Pulmonary embolism after a single-stage, combined anterior and posterior approach lumbar surgery

Traumatic Lumbar Spondylolisthesis: A Systematic Review and Case Series

STUDY DESIGN

Systematic review and case series.

OBJECTIVES

Any acute injury to the posterior elements of the lumbar spine resulting in listhesis is considered a traumatic spondylolisthesis. This rare injury caused by high-energy trauma is variably described in the literature as fracture-dislocation, where only case reports and series have been published. Our objectives were to propose evidence-based treatment recommendations and a new classification system for this injury.

METHODS

A systematic review of literature from PubMed, EMBASE, and Cochrane without time frame limitations was performed, which included 77 level IV and V articles and 9 patients as case series in the analysis.

RESULTS

A total of 125 cases were reviewed with mean age of 30.5 years. Half of the cases resulted from a vehicular accident. Back pain presented in 82%, while 50% had neurologic deficits. Operative treatment was performed in 93.6% (posterior decompression [PD] = 4%; posterior spinal fusion [PSF] = 43.2%; interbody fusion [IB] = 46.4%) with overall fusion rates of 74%. Binomial regression analysis for achieving solid fusion showed a 28.6× higher odds for IB compared to PSF (P = .008, r ² = 0.633). Subanalysis of cases with disc injuries revealed higher fusion outcomes for IB (87%) compared to PSF (46%; P = .006), while there were no significant differences for patients without disc injury. Pain and neurological symptoms improved significantly on final follow-up (P < .001). Overall complication rate was 22%.

CONCLUSION

Operative management with reduction, decompression for neurologic deficits, instrumentation, and fusion is recommended for traumatic spondylolisthesis. Interbody fusion is recommended to achieve better fusion outcomes especially with preoperatively identified disc lesions.

Risk factors for deep venous thrombosis of lower limbs in postoperative neurosurgical patients

Objectives:

To detect the risk factors for deep venous thrombosis (DVT) in patients after neurosurgery.

Methods:

Three hundred and seventy-six patients treated in the department of neurosurgery of our hospital from February 2013 to November 2015 were reviewed retrospectively. The clinical data including age, gender, hospital stay, operation time, occupation type, hypertension, coronary heart disease, diabetes, smoking status, drinking status, postoperative exercises, malignant tumor, and postoperative hormone or dehydrating agent were collected.

Results:

In this study, 52 patients were included in the DVT group and 295 patients in the Non-DVT group. There was significant difference in age, hypertension, occupation type, malignant tumors, operation time, smoking status, and postoperative exercises between the two groups (p<0.05). However, there was no significant difference in gender, drinking status, coronary heart disease, diabetes, hospital stay, and postoperative hormone or dehydrating agent (p>0.05). In multivariate analysis, age, malignant tumor, hypertension were independent risk factors, while physical labour and postoperative exercises were protective factor for DVT.

Conclusion:

The postoperative patients with older age, malignant tumor or hypertension should be paid high attention to prevent DVT, and postoperative exercises should be selected as precautionary measures.

Analysis of deep venous thrombosis after Gynecological surgery: A clinical study of 498 cases

Objectives:

To find out the clinical characteristics and risk factors for deep venous thrombosis (DVT) after gynecological surgery.

Methods:

Four hundred and ninety-eight patients treated surgically in the department of gynecology of our hospital from July 2012 to May 2014 were reviewed retrospectively. The data including patient age, gender, medical history, hospital stay, anesthesia type, operation time, occupation type, operative or postoperative medicine, perioperative bleeding, postoperative activity time, mortality rate and so on, were collected.

Results:

Among 498 patients, 58 were included in the thrombosis group, 423 patients in the non-thrombosis group and 17 patients were excluded. The incidence of deep venous thrombosis was 11.6%. In 58 cases with deep venous thrombosis, 6 cases developed pulmonary embolism and two patients died, the mortality rate for pulmonary embolism is 33.3%. In multivariate analysis, age, malignant tumor, cardiovascular comorbidity and postoperative hemostatics dose are independent risk factors, physical labour and minimally invasive surgery are protective factors for DVT.

Conclusion:

The patients with elder age, malignant tumor, cardiovascular comorbidity or large postoperative hemostatics dose should be paid high attention to and the minimally invasive surgery are optimal treatment in preventing DVT.