Introduction The vexing question of optimal glucose level in the intensive care unit has long perplexed intensivists. Hyperglycemia is a natural response to physiologic stress,1 and in the critically ill patient has been attributed to inflammatory processes, insulin counter-regulatory hormones, organ dysfunction, iatrogenic carbohydrate or medication related hyperglycemia, and insulin resistance as evidenced by concurrently elevated insulin levels.1 Hyperglycemia occurs in 50-75% of patients admitted to an ICU, and has been associated with various adverse outcomes including increased mortality, organ dysfunction, susceptibility to infections, and neurological complications.1,2 On the cellular level, tissue/organ damage is theorized to be mediated via the production of toxic polyol metabolites and reactive oxygen species,3 with compromise of mitochondrial/cellular function.1 At the opposite extreme, hypoglycemia is acutely detrimental and clearly mandates avoidance. Glucose variability has also been linked to adverse outcomes,4 and insulin administration itself has been associated with increased mortality.5 As such, it is believed that resolution of hypoglycemia, and not insulin administration, is the determinant of improved outcomes.5
{"title":"Glucose Control in the (Neuro) Intensive Care Unit","authors":"M. Moussouttas","doi":"10.29046/JHNJ.004.4.005","DOIUrl":"https://doi.org/10.29046/JHNJ.004.4.005","url":null,"abstract":"Introduction The vexing question of optimal glucose level in the intensive care unit has long perplexed intensivists. Hyperglycemia is a natural response to physiologic stress,1 and in the critically ill patient has been attributed to inflammatory processes, insulin counter-regulatory hormones, organ dysfunction, iatrogenic carbohydrate or medication related hyperglycemia, and insulin resistance as evidenced by concurrently elevated insulin levels.1 Hyperglycemia occurs in 50-75% of patients admitted to an ICU, and has been associated with various adverse outcomes including increased mortality, organ dysfunction, susceptibility to infections, and neurological complications.1,2 On the cellular level, tissue/organ damage is theorized to be mediated via the production of toxic polyol metabolites and reactive oxygen species,3 with compromise of mitochondrial/cellular function.1 At the opposite extreme, hypoglycemia is acutely detrimental and clearly mandates avoidance. Glucose variability has also been linked to adverse outcomes,4 and insulin administration itself has been associated with increased mortality.5 As such, it is believed that resolution of hypoglycemia, and not insulin administration, is the determinant of improved outcomes.5","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"252 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122861585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anemia in Subarachnoid Hemorrhage Anemia is a common problem among critically ill patients. Nearly two thirds of patients are anemic on admission to the intensive care unit (ICU)1 and between 70-95% of patients develop anemia by day 3.2,3 Lower hemoglobin levels decrease the oxygen carrying capacity of blood and may reduce tissue oxygenation. This is particularly detrimental for patients with subarachnoid hemorrhage (SAH) as they are subject to increased metabolic demand for oxygen from cerebral ischemia.
{"title":"Anemia and Blood Transfusion in Subarachnoid Hemorrhage","authors":"Monisha A. Kumar","doi":"10.29046/JHNJ.004.4.006","DOIUrl":"https://doi.org/10.29046/JHNJ.004.4.006","url":null,"abstract":"Anemia in Subarachnoid Hemorrhage Anemia is a common problem among critically ill patients. Nearly two thirds of patients are anemic on admission to the intensive care unit (ICU)1 and between 70-95% of patients develop anemia by day 3.2,3 Lower hemoglobin levels decrease the oxygen carrying capacity of blood and may reduce tissue oxygenation. This is particularly detrimental for patients with subarachnoid hemorrhage (SAH) as they are subject to increased metabolic demand for oxygen from cerebral ischemia.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125087345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
William Flounders, J. Gates, Steven Heffner, Bs Rn Msn Fnp-Bc Mba Michael Lawler, J. Pardini, Rn Ba Ccrn Scrn Maureen DePrince, Md Mba Facs Faha Robert H. Rosenwasswer
{"title":"A Systems Thinking Approach to Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission","authors":"William Flounders, J. Gates, Steven Heffner, Bs Rn Msn Fnp-Bc Mba Michael Lawler, J. Pardini, Rn Ba Ccrn Scrn Maureen DePrince, Md Mba Facs Faha Robert H. Rosenwasswer","doi":"10.29046/jhnj.013.2.001","DOIUrl":"https://doi.org/10.29046/jhnj.013.2.001","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130848904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Williams, E. Wuthrick, Hyun Kim, J. Palmer, S. Garg, H. Eldredge-Hindy, C. Daskalakis, K. Feeney, M. Mastrangelo, L. Kim, Takami Sato, T. Olencki, D. Liebner, C. Farrell, James J. Evans, K. Judy, D. Andrews, A. Dicker, M. Werner-Wasik, W. Shi, K. Kendra
{"title":"Phase I Study of Ipilimumab Combined with Whole Brain Radiation Therapy or Radiosurgery for Melanoma Patients with Brain Metastases","authors":"N. Williams, E. Wuthrick, Hyun Kim, J. Palmer, S. Garg, H. Eldredge-Hindy, C. Daskalakis, K. Feeney, M. Mastrangelo, L. Kim, Takami Sato, T. Olencki, D. Liebner, C. Farrell, James J. Evans, K. Judy, D. Andrews, A. Dicker, M. Werner-Wasik, W. Shi, K. Kendra","doi":"10.29046/jhnj.013.1.003","DOIUrl":"https://doi.org/10.29046/jhnj.013.1.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128913318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite advances in the diagnosis and treatment of neurosurgical diseases, spinal epidural abscesses (SEA) remain challenging. The diagnosis is complex, treatments are controversial, and the potential for adverse outcomes is significant. SEA accounts for 2 of every 10,000 of hospital admissions, an incidence which has doubled in the past twenty years. Reasons which may account for this include an aging population, increased IV drug use, and increase in number of vascular and spinal procedures. SEA can arise from an underlying medical condition, such as diabetes mellitus, alcoholism, chronic obstructive pulmonary disease (COPD), or HIV infection. Loci for SEA can be formed by other spinal abnormalities or by prior invasive spinal procedures, including epidurals, nerve blocks, or steroid injections. Sources for systemic infection may include vascular access catheters, IV drug use, or chronic UTI. 50% of spinal epidural infections have hematogenous origin, 30% arise from the skin or connective tissue, and 20% are unclassified. Common pathogens include S. aureus and P. aeruginosa. From 15% to 40% of SEA may be due to MRSA. In cases of spine trauma or spinal surgery, S. epidermidis may also be a pathogen. 79% of SEA appear dorsal to the spinal cord. A possible explanation for this finding is that the largest extent of the epidural space lies posterior to the nerve roots. The 21% that appear anterior are often associated with vertebral discitis and/ or osteomyelitis. Achieving correct diagnosis in cases of SEA may be challenging. 50% of epidural spinal abscesses are initially misdiagnosed. The most common presenting symptom is back pain, present in up to 85% of patients. Fever is present in up to 50%. Less common symptoms are paresthesias, sensory deficits, radicular pain, or motor deficits. SEA can occur spontaneously in patients with increased co-morbidi-ties. In post-operative patients, SEA may take days to weeks to appear. A dorsal SEA results from the spontaneous seeding of the dorsal epidural fat. As the abscess enlarges, neural compression may occur. Conversely, a ventral SEA may result from either spontaneous seed-ing of the ventral epidural fat or seeding of the disc space with secondary extension into the ventral epidural space. A ventral SEA is more likely to present with systemic symptoms (i.e., fevers, septicemia) prior to presentation of neurological deficits. The best way to diagnose SEA is to approach high-risk patients with suspicion. The neuro-logical exam may aid in localizing the level of spinal involvement in cases …
{"title":"Spinal Epidural Abscesses","authors":"Sonia Teufack","doi":"10.29046/jhnj.005.1.002","DOIUrl":"https://doi.org/10.29046/jhnj.005.1.002","url":null,"abstract":"Despite advances in the diagnosis and treatment of neurosurgical diseases, spinal epidural abscesses (SEA) remain challenging. The diagnosis is complex, treatments are controversial, and the potential for adverse outcomes is significant. SEA accounts for 2 of every 10,000 of hospital admissions, an incidence which has doubled in the past twenty years. Reasons which may account for this include an aging population, increased IV drug use, and increase in number of vascular and spinal procedures. SEA can arise from an underlying medical condition, such as diabetes mellitus, alcoholism, chronic obstructive pulmonary disease (COPD), or HIV infection. Loci for SEA can be formed by other spinal abnormalities or by prior invasive spinal procedures, including epidurals, nerve blocks, or steroid injections. Sources for systemic infection may include vascular access catheters, IV drug use, or chronic UTI. 50% of spinal epidural infections have hematogenous origin, 30% arise from the skin or connective tissue, and 20% are unclassified. Common pathogens include S. aureus and P. aeruginosa. From 15% to 40% of SEA may be due to MRSA. In cases of spine trauma or spinal surgery, S. epidermidis may also be a pathogen. 79% of SEA appear dorsal to the spinal cord. A possible explanation for this finding is that the largest extent of the epidural space lies posterior to the nerve roots. The 21% that appear anterior are often associated with vertebral discitis and/ or osteomyelitis. Achieving correct diagnosis in cases of SEA may be challenging. 50% of epidural spinal abscesses are initially misdiagnosed. The most common presenting symptom is back pain, present in up to 85% of patients. Fever is present in up to 50%. Less common symptoms are paresthesias, sensory deficits, radicular pain, or motor deficits. SEA can occur spontaneously in patients with increased co-morbidi-ties. In post-operative patients, SEA may take days to weeks to appear. A dorsal SEA results from the spontaneous seeding of the dorsal epidural fat. As the abscess enlarges, neural compression may occur. Conversely, a ventral SEA may result from either spontaneous seed-ing of the ventral epidural fat or seeding of the disc space with secondary extension into the ventral epidural space. A ventral SEA is more likely to present with systemic symptoms (i.e., fevers, septicemia) prior to presentation of neurological deficits. The best way to diagnose SEA is to approach high-risk patients with suspicion. The neuro-logical exam may aid in localizing the level of spinal involvement in cases …","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"229 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121107218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Guidelines Written by Residents","authors":"Andrews, W. David","doi":"10.29046/JHNJ.004.2.003","DOIUrl":"https://doi.org/10.29046/JHNJ.004.2.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122208659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Verma, T. Crothers, Brian J. Neuman, A. Vaccaro, J. Heller
{"title":"A Case of Intradural Extramedullary Spinal Tuberculosis Diagnosed 8 Years After Treatment of the Primary Infection","authors":"K. Verma, T. Crothers, Brian J. Neuman, A. Vaccaro, J. Heller","doi":"10.29046/JHNJ.008.1.005","DOIUrl":"https://doi.org/10.29046/JHNJ.008.1.005","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131401921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trigeminal Neuralgia: Case Report and Review","authors":"B. Zussman, Y. Moshel","doi":"10.29046/JHNJ.007.2.003","DOIUrl":"https://doi.org/10.29046/JHNJ.007.2.003","url":null,"abstract":"","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128447404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fever is frequent in patients with neurologic injury. Differentiating infectious fever from central fever can be challenging. It is important to diagnose the cause of fever in the neurological intensive care unit because of the detrimental effects of fever on brain injured patients. This is a comprehensive review of the role of the two commonly available biomarkers, C-reactive protein and procalcitonin in differentiating the central fever from infectious fever.
{"title":"Utility of Biomarkers in the Evaluation of Fever in the Intensive Care Unit After Brain Injury","authors":"Umer Mukhtar, Umer Shoukat, M. Athar, F. Rincon","doi":"10.29046/JHNJ.012.1.006","DOIUrl":"https://doi.org/10.29046/JHNJ.012.1.006","url":null,"abstract":"Fever is frequent in patients with neurologic injury. Differentiating infectious fever from central fever can be challenging. It is important to diagnose the cause of fever in the neurological intensive care unit because of the detrimental effects of fever on brain injured patients. This is a comprehensive review of the role of the two commonly available biomarkers, C-reactive protein and procalcitonin in differentiating the central fever from infectious fever.","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132007468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Expandable cages have been utilized as an option for immediate spinal stabilization after vertebrectomy. However, long-term follow-up in the oncology population has not been studied, and results remain unclear. This single-institution series of patients represents our success in utilizing expandable cages. Methods: A retrospective chart review for patients with spinal metastasis treated with expandable cages between 2001 and 2006 was performed with IRB approval. Data regarding date of anterior and posterior surgery, immediate postoperative neurological status versus preoperative status, revision, equipment status, pseudoarthrosis, time to ambulation, and mortality were gathered and analyzed. Results: Twenty-four patients with metastatic cancer to the spine were studied. Cages were placed from T5-L5, 21 of which were single level. Of the 24 patients, 5 (21%) were neurologically intact pre-operatively and postoperatively. 13 of the 24 (54%) improved postoperatively. The remaining six (25%) illustrated no change in neurologic status. No patients deteriorated. At two years’ follow-up, overall patient survival was 79%. Average time to ambulation for patients followed was 11.5 days. No revisions were done for hardware failure, while one revision was performed for tumor progression. Conclusions: Expandable cages appear to be a valid treatment option for the immediate stabilization of the spine following corpectomy from spinal metastasis. Results indicate that fast recovery, reasonable long-term mortality, and immediate stabilization are achievable with this modality. Consequently, expandable cages should be considered as a valid option in the treatment for stabilization following corpectomy in metastasis to the spine. Introduction The spinal column is a frequent site of metastatic disease, particularly from lung, prostate, breast, kidney as the primary sources, whereas primary spinal column tumors comprise a minority of spinal pathology (<2%) 4. Although patients may present in a variety of conditions, pathologic fractures or increased axial spinal pain are frequent issues. Surgical treatment for this disease includes decompression of the neural elements, alleviation of painful symptoms, resolution of mechanical instabilization, and resection of the oncologic burden 2. Surgical treatment options for patients with progressive neurologic deterioration include anterior, posterior or combined decompression with subsequent spinal reconstructions. Expandable cages have recently been utilized as a treatment option for spinal reconstruction after vertebrectomy, particularly in the trauma population1. With increased familiarity of these devices, cages are now being utilized after corpectomy from tumor metastasis, but data regarding this treatment option is lacking 2-3. Vertebral body replacement with expandable cages may provide several potential theoretical advantages such as permitting optimal anatomic placement in addition to concurrent correcti
导读:椎体切除术后，可膨胀的固定架被用作立即稳定脊柱的一种选择。然而，肿瘤人群的长期随访尚未研究，结果仍不清楚。这个单一机构系列的患者代表了我们在使用可扩展笼方面的成功。方法:回顾性回顾2001年至2006年经IRB批准的脊柱转移患者使用膨胀笼治疗的病例。收集和分析有关前后路手术日期、术后立即神经系统状态与术前状态、翻修、设备状态、假关节、活动时间和死亡率的数据。结果:对24例脊柱转移性肿瘤进行了研究。从T5-L5放置笼子，其中21个为单层。在24例患者中，5例(21%)术前和术后神经功能完整。24例患者中13例(54%)术后改善。其余6例(25%)未见神经状态改变。没有患者病情恶化。在两年的随访中，患者的总生存率为79%。随访患者的平均行走时间为11.5天。没有因硬件故障而进行修订，而因肿瘤进展而进行了一次修订。结论:对于脊柱转移性椎体切除术后的脊柱即刻稳定，可膨胀笼似乎是一种有效的治疗选择。结果表明，该方法可实现快速恢复，合理的长期死亡率和立即稳定。因此，在椎体切除术后转移至脊柱的稳定治疗中，应考虑使用可膨胀的固定架。脊柱是转移性疾病的常见部位，尤其是肺、前列腺、乳腺、肾脏为主要来源，而原发性脊柱肿瘤仅占脊柱病理的少数(<2%)4。尽管患者可能出现多种情况，但病理性骨折或增加的轴向脊柱疼痛是常见的问题。这种疾病的手术治疗包括神经元件的减压、疼痛症状的缓解、机械不稳定的解决和肿瘤负担的切除2。进行性神经功能恶化患者的手术治疗选择包括前路、后路或联合减压并随后进行脊柱重建。近年来，可膨胀笼已被用作椎体切除术后脊柱重建的一种治疗选择，特别是在创伤人群中。随着对这些装置的熟悉程度的提高，笼子现在被用于肿瘤转移的椎体切除术后，但关于这种治疗选择的数据缺乏2-3。椎体置换术中使用可伸缩支架可能提供几个潜在的理论优势，如允许最佳解剖放置，同时矫正脊柱畸形。这篇文章包括对脊柱转移性疾病椎体切除术后可扩展笼的临床资料的回顾性回顾。我们的假设是这些装置耐受性良好，因此是这一困难患者群体的治疗选择。临床资料和方法:2001年6月至2006年11月，通过回顾性的图表回顾，对24例连续患者进行了可扩展笼重建，以治疗转移性疾病并病理性骨折。患者研究方案通过机构内部审查委员会批准。纳入标准为:年龄大于18岁，T4 ~ L5间行椎体切除术，病理证实有转移性疾病。纳入分析的数据点包括:年龄、转移水平、原发肿瘤组织学、功能结果、活动时间、再次手术需要和其他围手术期并发症。神经系统检查采用ASIA评分系统，运动评分为6分制(0-5)，针刺和触觉评分为3分制(0、1、2)。所有病例均进行术后成像以评估结构稳定性和Shiveindra Jeyamohan, BS1, Alexander Vaccaro, MD, PhD 2, James S Harrop, MD 3费城托马斯杰斐逊大学杰斐逊医学院，PA 2费城罗夫曼研究所，PA 3费城托马斯杰斐逊大学神经外科
{"title":"Use of Expandable Cages in Metastasis to the Spine","authors":"Shiveindra B. Jeyamohan, A. Vaccaro, J. Harrop","doi":"10.29046/jhnj.004.4.002","DOIUrl":"https://doi.org/10.29046/jhnj.004.4.002","url":null,"abstract":"Introduction: Expandable cages have been utilized as an option for immediate spinal stabilization after vertebrectomy. However, long-term follow-up in the oncology population has not been studied, and results remain unclear. This single-institution series of patients represents our success in utilizing expandable cages. Methods: A retrospective chart review for patients with spinal metastasis treated with expandable cages between 2001 and 2006 was performed with IRB approval. Data regarding date of anterior and posterior surgery, immediate postoperative neurological status versus preoperative status, revision, equipment status, pseudoarthrosis, time to ambulation, and mortality were gathered and analyzed. Results: Twenty-four patients with metastatic cancer to the spine were studied. Cages were placed from T5-L5, 21 of which were single level. Of the 24 patients, 5 (21%) were neurologically intact pre-operatively and postoperatively. 13 of the 24 (54%) improved postoperatively. The remaining six (25%) illustrated no change in neurologic status. No patients deteriorated. At two years’ follow-up, overall patient survival was 79%. Average time to ambulation for patients followed was 11.5 days. No revisions were done for hardware failure, while one revision was performed for tumor progression. Conclusions: Expandable cages appear to be a valid treatment option for the immediate stabilization of the spine following corpectomy from spinal metastasis. Results indicate that fast recovery, reasonable long-term mortality, and immediate stabilization are achievable with this modality. Consequently, expandable cages should be considered as a valid option in the treatment for stabilization following corpectomy in metastasis to the spine. Introduction The spinal column is a frequent site of metastatic disease, particularly from lung, prostate, breast, kidney as the primary sources, whereas primary spinal column tumors comprise a minority of spinal pathology (<2%) 4. Although patients may present in a variety of conditions, pathologic fractures or increased axial spinal pain are frequent issues. Surgical treatment for this disease includes decompression of the neural elements, alleviation of painful symptoms, resolution of mechanical instabilization, and resection of the oncologic burden 2. Surgical treatment options for patients with progressive neurologic deterioration include anterior, posterior or combined decompression with subsequent spinal reconstructions. Expandable cages have recently been utilized as a treatment option for spinal reconstruction after vertebrectomy, particularly in the trauma population1. With increased familiarity of these devices, cages are now being utilized after corpectomy from tumor metastasis, but data regarding this treatment option is lacking 2-3. Vertebral body replacement with expandable cages may provide several potential theoretical advantages such as permitting optimal anatomic placement in addition to concurrent correcti","PeriodicalId":355574,"journal":{"name":"JHN Journal","volume":"142 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132064929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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