Autoradiographic examination correlated well, demonstrating isotope within the oedematous areas of the white matter in addition to the expected concentration in the leptomeningeal layers. These findings are discussed in the context of antibody binding to tumor tissue and the possible benefits conferred in the treatment of infiltrating tumor cells. (Neurosurgery25:253‐258, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Three patients, ages 69, 67, and 74 years, respectively, underwent surgical removal of cystic cerebellar astrocytomas. All three had past histories pointing to the existence of a cerebellar lesion for many decades prior to surgery: Patient 1 had had nystagmus on lateral gaze on the side of the tumor since early childhood; Patient 2 had had sensorineural hearing loss on the side of her neoplasm for 38 years preceding the operation; and Patient 3 was diagnosed as having a brain tumor 51 years before the operation. (He has been blind because of pressure hydrocephalus for half a century, but otherwise managed to live a productive farming and family life until he sustained a head injury in a car accident, which forced him to undergo removal of his cerebellar tumor.) The neoplasms in all three instances were found by histological examination to be low‐grade astrocytomas. These cases indicate that low‐grade cerebellar astrocytomas, which are well known for their characteristically long postoperative courses, may at times manifest a slow growth potential with an exceptionally long preoperative course. (Neurosurgery25:258‐264, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Chemical meningitis resulting from the spillage of the contents of a cystic tumor rarely constitutes the sole manifestation of a cranial or spinal tumor. The case of a man who initially had signs and symptoms of meningitis that on computed tomographic scan was shown to be a space‐occupying cerebellar lesion is reported. Thirty‐five cases of cranial and spinal tumors in which the presenting symptom was chemical meningitis are also reviewed. (Neurosurgery25:264‐270, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Microvascular Doppler recordings were taken from the nidus and draining system of a dural spinal cord arteriovenous malformation during operative treatment. Doppler signals readily showed the direction of blood flow in the draining vein and the hemodynamic effects of surgical maneuvers. Recording during alterations of mean arterial blood pressure and partial carbon dioxide pressure (pCO2) demonstrated lack of autoregulation and impaired CO2reactivity in the AVM nidus. Microvascular Doppler techniques provide useful intraoperative assessment of the hemodynamics of arteriovenous malformations of the spinal cord. (Neurosurgery25:270‐275. 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Patients treated with barbiturate coma for elevated intracranial pressure after head injury may suffer brain death. Since such patients have an iatrogenically induced absence of neurological function, brain death cannot be diagnosed clinically. Furthermore, as demonstrated by two of our patients, monitoring of intracranial pressure, even in the face of brain death, may show a low intracranial pressure and an intracranial pulse, suggesting the presence of adequate cerebral perfusion pressure and, therefore, brain viability. Under these circumstances. however, significant intracranial blood flow may be absent. Therefore, we suggest that a patient in barbiturate coma should undergo serial blood flow studies. even when the intracranial pressure is low and an intracranial pulse is present. to determine whether brain death has occurred. (Neurosurgery25:275‐278, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Post‐traumatic cervical epidural hematoma is an uncommon entity. A case is presented in which such a lesion developed after chiropractic manipulation of the neck. The patient presented with a Brown‐Séquard syndrome, which has only rarely been reported in association with cervical epidural hematoma. The correct diagnosis was obtained by computed tomographic scanning. Surgical evacuation of the hematoma was followed by full recovery. (Neurosurgery25:278‐280, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID