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Natural posture for pain-free living : the practice of mindful alignment
\"How to restore healthy posture from childhood for relief from chronic pain, easy flexibility, and enduring strength and vitality well into old age\"-- Provided by publisher.
Book
IDENTIFYING ACTIONABLE INFORMATION: PREVENTABLE 30-DAY NEUROSURGICAL READMISSIONS
BackgroundHospital readmissions within 30 days after discharge are increasingly recognized as markers of inpatient quality of care and significant contributors to rising healthcare expenditures. Identifying potentially preventable readmission causes and developing targeted interventions is a national priority.ObjectivesTo determine rate, reasons, and potential for prevention for 30-day unplanned neurosurgical readmissions at Yale-New Haven Hospital.MethodsOver a 6-month period, all patients who had been discharged from YNHH after receiving care from the Department of Neurosurgery and readmitted within 30 days were retrospectively identified. In-depth chart analysis was performed to uncover relevant medical/social history and admission/readmission details.ResultsDuring 6 months, 84 (6.6%) of 1,279 patients were readmitted within 30 days. Reasons for readmission were categorized into miscellaneous (34%), non-surgical site infections (15%), postoperative wound complications (14%), intracranial hemorrhage (13%), neurological deficits: brain (10%), CSF device malfunction (8%), neurological deficits: spine (4%), and ischemic CNS events (2%). Most complications were moderate (54%) or mild (31%). Overall, 17% of readmissions were determined to be likely preventable, 10% – potentially preventable, 73% – not preventable. Notably, 42% of postoperative wound complications and 32% of brain-related neurological deficits could have been prevented. 49% of readmissions were related to initial hospitalization and 12% resulted from inappropriate post-discharge care; 34% and 88% of those, respectively, were preventable.ConclusionsOverall, 27% of 30-day neurosurgical readmissions were determined to be potentially preventable. Underlying reasons were identified and will be used to design targeted interventions. Preventing postoperative wound complications and providing appropriate discharge arrangements/instructions are the most promising areas of improvement.
Journal Article
Fully Endoscopic Spine Separation Surgery in Metastatic Disease—Case Series, Technical Notes, and Preliminary Findings
Objective: This report aims to describe the surgical methodology and potential effectiveness of endoscopic separation surgery (ESS) in patients with metastatic spine disease. This concept may reduce the invasiveness of the procedure, which can potentially speed up the wound healing process and, thus, the possibility of faster application of radiotherapy. Materials and Methods: In this study, separation surgery for preparing patients for stereotactic body radiotherapy (SBRT) was performed with fully endoscopic spine surgery (FESS) followed by percutaneous screw fixation (PSF). Results: Three patients with metastatic spine disease in the thoracic spine were treated with fully endoscopic spine separation surgery. The first case resulted in the progression of paresis symptoms that resulted in disqualification from further oncological treatment. The remaining two patients achieved satisfactory clinical and radiological effects and were referred for additional radiotherapy. Conclusions: With advancements in medical technology, such as endoscopic visualization, and new tools for coagulation, we can treat more and more spine diseases. Until now, spine metastasis was not an indication for the use of endoscopy. This method is very technically challenging and risky, especially at such an early stage of application, due to variations in the patient’s condition, morphological diversity, and the nature of metastatic lesions in the spine. Further trials are needed to determine whether this new approach to treating patients with spine metastases is a promising breakthrough or a dead end.
Journal Article
Healthy posture for babies and children : tools for helping children to sit, stand, and walk naturally
\"With a multitude of easy-to-follow principles and exercises--far more fun and effective than the futile mantra of \"sit up straight\"--Kathleen Porter provides a detailed road map for parents, teachers, and health professionals to learn how to guide children back to their natural posture by inhabiting their bodies mindfully for a lifetime of easy movement, strength, and energetic vitality--the hallmarks of enduring good health\"-- Provided by publisher.
Book
How I do it? Uniportal full endoscopic contralateral approach for lumbar foraminal stenosis with double crush syndrome
BackgroundEvolution of endoscopic surgery provides equivalent results to open surgery with advantages of minimal invasive surgery. The literature on technique Uniportal Full endoscopic contralateral approach is scarce.MethodsThe endoscopic contralateral approach technique applies for patients presenting with double crush syndrome with foraminal and extraforminal stenosis. The key steps focus on contralateral ventral overriding superior articular process decompression, foraminal and extraforaminal discectomy, and lateral vertebral syndesmophyte decompression leading to enlargement of the contralateral foramen and extraforamen size.ConclusionThe Uniportal Full endoscopic contralateral approach is a good alternative to open surgery or minimally invasive microscopic surgery through direct endoscopic visualization of the entire route of exiting nerve with no neural retraction allowing both lateral recess and foraminal and extraforaminal decompression all in one approach.
Journal Article
On thin ice
The way twelve-year-old Ked Eakins of Norton, Maine, sees it, his life has been stolen from him, piece by piece--first by kyphosis, a spinal abnormality which has made him a social outcast at school and a target for the school bully; by his friends who have recently abandoned him; by his mother, who left for the West Coast taking the insurance which might have saved him with her; and by his father, who's a gambling addict who has lost the rent money. But Ked is a builder, and using the school's Maker Space he intends to build his life back, and maybe make a few real friends, and save his father while he's at it.
Book
The impact of craft type on operational spine postures in military boat operators
High-speed boat operators (HSBO) are exposed to high-impact forces and unstable platforms that are linked to spine pain and musculoskeletal injury risk. This study sought to determine the effects of different military occupational specialties (MOS) on spine kinematics in 86 active-duty personnel (64 HSBO and 22 Marines). The relationships between spine postures, pain, and disability were also examined. Upright MRI scans were performed in sitting and standing positions to determine sagittal cobb angle, angle with respect to the horizontal plane, sacral slope, T1 slope, and intervertebral angles of the lumbar and cervical spine. Disability and pain were assessed with the Oswestry Disability Index (ODI), Neck Disability Index (NDI), and a Visual Analog Scale (VAS). A two-way repeated measures ANOVA analyzed the effects of MOS and position on spine kinematics, and a stepwise linear regression analyzed the influence of pain and disability. Main effects of position were found for lumbar sagittal cobb angle, sacral slope, and intervertebral angles from L2-S1 (p < 0.0001), and cervical sagittal cobb angle (p = 0.02). MOS significantly affected sagittal cobb angle (p = 0.05) and angle w.r.t horizontal (p < 0.0001). Neck disability explained 4 % of the variance in cervical cobb angle, T1 slope, and the intervertebral angle at C5-C6. Pain did not predict lumbar or cervical spine posture. Position has a significant impact on spine kinematics in all groups, with MOS-related differences in cervical spine posture. Subjective pain measures did not reliably predict spine posture, underscoring the necessity for objective diagnostic approaches and targeted interventions to mitigate injury risk in HSBO.
Journal Article
Sustained rescue of prefrontal circuit dysfunction by antidepressant-induced spine formation
A better understanding of the mechanisms underlying the action of antidepressants is urgently needed. Moda-Sava
et al.
explored a possible mode of action for the drug ketamine, which has recently been shown to help patients recover from depression (see the Perspective by Beyeler). Ketamine rescued behavior in mice that was associated with depression-like phenotypes by selectively reversing stress-induced spine loss and restoring coordinated multicellular ensemble activity in prefrontal microcircuits. The initial induction of ketamine's antidepressant effect on mouse behavior occurred independently of effects on spine formation. Instead, synaptogenesis in the prefrontal region played a critical role in nourishing these effects over time. Interventions aimed at enhancing the survival of restored synapses may thus be useful for sustaining the behavioral effects of fast-acting antidepressants.
Science
, this issue p.
eaat8078
; see also p.
129
Spine formation in the prefrontal cortex is central to the long-term antidepressant effects of ketamine.
The neurobiological mechanisms underlying the induction and remission of depressive episodes over time are not well understood. Through repeated longitudinal imaging of medial prefrontal microcircuits in the living brain, we found that prefrontal spinogenesis plays a critical role in sustaining specific antidepressant behavioral effects and maintaining long-term behavioral remission. Depression-related behavior was associated with targeted, branch-specific elimination of postsynaptic dendritic spines on prefrontal projection neurons. Antidepressant-dose ketamine reversed these effects by selectively rescuing eliminated spines and restoring coordinated activity in multicellular ensembles that predict motivated escape behavior. Prefrontal spinogenesis was required for the long-term maintenance of antidepressant effects on motivated escape behavior but not for their initial induction.
Journal Article
