Minimally invasive spine surgeries (MISS) since its inception around 15 years ago has undergone rigorous changes with ever evolving technologies. Minimally invasive spine surgeries with “percutaneous” and “tubular” approaches is based on novel concept of minimizing collateral soft tissue damage, while achieving surgical goal in various spinal pathologies. MISS has been applied to simple spinal procedures of discectomy, decompression and fusion to even complex surgeries like deformity correction. MISS vis a vis “conventional open techniques” has benefits in terms of postoperative pain, concurrent tissue damage, disruption of spinal stabilizing structures, estimated blood loss, need of blood transfusion, length of hospital stay, surgical site infections, time to ambulation and functional recovery.
Minimally invasive spine surgeries (MISS) since its inception around 15 years ago has undergone rigorous changes with ever evolving technologies. Minimally invasive spine surgeries with “percutaneous” and “tubular” approaches is based on novel concept of minimizing collateral soft tissue damage, while achieving surgical goal in various spinal pathologies. MISS has been applied to simple spinal procedures of discectomy, decompression and fusion to even complex surgeries like deformity correction. MISS vis a vis “conventional open techniques” has benefits in terms of postoperative pain, concurrent tissue damage, disruption of spinal stabilizing structures, estimated blood loss, need of blood transfusion, length of hospital stay, surgical site infections, time to ambulation and functional recovery.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
Pain from acute vertebral fracture appears to be due in part to instability (non-union or slow union at the fracture site), while more than 1/3 of patients become chronically painful.
Traditional treatment for patients with painful VCFs includes bed rest, narcotic analgesics and bracing, resulting in increased pain because of acceleration bone loss and muscle weakness.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
Pain from acute vertebral fracture appears to be due in part to instability (non-union or slow union at the fracture site), while more than 1/3 of patients become chronically painful.
Traditional treatment for patients with painful VCFs includes bed rest, narcotic analgesics and bracing, resulting in increased pain because of acceleration bone loss and muscle weakness.
ENDOSCOPIC TREATMENT OF PILONIDAL SINUS IN EGYPTIAN PATIENTSindexPub
Background: Treatment for pilonidal disease using minimally invasive methods is a reliable and successful alternative to conventional surgery, with quicker recovery, better cosmetic outcomes, and better pain management. The primary goals of this study are to assess the early outcomes of endoscopic pilonidal sinus treatment and to demonstrate the surgical approach and its adaptations. Materials and Methods: Our study was conducted on 30 patients with pilonidal sinus disease as a prospective cohort study for endoscopic treatment of the pilonidal sinus, from October 2021 to October 2022, in our surgical department at Theodor Bilharz Research Institute (TBRI). Surgical outcomes of sinus healing, pain, and discharge were reviewed in the outpatient clinic, and patient satisfaction levels were assessed through a standardized phone interview. Results: There were 24 males and 6 females, with a median age of 21.87±1.85 years (ranging from 16 to 57 years). The mean operative time was 44.17 (35-55) ±1.26 min. During the follow-up period of 24 weeks, wound closure was seen after a median of 4 weeks. Wounds were closed in 72% of patients after one month and 93% of patients after two months. 2 patients had to be re-operated due to failure: one had persistence of discharge, and the other had recurrence after 3 months. The satisfaction rate was 93.3%. Conclusions: Endoscopic pilonidal sinus treatment is a minimally invasive and cosmetically favorable procedure. To find out if it reduces recovery time and the long-term recurrence rate, a larger sample size and a longer follow-up are needed.
Objectives:
•Learn about the current of SSI prevention in Canada
•Review the updated SSI-GSK
•Compare CPSI SSI-GSK to national and international literature
It is an oncologic emergency. This slides contains a brief discussion on mechanism of spinal cord compression , common malignancies presenting with spinal cord compression , approach to a patient with cord compression like features and management this catastrophic situation.
A Prospective comparative study of Local anaesthesia & Spinal anaesthesia for...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Research for Medical Students: Luxury or Necessity?Sohail Bajammal
An invited keynote speech, delivered on April 22, 2014 at the 4th Medical Students Research Symposium, Faculty of Medicine ay King Fahd Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
It argues the necessity of research methodology teaching in medical schools.
Diagrammatic Summary of Research Methodology, Ethics & StatisticsSohail Bajammal
A diagrammatic summary of three presentations given for the UQU Medical Research Club "Your Journey Towards Research: Writing Research Proposal" held at King Abdullah Medical City, Makkah. May 17, 2012.
Presentations summarized include:
1. Research Methodology
2. Research Ethics
3. Statistics
A presentation on important research methodology concepts for research proposals. Given for the UQU Medical Research Club "Your Journey Towards Research" held at King Abdullah Medical City, Makkah. May 17, 2012
A brief presentation on important research ethical concepts for research proposals. Given for the UQU Medical Research Club "Your Journey Towards Research" held at King Abdullah Medical City, Makka
UQUMRC KAMC Biostatistics for your Research Proposal 2012Sohail Bajammal
A brief presentation on important statistics concepts for research proposals. Given for the UQU Medical Research Club "Your Journey Towards Research" held at King Abdullah Medical City, Makkah. May 17, 2012
http://uqu2020.com
A virtual brainstorming on Twitter using the hashtag #uqu2020 with UQU staff and students on how to make UQU a better university in 2020.
The Consultant Experience in Saudi Arabia. A presentation given at:
“Research by Medical Trainees: Current Status and Future Planning Workshop”
King Faisal Specialist Hospital & Research Center – Riyadh in collaboration withSaudi Commission for Health Specialties
June 14-15, 2011
Evidence-based Back Pain Management (EBM in general)Sohail Bajammal
A generic introductory presentation on using evidence-based medicine (EBM) principles to answer clinical questions. Back pain was used as an example to introduce the concept. The presentation does not address the treatment of back pain. The presentation was given in May 2010.
A comprehensive presentation on the epidemiology, pathophysiology, clinical presentation, decision making and treatment options of spinal metastases. Supported with the best available evidence as of October 6, 2008
1. Postoperative Spinal Infection Sohail Bajammal, MBChB, MSc, FRCS(C), PhD(c) Consultant Orthopaedic Spine Surgeon, Al-Noor Specialist Hospital Assistant Professor, Umm Al-Qura University Makkah, Saudi Arabia May 13, 2010
2. “A surgeon who has no complications is a surgeon who either does not operate or is not truthful.” Herkowitz HN. Foreword. In An HS, Jenis LG (ed): Complications of Spine Surgery: Treatment and Prevention. Lippincott Williams & Wilkins. 2006.
3. Objectives By the end of the lecture, you will be able to Identify the incidence & risk factors of postoperative spinal infection List the preventive measures Devise a diagnostic plan Formulate a treatment plan
5. Incidence of Postoperative Spinal Infection <1% to 10.9% 13 studies: <5% 7 studies: between 5% and 11% Superficial versus deep infection Schuster et al., Spine 2010
9. Consistently Significant Factors Odds Ratio Range Age > 60 years Presence of diabetes Malnutrition Obesity ASA score ≥ 3 Higher glucose levels 2.7 3.5 to 6.3 2.5 to 15.6 2.2 to 7.1 2.6 to 9.7 3 to 3.3 Schuster et al., Spine 2010
11. Surgical Factors Posterior approach Instrumentation Bone graft harvest Blood loss or blood transfusion Duration of surgery Operative technique: Soft tissue dissection Foreign body Dead space Soft tissue coverage Schuster et al., Spine 2010
13. Not Consistently Significant Duration of surgery 2 out of 7 studies showed significant association OR: 2.4 to 4.7 Instrumentation: 2 out of 6 studies showed significant association OR: 2.5 to 3.4 Use of allograft 3 studies showed no difference Schuster et al., Spine 2010
14. Surgical Environment Prepping Draping Room traffic: number, talking Contaminated instruments Use of intraoperativefluoroscopy Schuster et al., Spine 2010
21. It is easier to stay out of trouble than to get out of trouble
22.
23. NASS Guidelines Recommend the use of preoperative antibiotics for instrumented and non-instrumented spinal surgery No superior agent: 1-2 gCefazolin 2 gCeftizoxime or 1 gvancomycin plus 80 mg gentamicin No specific protocol or regimen: Within one hour preoperatively
24. NASS Guidelines Preoperative versus redosingintraoperative: No evidence to support redosing Depends on comorbidities, length of surgery Duration of prophylaxis: No evidence to support longer than 24 hours The use of drains is not recommended as a means to reduce infection rates following single level surgical procedures
26. Prep Solution 849 patients preoperatively scrubbed with an applicator that contained 2% chlorhexidinegluconate and 70% isopropyl alcohol OR preoperatively scrubbed and then painted with an aqueous solution of 10% povidone–iodine
27. Prep Solution The overall rate of surgical-site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5% vs. 16.1%; P = 0.004) Both superficial and deep No difference in organ-specific infection Type of surgery: 73% abdominal 11% thoracic 10% gynecologic 6% urologic 41% reduction
28. Alcohol-based products Flammable risk of fire & chemical burns Especially with oxygen source & electrocautery Prep carefully: Donot use 26-ml applicator for head and neck surgery, do not useon an area smaller than 8.4 in. x 8.4 in., use a smaller applicatorinstead. Do not drape or use ignition source until solutionis completely dry (minimum of 3 minutes on hairless skin, upto 1 hour in hair). Do not allow solution to pool; remove wetmaterials from prep area."
29. Irrigation Solution Two RCTs reported lower infection rates in patients treated with 3.5% Betadine solution compared with saline solution: Cheng et al, Spine 2005 Chang et al, Eur Spine J 2006 Schuster et al., Spine 2010
30. Prevention - Preoperative Treat other infections before starting elective surgery Hair removal: When? How? Glycemic Control Smoking cessation Nutritional status: lymphoctytes counts, albumin
34. Review of 3174 spinal procedure over 10 yr 132 infection (4.2%) 48 superficial 84 deep or superficial & deep Staph. aureusin 65%
35. Clinical Presentation Fever (26%) Pain (28%) Erythema (19%, less common in deep infection) Swelling Warmth Tenderness to palpation Wound drainage (68%, most common sign) Neurological signs & symptoms Pull terGunne et al, Spine 2010
37. Investigation CBC (WBC): Not reliable, elevated in less than 50% ESR: Normal peak at 2 weeks, return to normal at 6 weeks Elevated in 94% of infection CRP: Normally takes 2 weeks to normalize Elevated in 97% of deep infection Blood culture: Positive in 30% of vertebral osteomyelitis Thelander et al, Spine 1992
38. Treatment Goals Appropriate selection of antibiotics & eradicate infection Obtain stable physiological wound closure Restore the mechanical integrity of the spine
40. Superficial Infection Incision and drainage Inspection of fascia Aspiration of superficial and deep compartments Oral antibiotics (average 2 weeks, follow CRP) Close or secondary intention (wet to dry dressing) Pull terGunne et al, Spine 2010
41. Deep Infection Optimal treatment: Wound debridement Removal of instrumentation IV antibiotics 6-8 weeks, then oral antibiotics 2 weeks (follow CRP)
42. Deep Infection Controversy Instrumentation: retain, replace primarily, replace delayed Wound closure: primary with suction, primary without suction, secondary intention
43. Deep Infected Spinal Instrumentation Retain if stable Weinstein et al, J Spin Disorders 2000 Mok et al, Spine 2009 Pull terGunne et al, Spine 2010 Remove and replace primarily Pull terGunne et al, Spine 2010 Remove and replace later: Bose, Spine J 2003 Tsiodras et al, ClinOrthopRelat Res 2006
44. Deep infection wound management Following debridement: Primary closure: Mok et al, Spine 2009 Pull terGunne et al, Spine 2010 A second look surgery: Weinstein et al, J Spin Disorders 2000 Tsiodraset al, ClinOrthopRelat Res2006