Preventive immobilisation of the cervical spine in pre-hospital emergency care in trauma patients: Update [Preventivní imobilizace krční páteře v přednemocniční neodkladné péči o pacienty s úrazem: aktuální pohled na problematiku]
Jancalek R.,Neurochirurgicka Klinika
Anesteziologie a Intenzivni Medicina | Year: 2016
Cervical spine or spinal cord injury occurs in 2-3% of trauma patients. Preventive immobilization of the cervical spine during prehospital care in trauma patients is common clinical practice because of the secondary spinal cord injury risks due to patient manipulation. The potential negative impacts of immobilization with hard cervical collar have led to the rise of the concept of selective cervical spine immobilization. Cervical immobilization of trauma patients who are (i) awake, alert, and are not intoxicated; (ii) who are without neck pain or tenderness; (iii) who do not have abnormal neurological examination; and (iv) who do not have any significant associated injury that might detract from their general evaluation, is not recommended. On the other hand, if any of the above four criteria is present, immobilization of the cervical spine is indicated. Spinal immobilization in patients with penetrating trauma is not recommended because of the increased mortality due to delayed resuscitation.
Smrcka M.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2011
Head injury is defined as severe in patients with a post-resuscitation Glasgow coma scale (GCS) figure of ≤8. Such patients are relatively deeply unconscious and cannot follow instructions. Therefore we need continuously to monitor those parameters that provide us with important information regarding patient condition and brain function. In recent years, the possibility of monitoring certain cerebral and intracranial function parameters has been added to the routine intensive care watch repertoire of pulse oxymetry, blood pressure, body temperature, laboratory monitoring, central venous pressure, fluid balance, end-tidal CO2, etc. Monitoring of neurological status, particularly the level of consciousness (GCS) and the pupils is obvious. In terms of invasive intracranial monitoring it is currently practically mandatory that intracranial pressure (ICP) be monitored, either by means of external ventricular drainage or by intraparenchymal probe. As well as this, we monitor cerebral perfusion pressure (CPP). Monitoring of brain tissue oxymetry (PtiO2) is becoming a standard modality, while microdialysis is also frequent in some departments. CT monitoring is very important to the clinician, particularly in the initial phases after the injury, mainly as an indication for decision-making in certain operative procedures. Individual approaches to multimodal monitoring have to be evaluated in relationship to one another and the patient. Special types of software help us to evaluate the indices of vascular reactivity and this knowledge is currently used to establish the optimal CPP for the individual patient. Monitoring of cerebral physiology should not be purposeless, but should serve for early diagnostics of pathological conditions and at the same time may indicate a correctly performed therapeutical intervention.
[Anterior interbody fusion of the cervical spine with a zero-p spacer: radiographic results with a minimum follow-up of one year in a prospective study]. [Přední mezitělová spondylodéza krční páteře klecí Zero-P (Prospektivní studie - radiologické výsledky s minimálně ročním sledováním).]
Vanek P.,Neurochirurgicka klinika
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca | Year: 2011
The aim of this study was to compare the efficacy of anterior cervical microdiscectomy and fusion carried out using a newly designed interbody spacer with that of a standard cage plate construct in patients with symptomatic cervical spine spodylosis. The comparison was based on radiographic results and fusion rates. A total number of 113 consecutive patients were enrolled in this prospective study between October 2008 and July 2009. Mono- or bisegmental spondylosis was diagnosed in the patients in whom conservative treatment of cervicobrachial symptoms had had no effect. Patients with myelopathy were not included.. All patients underwent standard anterior microdiscectomy (at one or two levels). The novel anchored spacer Zero-P was used in 61 patients (group 1) and, in 52 patients, stabilisation was done using the interbody spacer Cornerstone and dynamic plate Premier (group 2). Lateral radiographic views of the cervical spine were obtained before surgery and at 6 weeks, and then at 3, 6 and 12 months after surgery. During follow-up, the cervical spine sagittal alignment (CobbC), segmental angle of the treated levels (CobbS), amount of segmental collapse and fusion rates were measured. There was no significant difference in CobbC between the two groups during follow- up (p < 0.051). A significant difference in the first two values of CobbS was found (p < 0.001), but next changes in CobbS were without any difference in either group. The mean degree of interspace collapse was without any significant difference between the groups. The fusion rate was significantly higher in group 1 than group 2 nine months after surgery (p = 0.032), but was the same in both groups at 12 months after surgery (p = 1.0). The anchored spacer Zero-P provides biomechanical stability for the cervical spine similar to the cage and dynamic plate construct. Efforts to improve the cervical stand-alone anterior fusion device and to eliminate disadvantages of plate systems should be studied in larger patient groups with longer follow-ups. Key words: cervical spine, interbody fusion, fusion rate, radiology, stand-alone implant, Zero-P.
Hovorka J.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2010
In this paper we provide an overview of the basic principles of the treatment of epilepsy. These include attention to certain key points: making a correct diagnosis; the risk of seizure recurrence; the decision to initiate drug therapy in newly-diagnosed epilepsy; drug choice in relation to seizure/syndrome type and individual patient characteristics; treatment strategy in terms of monotherapy or of combination therapy; the treatment of pharmaco-resistant epilepsy, and finally the decision to withdraw antiepileptic drug(s) from seizure-free patients.
Kaiser R.,Neurochirurgicka Klinika |
Haninec P.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2012
Entrapment neuropathies of the lower limbs are rare. We present a series of four patients treated for tibial nerve compression in the tarsal tunnel. The symptoms developed spontaneously in two patients while the other two had a history of ankle injury. Transection of the flexor retinaculum and exoneurolysis of the tibial nerve and its branches was effective in all patients. The tarsal tunnel syndrome should be considered in all patients who develop pain and sensory disturbances in the sole and have a negative finding in the lumbar spine. EMG confirms the finding. Surgical treatment is simple and has good results.
Haninec P.,Neurochirurgicka Klinika |
Kaiser R.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2011
Brachial plexus injury has been attracting increasing attention in recent times, partly because of an increasing incidence arising out of higher survival rates for patients after polytrauma and also due to higher success rates for surgical treatment. Obstetric brachial plexus palsy has recently become the focus of interest for a number of articles. Many injured elements of the brachial plexus are reconstructed by a donor nerve transferred onto the recipient nerve, i.e. by neurotization. This method leads to better outcomes than suture of the injured nerve in the proximal part of the plexus, the main advantage of which is the opportunity to place the suture as close to the muscle as possible. There are two newer methods - Oberlin's technique and end-to-side anastomosis. It remains unclear as to which donor nerve is better to use for neurotization in specific recipients due to a lack of large, randomized clinical trials. Generally, neurotization using the intraplexal nerve as a donor of motor nerve fibres is more successful than neurotization using the extraplexal nerve.
Vaverka M.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2012
Objective: The author's experience with more than 2,200 open surgical releases of carpal tunnel syndrome with no serious complications are presented and compared with modern endoscopic methods. Patients and methods: Over 13 years, one surgeon had operated all patients using the same surgical technique. Patients from the last two years were followed-up prospectively, evaluating anatomical variants and all kinds of complications. Results: In 221 patients 299 surgeries were performed, 89 on the right side, 54 on the left and 78 on both hands (35.3%). Surprisingly positive results were also achieved in a subgroup of 87 seniors over 65 yrs. There was no injury to the median nerve or branches, postoperative hematoma or infection was not present. An important surgical variant was identified in 3 cases (1%), a minor anatomical change in 10%. Reoperation for scarring was needed in two cases (0.7%), with good final results. After 6 months, grip dysfunction and pillar syndrome were present in 1% of cases only, tendovaginitis of flexor pollicis longus was also treated in 1%. Conclusion: Open surgical approach - mini-open technique - still offers excellent results with minimal number of complications and minimal financial expenses.
Mracek J.,Neurochirurgicka klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2016
The fundamental idea behind decompressive craniectomy (DC) is a surgical solution to the conflict of an increasing intracranial content within the fixed-volume intracranial cavity. The expanding intracranial content is caused by brain edema caused by a variety of pathologies. In spite of DC renaissance over the recent years and some evidence of its effectiveness, its use is not yet generally accepted. Traumatic brain injury is by far the most frequent indication for DC. However, the evidence of its effectiveness is limited. Data on the role of secondary decompression in patients with refractory intracranial hypertension after conservative treatment failure are expected to be released soon. Bifrontal early DC is not superior to medical management in patients with diffuse traumatic injury. Primary decompression in patients with acute subdural haematoma has been investigated in a randomized trial. The most conclusive evidence is in patients with malignant middle cerebral artery infarction. In spite of this, the surgery is still underutilized and the frequency of its use does not correspond with the incidence of malignant infarction. When decompression is performed within 48 hours of stroke onset in patients younger than 60 years, it reduces mortality and improves functional outcome. DC is also a lifesaving procedure in patients over 60 years of age for whom it improves chances of survival without total dependency. Decompression should be considered in patients with cerebral venous thrombosis that causes intractable intracranial hypertension. Furthermore, patients with bilateral mydriasis can also profit from the procedure. DC with or without hematoma evacuation might reduce mortality in patients with large supratento- rial intracerebral hemorrhage who are in coma or have refractory intracranial hypertension. Even though the DC can be effective in selected subgroups of patients with subarachnoid hemorrhage, current guidelines, do not specify the role of decompression in these patients.
Treatment of Degenerative Spondylolisthesis of the Lumbosacral Spine by Decompression and Dynamic Transpedicular Stabilisation [Operace degenerativní spondylolistézy lumbosakrální páteře dekompresí a dynamickou transpedikulární stabilizací]
Hrabalek L.,Neurochirurgicka klinika |
Wanek T.,Neurochirurgicka klinika |
Adamus M.,Klinika anesteziologie a resuscitace
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca | Year: 2011
Purpose of the Study The aim of the study was to present the effect and advantages of surgical decompression and dynamic transpedicular stabilisation in patients with degenerative spondylolisthesis of the lumbosacral spine. Material and Methods This prospective study involved patients undergoing dynamic transpedicular stabilisation using Isolock or Isobar TTL (Scient X, France) systems. Between June 2003 and June 2009, 65 patients were treated and followed-up. They were aged 35 to 75 years (average, 57.17 years), and there were 32 men and 33 women. Follow-up ranged from 1 to 6 years. Based on indications for surgery they fell into two groups. Group 1 included 52 patients with grade I or II degenerative spondylolisthesis or retrolisthesis. Group 2 (control) consisted of 13 patients with degenerative disc disease or failed back surgery syndrome. The disorder had always been manifested by combined axial and radicular symptoms. Treatment included posterior decompression of nerve structures by laminectomy in conjunction with semi-rigid stabilisation, without fusion. Follow-up clinical (VAS, ODI), neurological and radiographic examinations were carried out at 6 weeks, 6 months and 1 to 6 years after surgery. The VAS and ODI results of both groups were statistically analysed and compared. Results During follow-up the ODI values decreased by 54 % (from 58.4 % to 26.8 %) and VAS values by 62 % (from 7.9 to 3.0) as compared with the pre-operative values, and this was statistically significant. When both groups were compared, the VAS values decreased significantly (by 5.61) in Group 1, as compared with Group 2 (decrease by 3.54). Discussion In the treatment of pseudospondylolisthesis, the semi-rigid stabilisation with spinal decompression, as presented here, is a convenient alternative to simple decompression without fixation or to various forms of instrumented or non-instrumented arthrodesis. A disadvantage associated with arthrodesis is a higher risk of ASD development; dynamic systems do not allow for reduction of spondylolisthesis and involve a change in sagittal spinal balance, and simple decompression carries the risk of slip progression and recurrent problems. Conclusions The authors demonstrated that decompression combined with semi-rigid stabilisation had a very good effect on the clinical state of patients with degenerative spondylolisthesis (retrolisthesis) at medium-term follow-up. The procedure was less effective in other indications. Semi-rigid stabilisation with Isobar TTL or Isolock systems prevented the progression of anterolisthesis or retrolisthesis; none of the patients experienced instrumentation failure. Neither symptomatic restenosis nor disc herniation was found in the instrumented segment. Semi-rigid stabilisation can, if necessary, be converted to fusion or disc replacement.
Vybihal V.,Neurochirurgicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2014
Hydrocephalus is a disease developing as a result of failure in production, circulation or resorption of the cerebrospinal fluid. It develops due to congenital or acquired causes, including bleeding, inflammation, injury or tumour. Clinical symptoms depend on age, type and speed of development of hydrocephalus. Computed tomography, magnetic resonance and ultrasound in children with open anterior fontanel are used to diagnose hydrocephalus. Surgical therapy is a gold standard for the treatment of hydrocephalus. Shunt surgeries are performed more frequently than other types of surgical interventions. Ventriculoperitoneal shunts are preferred due to less serious complications that are easy to repair. Ventriculoatrial shunts are implanted when it is not possible to drain cerebrospinal fluid into the abdominal cavity. The need for multiple surgical revisions makes shunt surgery difficult. Endoscopic operations have a low complication rate and do not require implantation of a foreign material. However, endoscopic operations are not suitable in all types of hydrocephalus. They are mainly indicated in obstructive hydrocephalus, although they can also be used in some types of communicating hydrocephalus. In these instances, however, success rate is lower.