Preferred Angle

The tops of the screws have a tulip. The tulip is typically polyaxial such that the rotation allows capture of the rod. In the picture below, the tulip is silver and blue part that does not have treads. If you look at the screw, the silver collar that rotates has a notch. This notch allows

Journal Club: Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomized controlled trials

Title and Citation Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomized controlled trials Lancet Neurology 2007 Background and importance Malignant MCA infarct associated with 80% mortality. Trial design Pooled analysis of 18-60 year old patients with space occupying MCA infarction included in DECIMAL, DESTINY, or HAMLET

Journal Club: Comparative Therapeutic Effectiveness of Anticoagulation and Conservative Management in Traumatic Cerebral Venous Sinus Thrombosis

Title and Citation Comparative Therapeutic Effectiveness of Anticoagulation and Conservative Management in Traumatic Cerebral Venous Sinus Thrombosis Neurosurgery 2022 Background and importance Traumatic cerebral venous sinus thrombosis does not have a clear treatment and largely modeled off spontaneous cerebral venous sinus thrombosis Trial design Retrospective Decision to initiate AC must have stable interval CT non

Journal Club: Randomized Trial Comparing Burr Hole Craniostomy, Minicraniotomy, and Twist Drill Craniostomy for Treatment of Chronic Subdural Hematoma

Title and Citation Randomized Trial Comparing Burr Hole Craniostomy, Minicraniotomy, and Twist Drill Craniostomy for Treatment of Chronic Subdural Hematoma Neurosurgery 2022 Background and importance Unknown best surgical technique for chronic subdural hematoma Recurrence of SDH despite evacuation can occur in up to 30% of patients Trial design Multicenter prospective randomized trial Drainage system for

Journal Club: Characteristics of Sagittal Spinopelvic Alignment Changes After Symptom Relief After Simple Lumbar Decompression

Title and Citation Characteristics of Sagittal Spinopelvic Alignment Changes After Symptom Relief After Simple Lumbar Decompression Neurosurgery 2022 Background and importance Sagittal spinal pelvic alignment used to determine/diagnose adult spinal deformities Misdiagnosis can lead to inappropriate surgery Trial design Retrospective cohort Analyzed patients who underwent lumbar decompression via laminectomy or laminectomy with discectomy without instrumentation

Empirical targets for acute hemodynamic management of individuals with spinal cord injury

Author: Squair, Jordan PhD et al Title: Empirical targets for acute hemodynamic management of individuals with spinal cord injury Background: Ideal clinically significant BP goals and/or spinal cord perfusion pressure goals are not well defined Guidelines suggest MAP 85-90mmHg x7 days after injury Trial Design: prospective observational n=92 Intrathecal lumbar catheter placed L2-3 or L3-4

Bovie Monopolar

Bovie Monopolar Electrocautery very specifically refers to direct current circuits. This is in contrast to electrosurgery in which alternating current is used. This distinction matters because in direct current circuits, current does not enter the patient. Typically, direct current is used to heat an element that comes in contact with tissue. With electrosurgery, the patient

Pedicle Angulation

Today’s post is a short post on pedicle angulation. In general the pedicles have a “textbook” angle in how to align the screw to obtain the proper trajectory through the pedicle without violating the walls and possibly injuring nearby structures. The angles are a general heuristic. However studying preoperative imaging can aid in refining plan

Cell Saver

Blood loss is a factor to consider in many surgeries and is especially important for longer surgeries in which blood loss is expected. This can be for reasons such as prior anticoagulant use, antiplatelets, or hemodialysis. Reversal agents are typically given, however there is still bleeding. Sometimes elevated blood pressure goals are needed and this

STICH II

Title: Early Surgery Versus Initial Conservative Treatment in Patients with Spontaneous Lobar Intracerebral Hematomas (STICH II): a randomized trial Authors: Mendelow et alLancet 2013 Background/Importance: Undetermined benefit of early surgical intervention for intracerebral hematoma Trial design: international multicenter randomized trialDuration: 67 monthsObjectives: Determine if early surgical intervention for intracerebral hemorrhage improves outcomesPrimary Outcome/Endpoint: prognosis based