Consequences and potential problems of operating room outbursts and temper tantrums by surgeons

George B. Jacobs, Rosanne L. Wille

Date of publication: 17-Jul-2012

Background:Anecdotal tales of colorful temper tantrums and outbursts by surgeons directed at operating room nurses and at times other health care providers, like residents and fellows, are part of the history of surgery and include not only verbal abuse but also instrument throwing and real harassment. Our Editor-in-Chief, Dr. Nancy Epstein, has made the literature review of “Are there truly any risks and consequences when spine surgeons mistreat their predominantly female OR nursing staff/colleagues, and what can we do about it?,” an assigned topic for members of the editorial board as part of a new category entitled Ethical Note for our journal. This is a topic long overdue and I chose to research it.

A review of intraoperative monitoring for spinal surgery

Mark M. Stecker

Date of publication: 17-Jul-2012

Background:Intraoperative neurophysiologic monitoring (IONM) is a technique that is helpful for assessing the nervous system during spine surgery.

Eliminating log rolling as a spine trauma order

Bryan P. Conrad, Gianluca Del Rossi, Mary Beth Horodyski, Mark L. Prasarn, Yara Alemi, Glenn R. Rechtine

Date of publication: 17-Jul-2012

Background:Currently, up to 25% of patients with spinal cord injuries may experience neurologic deterioration during the initial management of their injuries. Therefore, more effective procedures need to be established for the transportation and care of these to reduce the risk of secondary neurologic damage. Here, we present more acceptable methods to minimize motion in the unstable spine during the management of patients with traumatic spine injuries.

The lateral transpsoas approach to the lumbar and thoracic spine: A review

Paul M. Arnold, Karen K. Anderson, Robert A. McGuire

Date of publication: 17-Jul-2012

Background:In the last several years, the lateral transpsoas approach to the thoracic and lumbar spine, also known as extreme lateral interbody fusion (XLIF) or direct lateral interbody fusion (DLIF), has become an increasingly common method to achieve fusion. Several recent large series describe several advantages to this approach, including less tissue dissection, smaller incisions, decreased operative time, blood loss, shorter hospital stay, reduced postoperative pain, enhanced fusion rates, and the ability to place instrumentation through the same incision. Indications for this approach have expanded and now include degenerative disease, tumor, deformity, and infection.

Cervical disc arthroplasty: Pros and cons

Bradley Moatz, P. Justin Tortolani

Date of publication: 17-Jul-2012

Background:Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question.

Is posterior fusion necessary with laminectomy in the cervical spine?

Beck D. McAllister, Brandon J. Rebholz, Jeffery C. Wang

Date of publication: 17-Jul-2012

Background:Cervical decompressive laminectomy is a common procedure for addressing multilevel cervical spine pathology. The most common reasons for performing simultaneous posterior cervical fusion include the prevention of progressive postlaminectomy kyphotic deformity or other types of instability which can contribute to late neurological deterioration.

Controversies in Chiari I malformations

Jamie Baisden

Date of publication: 17-Jul-2012

Background:The diagnosis and management of Chiari I malformations (CMI) remains controversial, particularly since it is often an incidental finding on cervical MR scans performed for neck pain and/or headaches. Recently, some surgeons “over-operated” on asymptomatic patients with Chiari I malformations, or even on those without the requisite radiographic diagnostic features for Chiari I malformations: unfortunately, only a subset were admonished for indiscriminate surgery. Nevertheless, when this hindbrain malformation is truly symptomatic, contributing to impaired cerebrospinal fluid (CSF) circulation, various valid surgical management strategies may be adopted.

Multiple operations on the same patient

Fred L. Cohen, Gary W. Roberts

Date of publication: 17-Jul-2012

Background:Here, we present to practicing spine surgeons and an even broader professional audience a case in which one spine surgeon, operating in his own outpatient surgery facility, performed a staggering number of procedures or “multiple operations on the same patient” (MOSP). In the vacuum of information regarding the multiply operated patient, the authors are without any guidance or even knowledge as to whether or not MOSP is a complete aberration or occurs with some documentable frequency within the medical/surgical profession.

Hypofractionated stereotactic radiotherapy for large arteriovenous malformations

Huan-Chih Wang, Rachel J. Chang, Furen Xiao

Date of publication: 26-Apr-2012


Cerebral arteriovenous malformations (AVMs) are abnormal connections between the arteries and veins, with possible serious consequences of intracranial hemorrhage. The curative treatment for AVMs includes microsurgery and radiosurgery, sometimes with embolization as an adjunct. However, controversies exist with the treatment options available for large to giant AVMs. Hypofractionated stereotactic radiotherapy (HSRT) is one treatment option for such difficult lesions. We aim to review recent literature, looking at the treatment outcome of HSRT in terms of AVM obliteration rate and complications. The rate of AVM obliteration utilizing HSRT as a primary treatment was comparable with that of stereotactic radiosurgery (SRS). For those not totally obliterated, HSRT makes them smaller and turns some lesions manageable by single-dose SRS or microsurgery. Higher doses per fraction seemed to exhibit better response. However, patients receiving higher total dose may be at risk for higher rates of complications. Fractionated regimens of 7 Gy × 4 and 6–6.5 Gy × 5 may be accepted compromises between obliteration and complication. Embolization may not be beneficial prior to HSRT in terms of obliteration rate or the volume reduction. Future work should aim on a prospectively designed study for larger patient groups and long-term follow-up results.

Radiosurgery for high-grade glioma

Emanuela Binello, Sheryl Green, Isabelle M. Germano

Date of publication: 26-Apr-2012

Background:For patients with newly diagnosed high-grade gliomas (HGG), the current standard-of-care treatment involves surgical resection, followed by concomitant temozolomide (TMZ) and external beam radiation therapy (XRT), and subsequent TMZ chemotherapy. For patients with recurrent HGG, there is no standard of care. Stereotactic radiosurgery (SRS) is used to deliver focused, relatively large doses of radiation to a small, precisely defined target. Treatment is usually delivered in a single fraction, but may be delivered in up to five fractions. The role of SRS in the management of patients with HGG is not well established.