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Domenech P, Mariscal G, Marquina V, Bas P, Bas T. Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:159-167. [PMID: 37230411 DOI: 10.1016/j.recot.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To determine, through a systematic review, the effects of halo gravity traction in spinal deformity. METHODS Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.
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Affiliation(s)
- P Domenech
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - G Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - V Marquina
- Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, Spain
| | - P Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - T Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Domenech P, Mariscal G, Marquina V, Bas P, Bas T. Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T159-T167. [PMID: 38000543 DOI: 10.1016/j.recot.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/17/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE To determine, through a systematic review, the effects of halo-gravity traction (HGT) in spinal deformity. METHODS Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial HGT were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected. RESULTS Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases). CONCLUSIONS Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.
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Affiliation(s)
- P Domenech
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
| | - G Mariscal
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España.
| | - V Marquina
- Department of Orthopedic Surgery and Traumatology, Valencia General University Hospital, Valencia, España
| | - P Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
| | - T Bas
- Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, España
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Navarrete-Zampaña MD, Fernández-Baillo N, Pizones J, Sánchez-Márquez JM, Sellán-Soto MC. The post-surgical transition in adolescents who have idiopathic scoliosis. A qualitative study. Enferm Clin (Engl Ed) 2023; 33:361-369. [PMID: 37478906 DOI: 10.1016/j.enfcle.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/06/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To know the process experienced by adolescents suffering from idiopathic scoliosis when undergoing surgery to correct the physical deformity. METHOD Qualitative study with a symbolic interactionism approach. 22 semi-structured interviews were conducted with adolescents who underwent posterior spinal fusion in a third-level hospital in Madrid between May 2019 and January 2021. Taylor and Bogdan's analysis in progress was carried out. RESULTS Patients with adolescent idiopathic scoliosis present with a complex simultaneous health/illness and developmental transition. The main inhibitory conditions of the transition are the meanings about: their identity, social, beliefs about surgery, ignorance about the pathology, the surgical process, and their recovery. As facilitating conditions, we find: a positive attitude towards physical, aesthetic, and social change, socioeconomic level, and family support. CONCLUSIONS The informants of this study refer that aesthetic affectation and physical limitations are the main elements that cause them discomfort. Surgical intervention is presented as the solution to this situation. Recovery is a critical point in the transition process mainly due to pain. They accept the discomfort suffered during the recovery because they hope to obtain an improvement in the image and physical limitations. The changes and differences they experience during the transition make them think that they will be able to lead a «normal life» to which they constantly refer in their speeches.
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Affiliation(s)
| | | | - Javier Pizones
- Unidad de Columna, Hospital Universitario La Paz, Madrid, Spain
| | | | - María Carmen Sellán-Soto
- Red ENSI-España, Madrid, Spain; Departamento de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; IdiPAZ, Madrid, Spain
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Gómez Cristancho DC, Jovel Trujillo G, Manrique IF, Pérez Rodríguez JC, Díaz Orduz RC, Berbeo Calderón ME. Neurological mechanisms involved in idiopathic scoliosis. Systematic review of the literature. Neurocirugia (Astur : Engl Ed) 2023; 34:1-11. [PMID: 35256329 DOI: 10.1016/j.neucie.2022.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 02/01/2023]
Abstract
The literature that explains the neurological mechanisms underlying the development or compensation of idiopathic scoliosis is limited. The objective of the article is to describe and integrate the mechanisms and nerve pathways through which idiopathic scoliosis is compensated and/or developed. A narrative systematic review in different databases of the studies published between January 1, 1967 and April 1, 2021 was performed, using the following terms: "scoliosis", "vision", "eye", "vestibule", "labyrinth" "posture", "balance", "eye movements", "cerebellum", "proprioception", and "physiological adaptation". In the search, 1112 references were identified, of which 50 were finally included: 46 observational analytical clinical studies-descriptive (between cohorts, report and series of cases) and 4 experimental studies. In the neurological response to idiopathic scoliosis, the sensory-cortical integration of the afferences in the visual-oculomotor-vestibular-proprioceptive systems, allows modifications at the postural level in order to achieve an initial compensation on the sagittal balance and the centre of body mass; however, over time these compensation mechanisms may be exhausted causing progression of the initial deformity.
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Affiliation(s)
- David Camilo Gómez Cristancho
- Médico General, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Gabriela Jovel Trujillo
- Estudiante de Medicina, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Iván Felipe Manrique
- Estudiante de Medicina, Miembro Semillero Neurología y Neurocirugía, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Roberto Carlos Díaz Orduz
- Médico Neurocirujano, Pontificia Universidad Javeriana-Hospital Universitario San Ignacio, Bogotá, Colombia
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Bitler J, Cernadas CC, Montivero NA, Eymann A. Juvenile scoliosis as the first manifestation of syringomyelia associated with Chiari malformation type I. Bol Med Hosp Infant Mex 2023; 80:28-32. [PMID: 37490682 DOI: 10.24875/bmhime.m23000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/28/2022] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Scoliosis is a spinal deformity that usually manifests as a structural curve determining a variable deformity of the trunk. According to some published series, 4 to 26% of scoliosis initially classified as idiopathic show neurological alterations when studied with nuclear magnetic resonance, such as syringomyelia and Chiari malformation, among the most frequent. Chiari malformations are characterized by descending herniation of the cerebellar tonsils, brainstem, and IV ventricle into the spinal canal. CASE REPORT We present the case of a patient whose first symptomatic manifestation was early-onset scoliosis. The overlapping of some physical examination signs, such as postural lateralization and scoliosis, reinforced the active suspicion of neuroaxis alterations. CONCLUSIONS Early childhood-onset scoliosis should raise a high degree of suspicion for association with neuro-spinal diseases. Although the frequency of Chiari malformation is low, its early approach could reduce the progression of associated comorbidities. An early detection could change the prognosis of the disease.
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Affiliation(s)
| | | | | | - Alfredo Eymann
- Servicio de Clínica Pediátrica
- Departamento de Pediatría, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
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López-Puerta JM, Fernández-Marín MR, Martín Benlloch JA, Lorente R. Spinal osteoid osteoma recurring as an aggressive osteoblastoma. Neurocirugia (Astur) 2020; 31:146-50. [PMID: 31488355 DOI: 10.1016/j.neucir.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/26/2019] [Accepted: 06/08/2019] [Indexed: 11/24/2022]
Abstract
We report an uncommon case of osteoid osteoma recurring as an aggressive osteoblastoma of the spine. A 15-years-old male consulted in our department with long-term painful scoliosis. The CT-scans and MRI revealed a sclerotic bone forming tumor of 7mm diameter consistent with a osteoid osteoma. A percutaneous radiofrequency ablation was performed with complete resolution of the symptoms. After 6 months, the symptoms recurred. A new CT and a MRI showed a growth of the nidus on the right L4 lamina, with a size of 15mm. Therefore, a marginal resection by laminectomy of L4 was performed. Pathology confirmed an epithelioid osteoblastoma. A year later, subsequent imaging studies showed a new recurrence with aggressive features and invasion of the spinal canal. The patient then underwent an "in block surgery" needing concurrent stabilization of the spine. Histopathology confirmed the diagnosis of epithelioid osteblastoma.
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Navarrete-Zampaña MDLD, Sellán-Soto MC, Díaz-Martínez ML. Painful experience in adolescents undergoing surgical correction of scoliosis. Enferm Clin (Engl Ed) 2019; 29:297-301. [PMID: 30685342 DOI: 10.1016/j.enfcli.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of our study is to learn about the post-surgical pain experience in adolescents undergoing surgical correction of Adolescent Idiopathic Scoliosis (AIS). METHODS Qualitative study with an interpretative phenomenological approach. Through semi-structured interviews, 7 informants, women aged between 12 and 21, were interviewed between the third and fifth day after being surgically treated for AIS correction. The speeches were recorded and transcribed verbatim. Content Analysis method was used to analyse the discourse. RESULTS The categories established were: influential factors, values and ideas, coping mechanisms and improvement areas. Painful experience is a determining factor during recovery, influenced by the individuals themselves, as well as by the support received, and the environment. Their main values and ideas about the process are based on pre-surgical information, which they consider insufficient. In order to cope, they use of distraction, relaxation and drug consumption. According to the informants, increasing the information they are given about the process, facilitating visits and incorporating complementary techniques would improve pain control. CONCLUSIONS Pain is the main focus of the process and is influenced by several factors. The patients' coping mechanisms help in its management. They also put forward different improvement areas.
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Affiliation(s)
| | - María Carmen Sellán-Soto
- Red ENSI-España, Madrid, España; Profesora, doctora, Departamento de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - María Luisa Díaz-Martínez
- Red ENSI-España, Madrid, España; Profesora, Departamento de Enfermería, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
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Leal-Hernández M, Martínez-Monje F, Pérez-Valencia M, García-Romero R, Mena-Poveda R, Caballero-Cánovas J. [Analysis of the quality of life in patients affected by scoliosis]. Semergen 2018; 44:227-33. [PMID: 28506755 DOI: 10.1016/j.semerg.2016.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/06/2016] [Accepted: 11/22/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the quality of life using the SRS 22 test in patients with scoliosis of 20 or more degrees Cobb. MATERIAL AND METHODS A prospective descriptive study was conducted between April and May 2016 on patients with scoliosis of at least 20 degrees Cobb and aged between 10 and 20 years. A record was made of weight, height, body mass index, and the SR 22 specific quality of life questionnaire for patients with scoliosis was completed. Patients were divided into two groups for analysis: a) scoliosis between 20 and 29 degrees Cobb (n=44); and b) scoliosis with a Cobb of 30 degrees or greater (n=32). RESULTS There were significant differences in the dimensions that assess pain, image self-perception, and satisfaction with treatment, being valued worse when the degree of scoliosis Cobb is 30 degrees or higher. There were no significant differences in function/activity or mental health. The overall score of the questionnaire was also worse in the group with the highest degree of scoliosis. The weight, height, and BMI showed no significant differences due to the varying degrees of scoliosis. CONCLUSIONS Scoliosis significantly affects the quality of life of people who suffer it, and there is a negative correlation between the severity of scoliosis measured by degrees Cobb and quality of life.
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Perez-Ferrer A, Gredilla-Díaz E, de Vicente-Sánchez J, Navarro-Suay R, Gilsanz-Rodríguez F. Vancomycin added to the wash solution of the cell-saver. Effect on bacterial contamination. Rev Esp Anestesiol Reanim 2017; 64:185-191. [PMID: 28094033 DOI: 10.1016/j.redar.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study is to test whether the addition of a low-dose of antibiotic (vancomycin) to the wash solution (saline) of the cell-saver reduces the incidence of bacterial contamination of the autologous red blood cell (RBCs) concentrate recovered. MATERIAL AND METHOD Experimental, randomized, double-blind, parallel group study performed on 20 consecutive patients scheduled for posterior spinal fusion surgery. Intraoperative bleeding was processed through a cell-saver: HaemoLite® 2+, in which the RBCs were washed according to randomization group, with saline (control group) or saline+10μg/ml-1 vancomycin (vanco group). Data regarding age, weight, processed and recovered volume, blood count, blood culture, and vancomycin concentration in RBCs concentrates obtained and incidence of fever after reinfusion were collected. RESULTS Processed volume was 843±403ml and recovered volume 121±29ml, with haemoglobin concentration 10.4±5.0g/dl-1 and haematocrit 29.1±15.9% (mean±SD). Recovered RBC concentrate cultures were positive for coagulase-negative Staphylococcus in 5 cases (50%) of the control group while all cultures were negative in the vanco group (P=.016). The difference between the theoretical concentration of vancomycin administered and the concentration determined in the recovered RBC concentrate was 1.31μg/ml-1 (95% CI 1.19 to 1.43; P=.074). CONCLUSIONS The addition of vancomycin at a concentration of 10ug/ml-1 to the wash solution of the cell-saver achieved similar concentrations in the autologous blood concentrate recovered allowing for bacterial removal, with negative blood cultures in all cases.
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Affiliation(s)
- A Perez-Ferrer
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Gredilla-Díaz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - J de Vicente-Sánchez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - R Navarro-Suay
- Servicio de Anestesiología y Reanimación, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - F Gilsanz-Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
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Fernández-Vega Cueto A, Rodríguez-Ezcurra JJ, Rodríguez-Maiztegui I. Horizontal gaze palsy and progressive scoliosis in a patient with congenital esotropia and inability to abduct. A case report. ACTA ACUST UNITED AC 2016; 91:592-595. [PMID: 27318526 DOI: 10.1016/j.oftal.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
CASE REPORT The case is presented on a 4- year-old child with congenital esotropia, limitation of abduction, cross-fixation, and thoracolumbar scoliosis. Genetic testing of ROBO3 gene confirmed the diagnosis of horizontal gaze palsy and scoliosis (HGPSS) DISCUSSION: HGPPS is a rare congenital disorder characterised by absence of conjugate horizontal eye movements and progressive scoliosis developed in childhood and adolescence. We highlight this motility disorder as a part of the differential diagnosis of early childhood esotropia with cross- fixation and limitation of abduction.
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Affiliation(s)
- A Fernández-Vega Cueto
- Unidad de Estrabismo y Visión Binocular, Centro de Oftalmología Barraquer, Barcelona, España.
| | - J J Rodríguez-Ezcurra
- Unidad de Estrabismo y Visión Binocular, Centro de Oftalmología Barraquer, Barcelona, España
| | - I Rodríguez-Maiztegui
- Unidad de Estrabismo y Visión Binocular, Centro de Oftalmología Barraquer, Barcelona, España
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Perez-Ferrer A, Gredilla-Díaz E, de Vicente-Sánchez J, Navarro-Suay R, Gilsanz-Rodríguez F. Characteristics and quality of intra-operative cell salvage in paediatric scoliosis surgery. ACTA ACUST UNITED AC 2015; 63:78-83. [PMID: 26162899 DOI: 10.1016/j.redar.2015.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the haematological and microbiological characteristics of blood recovered by using a cell saver with a rigid centrifuge bowl (100ml) in paediatric scoliosis surgery and to determine whether it conforms to the standard expected in adult patients. MATERIAL AND METHODS A cross-sectional, descriptive cohort study was performed on 24 consecutive red blood cell (RBC) units recovered from the surgical field and processed by a Haemolite® 2+ (Haemonetics Corp., Braintree, MA, EE. UU.) cell saver. Data were collected regarding age, weight, surgical approach (anterior or posterior), processed shed volume and volume of autologous RBC recovered, full blood count, and blood culture obtained from the RBC concentrate, and incidence of fever after reinfusion. RESULTS The processed shed volume was very low (939±569ml) with high variability (coefficient of variation=0.6), unlike the recovered volume 129±50ml (coefficient of variation=0.38). A statistically significant correlation between the processed shed volume and recovered RBC concentrate haematocrit was found (Pearson, r=.659, P=.001). Haematological parameters in the recovered concentrate were: Hb 11±5.3g dl(-1); haematocrit: 32.1±15.4% (lower than expected); white cells 5.34±4.22×103 ul(-)1; platelets 37.88±23.5×103 ul(-1) (mean±SD). Blood culture was positive in the RBC concentrate recovered in 13 cases (54.2%) in which Staphylococcus coagulase (-) was isolated. CONCLUSIONS Cell salvage machines with rigid centrifuge bowls (including paediatric small volume) do not obtain the expected haematocrit if low volumes are processed, and therefore they are not the best choice in paediatric surgery.
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Affiliation(s)
- A Perez-Ferrer
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Gredilla-Díaz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - J de Vicente-Sánchez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - R Navarro-Suay
- Servicio de Anestesiología y Reanimación, Hospital Central de la Defensa Gómez Ulla, Madrid, España
| | - F Gilsanz-Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
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Pérez-Ferrer A, Gredilla-Díaz E, de Vicente-Sánchez J, Sánchez Pérez-Grueso F, Gilsanz-Rodríguez F. Implementation of a patient blood management program in pediatric scoliosis surgery. ACTA ACUST UNITED AC 2015; 63:69-77. [PMID: 26049212 DOI: 10.1016/j.redar.2015.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/07/2015] [Accepted: 04/19/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine whether the implementation of a blood conservation program, and the adoption and progressive association of different methods, reduces transfusion requirements in pediatric patients undergoing scoliosis surgery of different origins. MATERIAL AND METHOD Quasi-experimental, nonrandomized, descriptive study, approved by the Ethics Committee for Research of our institution. 50 pediatric patients (ASA I-III) aged 5 to 18 years, undergoing scoliosis surgery of any etiology by a single posterior or double approach (anterior and posterior) were included. A historical group with no alternatives to transfusion: Group No ahorro=15 patients (retrospective data collection) was compared with another 3 prospective study groups: Group HNA (acute normovolemic hemodilution)=9 patients; Group HNA+Rec (intraoperative blood salvage)=14 patients, and Group EPO (HNA+Rec+erythropoietin±preoperative donation)=12 patients; according with the implementation schedule of the transfusion alternatives in our institution. RESULTS The rate of transfusion in different groups (No ahorro, HNA, HNA+Rec, EPO) was 100, 66, 57, and 0% of the patients, respectively, with a mean±SD of 3.40±1.59; 1.33±1.41; 1.43±1.50; 0±0 RBC units transfused per patient, respectively. Statistically significant differences (P<.001) were found in both the transfusion rate and number of RBC units. CONCLUSIONS The application of a multimodal blood transfusion alternatives program, individualized for each pediatric patient undergoing scoliosis surgery can avoid transfusion in all cases.
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Affiliation(s)
- A Pérez-Ferrer
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Gredilla-Díaz
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - J de Vicente-Sánchez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - F Sánchez Pérez-Grueso
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz-Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
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Agámez Medina GL, Pantin EJ, Lorthé J, Therrien PJ. [Anaesthesia for correction of scoliosis in pediatric patient with Friedreich's ataxia]. ACTA ACUST UNITED AC 2014; 62:42-5. [PMID: 24775406 DOI: 10.1016/j.redar.2014.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/02/2014] [Accepted: 03/04/2014] [Indexed: 12/31/2022]
Abstract
Friedreich ataxia (FA) is an inherited autosomal recessive disease characterized by a neurological degenerative process of the cerebellum, spinal cord, and peripheral nerves. FA is associated with ataxia, dysarthria, motor and sensory impairment, scoliosis, cardiomyopathy, and diabetes. There is a significant risk of perioperative major complications during the anesthetic management of these patients. We present the case of a fourteen-year-old patient with FA, who had a posterior spinal fusion and instrumentation underwent to total intravenous anesthesia.
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Affiliation(s)
- G L Agámez Medina
- Servicio de Anestesia y Reanimación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - E J Pantin
- Department of Anesthesiology, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - J Lorthé
- Department of Anesthesiology, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
| | - P J Therrien
- Pediatric Orthopedics, Robert Wood Johnson Medical School, Rutgers University, New Jersey, USA
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Verdú-López F, Beisse R. [Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous]. Neurocirugia (Astur) 2014; 25:62-72. [PMID: 24456908 DOI: 10.1016/j.neucir.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. DEVELOPMENT After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. CONCLUSIONS Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery.
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Affiliation(s)
| | - Rudolf Beisse
- Wirbelsäulenzentrum Starnberger See Benedictus Krankenhaus, Tutzing, Alemania
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