...fact that the procedure doesn’t involve removal of any body part unlike Spinal Discectomy or Laminectomy. While the Fusion procedure is an improvement and better alternative over the other two for back problems, it still is a medical procedure with significant risk. The patient may lose the ability to walk in some conditions and it’s a very expensive procedure. Rate of Spinal surgeries Increase in the rate of Spinal Fusion procedure may be attributed to the incentive for hospital profits. While many hospitals setup separate spinal care units to solve all back pain problems, it still is the surgeon’s decision whether the patient needs a surgery or not. If the surgeon owns a POD, the incentive for the doctor to approve the surgery is high. Hospital profits and revenue due to spinal procedures are a prime factors that drive the increase in rate of spinal surgeries. The invention of spinal fusion procedure set the rate of spinal surgery trend line to a burgeoning growth because it’s a “relatively safer” surgery. The term “relatively safer”, if advertised can mislead the patients suffering from back pain and mask the risks involved the procedure. For most aging humans, back problems are inevitable due to the present lifestyle. Although most problems can be cured by a mere lifestyle change, medication, and therapy, people often have a misconception that it’s easy to undergo a surgical procedure and get over with the pain. With the introduction of healthcare reform and Obamacare...
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...pars interarticularis is detached and there is a separation of the joints. It is typically caused by stress fracture of the bone, and is especially common in adolescents who overtrain in activities. Treatment Rehabilitation and surgery are the two methods of management in conventional therapy. The most notable non-surgical rehabilitation procedure done with an individual with spondylolysis is Physical Therapy. Therapy usually ranges from 3 to 6 months depending on the status of the injury. Besides this, treatments for acute spondylolysis include resting from sports participation or wearing an anti-lordotic brace. Medication such as ibuprofen and other pain relievers may also be used during these treatments to reduce the pain and decrease inflammation. During treatment, the patient is usually asked to stay off their feet and get as much rest as they can by lying down for the majority of the day. If for any reason the patient should do any sort of activity, the brace should be worn to prevent any excessive movement. Surgery may be done to those who have not had success with treatments but this is not common.There are two types of surgery for this condition. Laminectomy (This is a procedure to remove the lamina from the bony ring of the vertebra and release pressure) and Posterior Lumbar Fusion. (Spinal fusion is a procedure that joins two or more bones (vertebrae) together into one solid one which will prevent the joints and bones from moving. Surgeons apply metal screws, and rods...
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...DOI: 11/28/1984. The patient is a 65 -year-old male pump installer/laborer who sustained a work-related injury to his low back after repetitive jumping off his 4-feet high truck bed. The patient is diagnosed with postlaminectomy syndrome. The patient was subsequently diagnosed with postlaminectomy syndrome, not elsewhere classified. As per office notes dated 6/1/16, the patient presents with chief complaints of low back and neck pain. The patient continues with chronic intractable low back pain as well as chronic intractable neck pain. The patient states that he has paying for methadone as an out-of-pocket expense. He notes that, “the pain would be intolerable without the medication.” The patient exhibits no aberrant behavior toward the pain medication today and denies adverse...
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...Solution: • No matter how carefully a production process is controlled, these quality measurements will vary from item to item, and there will be a probability distribution associated with the population of such measurements. • If all important sources of variations are under control in a production process, then the slight variations among the quality measurements usually cause no serious problems. • Such a process should produce the same distribution of quality measurements no matter when it is sampled, thus this is a “stable system.” • Objective of quality control is to develop a scheme for sampling a process, making a quality measurement of interest on sample items, and then making a decision as to whether or not the process is in the stable state, or “in control.” • If the sample data suggests that the process is “out of control,” a cause is for the abnormality is sought. • A common method for making these decisions involves the use of control charts. • These are very important and widely used techniques in industry, and everyone in the industry, even if not directly related to quality control, should be aware of these. • Attributes – A performance characteristics that is either present or absent in the product or service under consideration. • Examples: Order is either complete or incomplete; an invoice can have one, two, or more errors. • Attributes data are discrete and tell whether the characteristics...
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...injuries occur in men aged 15-35 who are relatively healthy individuals. The death rates of these young individuals with spinal injuries are significantly very high. Causes Many injuries are a result of gunshot wounds, motor accidents, falls and sports injuries. A minor spinal cord injury occurs if spine is weakened (osteoporosis/rheumatoid arthritis/spinal stenosis). The reason behind this can be explained by the normal ageing process. Patients who have had other medical problems which make them more prone to falling from weakness (e.g. stroke) can also be classified under this heading. Other causes include direct injury to the spinal column where the disks or bones have been fragmented. This can be for example if the cord is compressed, pulled in either direction or even if the head, back or neck are twisted beyond their normal rotational angle during an injury or accident. Compression can result from blood being accumulated inside the spinal canal causing damage to occur to the spinal cord. Symptoms The symptoms patients experience depend on the location of the injury as it causes weakness and sensory loss at and below the point of injury. Injury severity is determined by a complete or partial cord impairment. NB. “The spinal cord doesn't go below the 1st lumbar vertebra, so injuries at and below this level do not cause spinal cord injury. However, they may cause "cauda equina syndrome" -- injury to the nerve roots in this area.” Cervical Injuries – Injuries...
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...anterior 2/3 tongue 9. Mouth droop Evaluation & Diagnosis * Bell’s Palsy is a clinical diagnosis based on * typical presentation * absence of other explanation or other underlying disease * absence of cutaneous lesions * otherwise normal neuro exam * Proceed with imaging (MRI) if * Atypical Presentation * Slowly progressive over 2-3 weeks * If no improvement in symptoms in 6 wks * Electrophysiology (CMAP) performed if complete facial paralysis remains after 1 week of treatment Treatment * PT management: modalities, facial exercise, massage * Manual closing of eye such as with tape while sleeping, lubricating eye drops * Steroids * +/-Acyclovir * Surgical Decompression – no good evidence to support Prognosis * 80% recover within weeks to months * If motor nerve conduction studies show evidence of...
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...Occasionally, early stage symptoms include hearing loss, tinnitus (ringing in the ears), and having troubles with balance. Generally patients in their thirties will grow tumors in both ears. Rarely patients develop cataracts, clouding of the lense, in either one or both eyes, often in early childhood. Similar to type 1, there is no cure, but there are options. It is possible to surgically remove the tumors, but the risks are detrimental, for example, removing tumors from the nerve tissue could further damage your hearing and cause paralysis of your facial muscles. Removing tumors from the spinal cord can be risky as well, it carries a slim chance of damaging your spinal cord which could lead to paralysis. Often times, it is necessary to have surgery because if not treated properly, such as a tumor aging in the brain, causing vital damage, would lead to more...
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...Psychological treatments given to the patient helps him to learn about the physiological changes produced by pain. Also important adjunct information can be provided to drug or surgical treatment. Thereby required support is given to the patient suffering from pain. Chiropractic Care It is used to treat back pain, neck pain, headaches and musculoskeletal conditions. In this method, the relationship between the body structure (mainly spine) and its function is adjusted by hands-on therapy. For example, chiropractic spinal manipulation includes adjustments and manipulation of joints and adjacent tissue and it may also involve therapeutic and rehabilitative exercise. Exercise Exercise is often prescribed nowadays as a part of the treatment regime for patients suffering from chronic pain. Because chronic pain is related to tense and weak muscles while exercise maintain a good blood supply to the muscles, keeping them nourished and healthy. Therefore, even light to moderate exercises such as walking or swimming can relieve the patient of chronic pain. Also pain occurs due to stress, which can be reduced by exercise, sleep and relaxation. Thereby exercise provides pain relief to the patient. But pain relief can only be achieved if the patient follows the routine laid out by their...
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...They evaluated about 40,000 infants to see if they had any predetermined symptoms associated with CP. They found that children had at least on of the following symptoms: birth weight was less than 2,000 grams and prolonged crying for more than one day (Nelson & Ellenberg, 1979). Further they found that diminished activity, apgar score of 3 or less, thermal instability, gavage feeding or hypo/hypertonia were (Nelson & Ellenberg, 1979). A popular surgical treatment was selective posterior rhizotomy (SPR) which is where a lumbar laminectomy is done with the stimulation of rootlets in the spine from L2 to S2 (Peacock, Arens, and Berman 1987). Another study identified 25 children with spastic CP before and after the surgical treatment to assess the effects of SPR. The results showed a reduction in muscle tone, range of movement and motor function (Peacock & Staudt, 1991). It also showed improvements in gross motor skills (Peacock & Staudt,...
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...3 in every 10,000 block. It has been thought that proximal nerve blockades are riskier than distal techniques because of the higher proportion of neural tissues in proximal nerves. There are however no compelling evidence to validate or invalidate this despite multiple studies. Peripheral nerve injuries are common in the first days to month after peripheral nerve blockade. They however rarely result in permanent injury. The incidence is reduced with time – 0-2.2% at 3 months, 0-0.8% at 6 months and 0-0.2% at 1 year. On the other hand, the risk of injury after neuraxial blockade is extremely low, but when they do happen, the injuries are often permanent. Studies estimate an incidence of 1 in 8,000 of neuraxial blockade result in a laminectomy. The risk of permanent injury after a neuraxial blockade is estimated to be between 1 in 5,800 to 1 in 12,200. 2. Which of the following is not a risk factor for neuraxial injury? A. Epidural technique as compared to subarachnoid technique B. Presence of coagulopathy C. Concurrent spinal stenosis D. Obstetric procedures Answer: D Explanation: The risk for neuraxial injury, combining hematoma, infection, and spinal cord injury, is lower in obstetrical procedures. It is however higher in orthopedic surgeries, coagulopathy, increased age, and female sex. The risk of hematoma is also higher with epidural than subarachnoid techniques. Concurrent spinal stenosis or preexisting neurologic diseases can worsen injury severity in the presence...
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...compared to the contralateral side. The skin of the affected extremity was intact. A 2+ dorsalis pedis pulse was present on the left foot. In addition, the patient did not complain of pain upon palpation of the left thigh, knee, ankle, and foot. However, the patient complained of excruciating pain of the left hip upon attempted ROM. The findings of the pelvis CT scan showed a dislocation of the left femoral head superiorly and posteriorly with a comminuted fracture of the medial left femoral head and superior left acetabulum. The emergency department physician performed a reduction of the left hip with placement of skeletal traction pins before the patient arrived at the Ortho/Trauma Unit. Finally, a total hip arthroplasty (THA) was recommended and the patient is currently awaiting surgery that is scheduled on February 03, 2015. H.B.’s surgical history includes a colon resection for pre-cancerous polyp in 2013, a right wrist surgery in 2009, and a laminectomy in 1996. His medical history is composed of hypertension (HTN) and asthma. H.B. takes amlodipine and losartan for hypertension at home. He denies taking any medication for the treatment of his asthma. The patient has no known allergies. Family and Social History H.B. is a diesel mechanic who lives in Savannah, Georgia with his wife. He has no children. The patient denies the usage of illegal drugs, but states that he chews tobacco and drinks alcohol occasionally. His support system includes his wife,...
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...Mira LaVergne Mrs. Angie Herbert English II 14 March 2012 Chiari Malformation To say the human brain is complex is an understatement. Simply laughing requires help from five different areas of the brain. Nursing Assistant Central 4. Dr. Choug Bui’s procedure for Chiari Malformation is better because he uses the body’s own tissue instead of synthetic materiel. In the normal brain Attached to the brain stem is the cerebellum. It looks a lot like a cauliflower. The cerebellum controls movement and balance. It is important with the coordation of the body and the body’s equilibrium. The brain stem starts out at brain and continues throughout the body’s spine; which advent ally turns into the spinal cord. The brain stem is what makes the body alive. Its sends signals throughout the body, most importantly to the body’s main organs. It also regulates the body’s consciousness. The spine contains 26 bones, 24 are vertebrates. Vertebrates are the main part of the spine. The spine is divided into 5 parts: cervical, thoracic, lumbar, sacrum, and coccyx. When compared to the normal human brain, the Chiari Malformation is clearly different. This Malformation was discovered by Hans Chiari in 1819. Hewitt and Gabata 4. It is a rare, but serious neurological condition. Labuda 20. Chiari Malformation is where the cerebellum descends out into the spinal canal. Labuda 20. It is a progressive condition. Mayo Clinic Staff. It forms a lot of compression with cerebellum and the skull. “Chiari...
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...3. http://en.wikipedia.org/wiki/Tramadol. 4. P R Bromage et al. Epidural Narcotics for Postoperative Analgesia. Anesth Analg 1980; 59:473-480. 5. Bach V et al. Potentiation of epidural opioids with epidural droperidol. Anaesthesia 1986; 41:1116-1119. 6. M.Morgan. The rational use of intrathecal and extradural opioids. Br J Anaesth 1989; 63; 165-188. 7. Parvis Naji et al. Epidural Droperidol and Morphine for Postoperative Pain. Anesth Analg 1990;70582-8. 8. J C Tortosa et al. Efficacy of augmentation of epidural analgesia for caesarean section. Br J Anaesth 91 (4); 532-5 (2003). 9. Sylvie Rostaing et al. Effect of epidural clonidine on analgesia and pharmacokinetics of epidural fentanyl in postoperative patients. Anesthesiology 1991; 75:420-425. 10. Torben Mogensen et al. Epidural Clonidine Enhances Postoperative Analgesia From a Combined Low-Dose Epidural Bupivacaine and Morphine Regimen. Anesth Analg 1992;75:607-10. 11. James Eisenach et al. Hemodynamic and analgesic action of epidurally administered clonidine. Anesthesiology 78:277-87, 1993. 12. M De Kock et al. Intravenous or epidural clonidine for intra and postoperative analgesia. Anesthesiology 79:525-531,1993. 13. Anis Baraka et al. A comparison of epidural tramadol and epidural morphine for postoperative analgesia. Can J Anaesth 1993/40:4/pp 308-13. 14. A. E. Delilkan et al. Epidural bamadol for postoperative pain relief. Anaesthesia, 1993, Volume 48, page 328-331...
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...analgesics, mixture of opioid analgesics and local anesthetics, local anesthetics and it also supervise into many Alpha-2 agonists, for example, as an add-on to epidural clonidine might be seen in future. For pain relief in the post operative care of Ms Taylor, the use of epidural infusion can be very much effective. If it is taken as the pain reliever in the post operative care then it can be very much useful to reduce the pain. After the operation, Ms Angie Taylor direly needs a pain reliever which can provide her immense relief in pain (Bollish SJ, 1985). Therefore, Epidural infusion is very much effective and functional for pain relief in the post operative care of Ms Angie Taylor. The epidural infusion is applied in the body of the patient in the post operative care which can be very much preventive. The epidural infusion functions...
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...Blue Box Notes Back Strain, Sprains and Spasms (p. 495) • Warm up and stretching – increase tonus of “core muscles” (anterolateral abdominal wall—transverse abdominis—lumbar stabilization) prevent back strains and sprains • Back sprain – injury to ligamentous or attachment of ligament to bone. o NOT DISLOCATION OR FRACTURE o Excessively strong contractions for extension or rotation of vertebral column • Back strain – degree of stretching or microscopic tearing of muscle fibers o Sports; overly strong contraction o Muscles usually involved with producing movement of lumbar IV joints ▪ ERECTOR SPINAE o Weight not properly balanced on vertebral column o Do NOT use back as lever, crouch and keep back straight ▪ Use muscles of butt and lower limbs • Spasm – sudden involuntary contraction of one or more muscle groups o Protective mech o Attended by cramps, pain, and interference with f(x), producing involuntary movement and distortion Reduced Blood Supply to Brainstem (p. 496) • Winding course of vertrebral arteries through foramina transverasii of the transverse process of the cervical vertebrae and through subocciptal triangle • Problem when arteriosclerosis (hardening of arteries) – reduces blood flow • Symptoms – prolonged turning of the head such as trying to back up in car causes lightheadedness, dizziness, and other symptoms...
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