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To identify which combination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) is most reliable for postoperative motor deterioration during spinal cord tumor surgery, according to anatomical and pathologic type.
MEPs and SEPs were monitored in patients who underwent spinal cord tumor surgery between November 2012 and August 2016. Muscle strength was examined in all patients before surgery, within 48 hours postoperatively and 4 weeks later. We analyzed sensitivity, specificity, positive and negative predictive values of each significant change in SEPs and MEPs.
The overall sensitivity and specificity of SEPs or MEPs were 100% and 61.3%, respectively. The intraoperative MEP monitoring alone showed both higher sensitivity (67.9%) and specificity (83.2%) than SEP monitoring alone for postoperative motor deterioration. Two patients with persistent motor deterioration had significant changes only in SEPs. There are no significant differences in reliabilities between anatomical types, except with hemangioma, where SEPs were more specific than MEPs for postoperative motor deterioration. Both overall positive and negative predictive values of MEPs were higher than the predictive values of SEPs. However, the positive predictive value was higher by the dual monitoring of MEPs and SEPs, compared to MEPs alone.
For spinal cord tumor surgery, combined MEP and SEP monitoring showed the highest sensitivity for the postoperative motor deterioration. Although MEPs are more specific than SEPs in most types of spinal cord tumor surgery, SEPs should still be monitored, especially in hemangioma surgery.
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To evaluate the effects of the implementation of critical pathway (CP) in stroke patients treated at a single university hospital.
A retrospective medical review collected data from 497 patients who had suffered acute stroke in the rehabilitation center. Stroke outcomes were compared between before and after the implementation of CP based on factors including demographic factors, stroke characteristics, pre-existing medical conditions, medical complications, functional states, and length of stay (LOS).
After the implementation of CP, the patients showed significantly higher stage for upper proximal (p=0.008) and lower extremity (p=0.001) on Brunnstrom stage and significantly lower scores for modified Rankin Scale (p=0.003) at transfer. For those with pre-existing medical conditions, there were significantly increased osteoarthritis (p=0.002) and valvular heart disease (p=0.011). Regarding medical complications during acute inpatient rehabilitation, there were significantly decreased shoulder pain (p=0.001) and dysphagia (p=0.017), and significantly increased gastrointestinal symptoms (p=0.001). Functional gain and efficiency of stroke patients during rehabilitation center hospitalization did not significantly change after implementation of CP. But, shorter LOS of total hospitalization, pre-rehabilitation center hospitalization, and rehabilitation center hospitalization were evident.
After the implementation of CP, patients less often developed complications and displayed no changes in functional gain and efficiency. They had shorter LOS of total hospitalization, pre-rehabilitation center hospitalization and rehabilitation center hospitalization.
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A 49-year-old man received prolotherapy in the upper cervical region at a local medical clinic. Immediately after the procedure, he felt a sensation resembling an electric shock in his right upper and lower extremities, and continuously complained of numbness and discomfort in the right hemibody. He visited our clinic a week later. Upon physical examination, there were no significant abnormal findings. The visual analog scale was 60 points. T2-weight magnetic resonance images of the cervical spine showed a 0.7 cm sized bright oval spot on the right side of the spinal cord at the level of C4-C5 disc, suggesting spinal cord injury. There were no definite electrodiagnostic abnormalities. Digital infrared thermal images showed moderately decreased surface temperature on lateral aspect of the right forearm and dorsum of the right hand compared with the other side. Considering that very rare complications like spinal cord injury may develop after prolotherapy, we suggest that special interventions such as prolotherapy be performed by professional experts.
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Objective: The risk of barium aspiration has been reported through animal and clinical studies. Although the barium aspiration occurs frequently during videofluoroscopic barium swallowing study (VFSS) that is used in a standard method for diagnosis of dysphagia, there has been no research about the risk of VFSS.
Method: One hundred VFSS of sixty nine patients were analyzed prospectively. The patients were diagnosed to dysphagia clinically. VFSS findings were classified into 5 groups according to the severity of aspiration. The incidences of complications, such as fever (＞38.3oC), leukocytosis (＞10,000), dyspnea and abnormality of chest roentgenogram within 24hours after VFSS were determined in each group. Odds ratios of complications after VFSS for severity of their findings were calculated.
Results: The complications of VFSS are as follows; five febrile conditions, three leukocytosis and three dyspnea among 100 VFSS cases. Odds ratios for complications were over 1 except for the abnormality of chest roentgenogram, but which was not statistically significant.
Conclusion: The incidence of complication after VFSS was 5% in dysphagic patients. But the severity of complication was mild and there was no statistical significance between complication and aspiration on VFSS, so VFSS was a relatively safe procedure.
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