Neurosurgery clinics of North America
-
The cause of seizures in the neurosurgical intensive care unit (NICU) can be categorized as emanating from either a primary brain pathology or from physiologic derangements of critical care illness. Patients are typically treated with parenteral antiepileptic drugs. ⋯ Late seizures have a more ominous risk for subsequent epilepsy and should be treated for extended periods of time or indefinitely. This review ends by examining the treatment algorithms for simple seizures and status epilepticus and the role newer antiepileptic use can play in the NICU.
-
Neurosurg. Clin. N. Am. · Jul 2013
ReviewManagement of acute spinal cord injury in the neurocritical care unit.
Acute spinal cord injury (SCI) is associated with widespread disturbances not only affecting neurologic function but also leading to hemodynamic instability and respiratory failure. Traumatic SCI rarely occurs in isolation, and frequently is accompanied by trauma to other organ systems. ⋯ Typically this level of care is provided in the neurocritical care unit. This article reviews the pathophysiology of the neurologic, cardiovascular, and pulmonary derangements following traumatic SCI and their management in the critical care setting.
-
The goal of any ambulatory patient is to maintain a horizontal gaze with the least amount of energy expenditure. With progressive deformity, and in particular sagittal malalignment, significant compensatory mechanisms must be used to achieve this goal. ⋯ The pelvis may compensate for decreasing lumbar lordosis (eg, age, flat back deformity) by retroverting and increasing pelvic tilt and decreasing the sacral slope. Underappreciation for these spinopelvic compensatory mechanisms leads to surgical under-correction, iatrogenic flat back and poor clinical outcomes.
-
Various osteotomies are useful in making a rigid deformity flexible enough for realignment in coronal and sagittal plane. This article defines the osteotomies and their usefulness in treatment of specific rigid deformities. The pedicle subtraction osteotomy and vertebral column resection used in treating rigid deformities are described in detail.
-
Neurosurg. Clin. N. Am. · Apr 2013
ReviewClassifications for adult spinal deformity and use of the Scoliosis Research Society-Schwab Adult Spinal Deformity Classification.
Adult spinal deformity (ASD) is a complex disease state that pathologically alters standing upright posture and is associated with substantial pain and disability. This article provides an overview of classification systems for spinal deformity, clarifies the need to differentiate between pediatric and adult classifications, and provides an explanation on the use of the Scoliosis Research Society-Schwab Adult Spinal Deformity Classification (SRS-Schwab ASD Classification). This information allows surgeons, researchers, and health care providers to (1) identify sources of pain and disability in patients with ASD and (2) accurately use the SRSeSchwab ASD Classification to evaluate patients with ASD.