World Neurosurg
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While prophylaxis with intravenous unfractionated heparin (UFH) can effectively prevent venous thromboembolism (VTE) during the neurocritical care of patients with severe aneurysmal subarachnoid hemorrhage (aSAH), the risk for intracranial bleeding complications might increase. Owing to this therapeutic dilemma, the UFH administration regimen in this critical patient population remains highly controversial. ⋯ Even in high-risk neurocritical patients with severe SAH and prolonged ICU treatment, low-dose UFH-administration for VTE prophylaxis is equally effective as therapeutic UFH administration and carries a lower risk of bleeding complications.
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To date, no information about the cortical bone microstructural properties in atlas vertebrae with arcuate foramen has been reported. As a result, we aimed to test in an experimental model if there is a cortical bone thickening in an atlas vertebra which has an arcuate foramen that may play a protective role against bone fracture. ⋯ An atlas with arcuate foramen presents cortical bone thickening. This advantage in bone microarchitecture seems to contribute to a lower fracture risk compared to subjects without arcuate foramen as no coexistence in the same vertebra of a posterior atlas arch fractures and arcuate foramen was found.
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Observational Study
The Frequency of Re-Surgery After Cervical Disc Nucleoplasty.
In percutaneous cervical nucleoplasty (PCN) a portion of the nucleus tissue is ablated using the Coblation technique. Re-surgery is an important factor for the clinical outcome. However, the rate of subsequent surgery after PCN is still unknown. The aim of this study was to investigate the frequency of an additional open surgery after PCN in a retrospective of more than 10 years. ⋯ This is the first study reporting the frequency of re-surgery after PCN. Overall, 70.7% patient satisfaction was observed after 1 month. This result is worsened because of a re-surgery rate of 19.5%. The data from this study suggest that PCN is a poor replacement for conventional open surgery. Degeneration of the disc is progressive despite or because of PCN.