European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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In a 63-year-old, 165-cm-tall woman with a history of repeated tick bites, dilative cardiomyopathy, osteoporosis, progressive head ptosis with neck stiffness and cervical pain developed. The family history was positive for thyroid dysfunction and neuromuscular disorders. Neurological examination revealed prominent forward head drop, weak anteflexion and retroflexion, nuchal rigidity, weakness of the shoulder girdle, cogwheel rigidity, and tetraspasticity. ⋯ The response to anti-Parkinson medication was poor. In conclusion, dropped head syndrome (DHS) may be due to multi-organ mitochondriopathy, manifesting as Parkinsonism, tetraspasticity, dilative cardiomyopathy, osteoporosis, short stature, and myopathy. Anti-Parkinson medication is of limited effect.
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The influence of additional dorsal structure damage on anterior stabilization of a thoracolumbar fracture is still unknown. Screw-cement enhancement can be used to reinforce the stability of anterior instrumentation. We have developed a new anchorage system for fixation of anterior stabilization devices, adapted through geometric optimization and the additional option of cementation after screw insertion. ⋯ It was also compared with a single anterior, posterior or combined procedure in the presence of additional dorsal structure damage (vertebrectomy). The use of an additional cementable screw dowel enhanced the primary stability of the anterior instrumentation, compensating for dorsal instability. These results are warranted for the clinical use of minimally open or endoscopic techniques, creating the highest possible primary stability while performing a single anterior enhanced instrumentation with a tissue-preserving approach.
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Orthopaedic patients frequently require blood transfusions to treat peri-operative anemia. Research in the area of hemoglobin substitutes has been of great interest since it holds the promise of reducing the reliance on allogeneic blood transfusions. The three categories of hemoglobin substitutes are (1) cell-free, extracellular hemoglobin preparations made from human or bovine hemoglobin (hemoglobin-based oxygen carriers or HBOCs); (2) fluorine-substituted linear or cyclic carbon chains with a high oxygen-carrying capacity (perfluorocarbons); and (3) liposome-encapsulated hemoglobin. ⋯ This has been demonstrated in vascular, cardiothoracic, and orthopaedic patients. HBOC-201, which is a preparation of cell-free bovine hemoglobin, has been approved for clinical use in South Africa. These products may well become an important tool for physicians treating peri-operative anemia in orthopaedic patients.
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Aprotinin is a potent pharmacological agent that reduces bleeding and limits blood transfusion requirements in current surgical practice. Many studies have been conducted in orthopedic surgery. In several trials performed in total hip replacement (THR) and total knee replacement (TKN) patients, aprotinin only moderately decreased blood-loss-replacement requirements. ⋯ The only major side effect could be the potential occurrence of an anaphylactoid reaction. Prophylactic administration of aprotinin should be considered in extensive spine surgery and in high-risk major orthopedic operations. The decision to use aprotinin should be guided by a risk/benefit analysis.
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Spinal surgery in adults can vary from simple to complex and can also have variable anticipated surgical blood loss. There are several factors that can put patients at increased risk for greater intraoperative blood loss. These factors, including a review of the literature, will be discussed.