scholarly journals Safety analysis and complications of condylar screws in a single-surgeon series of 250 occipitocervical fusions

2021 ◽  
Author(s):  
Sharon Ka Po. Tam ◽  
Paolo A. Bolognese ◽  
Roger W. Kula ◽  
Andrew Brodbelt ◽  
Mansoor Foroughi ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Intraoperative Imaging ◽  
Case Series ◽  
Anatomical Landmarks ◽  
Occipitocervical Fusion ◽  
Neurophysiologic Monitoring ◽  
The Sacrifice ◽  
Venous Stroke

Abstract Objective Condylar screw fixation is a rescue technique and an alternative to the conventional configuration of occipitocervical fusion. Condylar screws are utilized when previous surgical bone removal along the supraocciput has occurred which makes anchoring of a traditional barplate technically difficult or impossible. However, the challenging dissection of C0-1 necessary for condylar screw fixation and the concerns about possible complications have, thus far, prevented the acquisition of large surgical series utilizing occipital condylar screws. In the largest case series to date, this paper aims to evaluate the safety profile and complications of condylar screw fixation for occipitocervical fusion. Methods A retrospective safety and complication-based analysis of occipitocervical fusion via condylar screws fixation was performed. Results A total of 250 patients underwent occipitocervical fusions using 500 condylar screws between September 2012 and September 2018. No condylar screw pullouts, or vertebral artery impingements were observed in this series. The sacrifice of condylar veins during the dissection at C0-1 did not cause any venous stroke. Hypotrophic condyles were found in 36.4% (91 of the 250) cases and did not prevent the insertion of condylar screws. Two transient hypoglossal deficits occurred at the beginning of this surgical series and were followed by recovery a few months later. Corrective strategies were effective in preventing further hypoglossal injuries. Conclusions This surgical series suggests that the use of condylar screws fixation is a relatively safe and reliable option for OC fusion in both adult and pediatric patients. Methodical dissection of anatomical landmarks, intraoperative imaging, and neurophysiologic monitoring allowed the safe execution of the largest series of condylar screws reported to date. Separate contributions will follow in the future to provide details about the long-term clinical outcome of this series.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Closed Reduction And Cannulated Screw Fixation For Pediatric Femoral Neck Fractures: A Case Series

2021 ◽  
Author(s):  
Hakan Cici ◽  
Sabahaddin Kiliç
Keyword(s):  
Femoral Neck ◽  
Closed Reduction ◽  
Screw Fixation ◽  
Case Series ◽  
Femoral Neck Fractures ◽  
Cannulated Screw ◽  
Fixation Method ◽  
Coxa Vara

Objective: Pediatric femoral neck fractures are uncommon injuries. Accurate early reduction and fixation is recommended to avoid serious long-term complications. The aim of this study was to analyze the clinical and radiological outcomes of 12 children with femoral neck fractures who were treated with closed reduction and cannulated screw fixation. Method: Between November 2015 and December 2019, 12 children (4 males,8 females) with an average age of 9.7 were operated by closed reduction and cannulated screw fixation for femoral neck fractures. We evaluated the medical records of all patients, including age, gender, injury mechanism, fracture type, initial displacement, postoperative reduction, follow-up roentgenograms and Ratliff’s scores. Results: The mean follow-up was 22.3 months (range 12–47 months). Six Delbett type 2, five Delbett type 3 and one Delbett type 4 fractures were operated with an avarage time to surgery of 12.5 (range: 1-75 hours). Satisfactory outcomes according to Ratliff’s criteria were obtained in 10 (%83.3) children. Coxa vara occurred in 2 cases. Any avascular necrosis was not seen during the follow-up period. Conclusion: Early closed reduction and cannulated screw fixation may be effective to avoid long-term complications in pediatric femoral neck fractures. Keywords: Femoral neck fracture, Pediatric, Closed reduction

Long-term efficacy of abatacept in pediatric patients with idiopathic uveitis: a case series

2015 ◽  
Vol 253 (10) ◽  
pp. 1813-1816 ◽  
Author(s):  
Edoardo Marrani ◽  
Valeria Paganelli ◽  
Cinzia de Libero ◽  
Rolando Cimaz ◽  
Gabriele Simonini
Keyword(s):  
Pediatric Patients ◽  
Case Series ◽  
Term Efficacy

Encephaloduroarteriosynangiosis for Pediatric Moyamoya Disease: A Single-Center Experience With 67 Cases in China

2018 ◽  
Vol 33 (14) ◽  
pp. 901-908 ◽  
Author(s):  
Chengjun Wang ◽  
Meng Zhao ◽  
Jia Wang ◽  
Shuo Wang ◽  
Dong Zhang ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Pediatric Patients ◽  
Positive Impact ◽  
Case Series ◽  
Stroke Recurrence ◽  
Long Term Outcomes ◽  
Single Center Experience ◽  
The Mean

The purpose of this study is to investigate the surgical results and long-term outcomes of encephaloduroarteriosynangiosis for moyamoya disease in pediatric patients. We performed a retrospective analysis of 67 pediatric patients with moyamoya disease who underwent encephaloduroarteriosynangiosis in Beijing Tiantan Hospital. The case series included 36 boys and 31 girls. All the patients underwent surgical revascularization, and a total of 93 encephaloduroarteriosynangiosis procedures were performed (41 unilateral, 26 bilateral). The mean follow-up period after surgery was 30 months. During follow-up, ischemic stroke events were detected in 5 patients and the stroke rate for pediatric patients who underwent encephaloduroarteriosynangiosis procedure was 7.1% per patient-years. At the last follow-up, favorable outcomes (modified Rankin Scale score ≤ 2) were observed in 65 cases (97.0%). Our study suggests that long-term surgical outcome of encephaloduroarteriosynangiosis in pediatric moyamoya disease patients is satisfactory, and this technique has a positive impact on the prevention of stroke recurrence.

scholarly journals Long-Term Outcome of Indomethacin Treatment in Pediatric Patients with Paroxysmal Hemicrania—A Case Series

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 101
Author(s):  
Maximilian David Mauritz ◽  
Anna Enninger ◽  
Christine Wamsler ◽  
Julia Wager ◽  
Boris Zernikow
Keyword(s):  
Pediatric Patients ◽  
Case Series ◽  
Primary Headache ◽  
Paroxysmal Hemicrania ◽  
Trigeminal Autonomic Cephalalgias ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Indomethacin Treatment

Paroxysmal Hemicrania is a rare form of primary headache in children and adolescents, belonging to the group of trigeminal autonomic cephalalgias. Patients suffer from severe, short-lasting unilateral headaches accompanied by symptoms of the autonomic system on the same side of the head. The short duration of attacks distinguishes Paroxysmal Hemicrania from other trigeminal autonomic cephalalgias. Indomethacin is the treatment of choice, and its effectiveness provides a unique diagnostic criterion. However, the long-term outcomes in children are highly underreported. In this case-series, n = 8 patients diagnosed with Paroxysmal Hemicrania were contacted via telephone 3.1 to 10.7 years after initial presentation. A standardized interview was conducted. n = 6 patients were headache-free and no longer took indomethacin for 5.4 ± 3.4 years. The mean treatment period in these patients was 2.2 ± 1.9 years. Weaning attempts were undertaken after 1.7 ± 1.3 months; in n = 3 patients, more than one weaning attempt was necessary. n = 2 patients were still taking indomethacin (4.5 and 4.9 years, respectively). Both unsuccessfully tried to reduce the indomethacin treatment (two and six times, respectively). Adverse effects appeared in n = 6 (75%) patients and led to a discontinuation of therapy in n = 2 patients. Our long-term follow-up suggests that in a substantial proportion of pediatric patients, discontinuing indomethacin therapy is possible without the recurrence of Paroxysmal Hemicrania.

scholarly journals Vedolizumab: An Emerging Treatment Option for Pediatric Inflammatory Bowel Disease

2021 ◽  
Vol 26 (8) ◽  
pp. 795-801
Author(s):  
Pooja Shah ◽  
Danielle McDonald
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Randomized Trials ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Case Series ◽  
Pediatric Inflammatory Bowel Disease ◽  
Dosing Regimens ◽  
Inflammatory Bowel

Vedolizumab is a humanized α4β7-integrin antagonist that is currently FDA-approved for adult inflammatory bowel disease. Limited evidence is available to guide use in pediatric patients, though off-label use is described in the form of retrospective reviews and case series. Collectively these publications begin to establish safety and efficacy data in pediatric patients < 18 years of age. Additionally, dosing regimens described in the literature serve to guide weight-based dosing, which is not established at this time. This narrative review aims to summarize the available literature and provide recommendations for vedolizumab use in the pediatric population. A literature search was performed in PubMed (January 2014–December 2020) using the keyword vedolizumab. Based on the available evidence, vedolizumab appears to be a safe and moderately effective agent for treatment of refractory pediatric inflammatory bowel disease. Prospective, randomized trials are warranted to optimize dosing regimens and to establish long-term safety.

First-Line, Early and Long-Term Eculizumab Therapy in Atypical Hemolytic Uremic Syndrome: A Case Series in Pediatric Patients

2016 ◽  
Vol 18 (6) ◽  
pp. 413-420 ◽  
Author(s):  
Selçuk Yüksel ◽  
Havva Evrengül ◽  
Z. Birsin Özçakar ◽  
Tülay Becerir ◽  
Nagihan Yalçın ◽  
...  
Keyword(s):  
Hemolytic Uremic Syndrome ◽  
Pediatric Patients ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Case Series ◽  
First Line ◽  
Uremic Syndrome

S245 – Pulmonary Complications after Coblation Tonsillectomy

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P157-P157
Author(s):  
Michael J Wilhelm ◽  
Mark E Boseley
Keyword(s):  
Pediatric Patients ◽  
Clinical Signs ◽  
Case Series ◽  
Pulmonary Complications ◽  
Postoperative Pulmonary Complications ◽  
X Ray ◽  
Institutional Experience ◽  
Chest X Ray ◽  
Throat Pack

Objectives 1) Evaluate an institutional experience with postoperative pulmonary complications using the Coblator (ArthroCare Corp, Sunnyvale, CA), for pediatric tonsillectomy. 2) Understand how to minimize and prevent pulmonary complications following coblation tonsillectomy. Methods Case series of 4 tonsillectomy patients who developed clinical signs of aspiration following surgery, from October 2006 to January 2008. Results 4 pediatric patients were reported in this case series. All 4 experienced perioperative fever, tachycardia, pulmonary desaturation, and cough following tonsillectomy using the Coblator. In 1 case, the patient had course respirations, a chest x-ray demonstrating diffuse pulmonary infiltrates, and was unable to maintain his oxygen saturations without supplemental oxygenation. In all cases, the symptoms, to include fever, resolved by post-operative day 2. No long-term sequelae were noted. In all cases, the patients were intubated using an uncuffed endotracheal tube. Conclusions Pulmonary aspiration is a possible adverse consequence of oropharyngeal pooling of saline while performing a tonsillectomy using the Coblator. Pediatric patients in whom an uncuffed endotracheal is used are more likely to aspirate the irrigation. Recognition of this potential complication allows the surgeon to take the necessary precautions to avoid this complication by using a throat pack, trendelenberg positioning, and avoidance of pooling of irrigation in the oropharynx.

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