Early Management of Adult Traumatic Spinal Cord Injury in Patients with Polytrauma: A Consensus and Clinical Recommendations Jointly Developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies (EANS)

BACKGROUND: The early management of polytrauma patients with traumatic spinal cord injury (tSCI) is a major challenge. Sparse data is available to provide optimal care in this scenario and worldwide variability in clinical practice has been documented in recent studies. METHODS: A multidisciplinary consensus panel of physicians selected for their established clinical and scientific expertise in the acute management of tSCI polytrauma patients with different specializations was established. The World Society of Emergency Surgery (WSES) and the European Association of Neurosurgical Societies (EANS) endorsed the consensus, and a modified Delphi approach was adopted. RESULTS: A total of 17 statements were proposed and discussed. A consensus was reached generating 17 recommendations (16 strong and 1 weak). CONCLUSIONS: This consensus provides practical recommendations to support a clinician\u27s decision making in the management of tSCI polytrauma patients

Minimally Invasive Transpedicular Screw Fixation: Review of 152 Cases in a Single Institution. Steep or Shallow Learning Curve?

AbstractBackground In this study, we analyze our institutional experience and personal impressions using minimally invasive spine surgery (MISS) to describe our learning curve and how experience influenced different parameters of the surgical procedure.Methods The study was conducted prospectively and included the first consecutive 152 patients treated with MISS techniques. Patient demographics, surgical data, length of hospital stay, and clinical outcome were reviewed. The cohort was divided into consecutive quarters. Comparison between the quarters and timeline analysis were made to assess the learning curve.Results Only percutaneous transpedicular screw fixation was performed in 65 cases, minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in 70 cases, and vertebral body replacement in 4 cases. The average blood loss was 113.3, 115, 106.6, and 107.1 mL for each quarter. The average operative time was 155.0, 143.2, 134.5, and 133.8 minutes for the four quarters, whereas the average radiation exposure time was 105.4, 85.3, 46.2, and 45.2 seconds. Differences in the operative time and radiation exposure time between the first to third and the first to fourth quarters were statistically significant.Conclusions Some advantages of MISS techniques could be observed with the very first cases and were not related significantly with the surgeon's experience with MISS. With the acquisition of more experience, some disadvantages of MISS techniques such as longer operative time and longer X-ray exposure can be substantially reduced. Surgical experience, familiarity of the team with the MISS instrumentation, and good patient selection are crucial for achieving all the benefits of MISS.</jats:p

IDH1/IDH2 but Not TP53 Mutations Predict Prognosis in Bulgarian Glioblastoma Patients

Mutations in genes encoding isocitrate dehydrogenase isoforms 1 (IDH1) and 2 (IDH2) have been associated with good prognosis for patients with brain neoplasias and have been commonly found together with mutated TP53 gene. To determine the prevalence of IDH1, IDH2, and TP53 mutations and their impact on overall survival 106 glioblastoma patients were analysed. IDH1 mutations were detected in 13 and IDH2 mutation in one patient. Two homozygous samples with R132H mutation in IDH1 gene and a novel aberration K129R in IDH2 gene were found. Sixty-four percent of IDH1/IDH2 mutated tumours harboured also a mutation in TP53 gene. Genetic aberrations in TP53 were present in 37 patients. Statistical analysis of the impact of the studied factors on the overall survival showed that the mutations in IDH1/IDH2, but not the ones in TP53, were associated with longer survival. Also, the impact of age on prognosis was confirmed. This is the first comprehensive study on glioblastomas in Bulgaria. Our results suggest that IDH1/IDH2 but not TP53 mutations together with other prognostic factors such as age might be applied in clinical practice for prediction of outcome in patients with glioblastomas