Medicolegal corner (spine): Contraindicated use of DuraSeal in anterior cervical spine led to quadriplegia

xlomafota13 shared this article with you from Inoreader Medicolegal corner (spine): Contraindicated use of DuraSeal in anterior cervical spine led to quadriplegia Via leak of cerebrospinal fluid Surg Neurol Int. 2021 Oct 19;12:532. doi: 10.25259/SNI_875_2021. eCollection 2021. ABSTRACT BACKGROUND: The package insert for DuraSeal (Integra LifeSciences, Princeton NJ) states it is Contraindicated for use in the anterior cervical spine (confined space): "Do not apply DuraSeal® hydrogel to confined bony structures where nerves are present since neural compression may result due to hydrogel swelling (…up to 12% of its size in any direction)." Further, it should not be used to treat massive unrepaired cerebrospinal fluid (CSF) leaks in any location; "…(it) is indicated as an adjunct to sutured dural repair during spine surgery to provide watertight closure," but it is not to be used "...for a gap greater than 2 mm…." METHODS: A spinal surgeon interpreted a geriatric patient's MR as showing severe C3-C4 to C5-C6 anterior cord compression due to disc disease/spondylosis. However, he never reviewed the CT report/images that documented marked ossification of the posterior longitudinal ligament (OPLL) with multiple signs of dural penetrance. RESULTS: The anterior C4, C5 corpectomy, and C3-C6 strut fusion/plating resulted in a massive, irreparable cerebrospinal fluid (CSF) leak. Despite the contraindications, the surgeon mistakenly applied DuraSeal which caused the patient's postoperative quadriplegia (i.e., as documented on the delayed postoperative MR scan). Following a secondary surgery consisting of a laminectomy/posterior fusion, the patient was still quadriplegic. Further, as he requested no postoperative MR scan and performed no subsequent corrective surgery (i.e., anterior removal of DuraSeal), the patient remained permanently quadriplegic. CONCLUSION: DuraSeal is directly contraindicated for use in the anterior cervical spine, with/without a CSF leak. Here, utilizing DuraSeal for anterior cervical OPLL surgery resulted in permanent quadriplegia, and was below the standard of care. PMID:34754582 | PMC:PMC8571335 | DOI:10.25259/SNI_875_2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bone Conduction

xlomafota13 shared this article with you from Inoreader Bone Conduction Via Otolaryngologic Clinics of North America Bone conduction devices (BCDs) are a well-established and effective treatment solution for children with conductive and mixed hearing loss. Evidence indicates that early intervention through BCDs can improve hearing, speech, and language, and developmental outcomes. BCDs overcome several limitations associated with traditional hearing aids, and in many cases offer children an alternative to more invasive surgical management. Despite these benefits, children with conductive hearing loss are often subject to delays in intervention. In addition, interventional challenges and technological limitations of BCDs prevent widespread adoption and acceptance, particularly in early childhood. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Continuing to establish the relationship between anatomical location of cutaneous head and neck melanoma primaries and locoregional sites of metastasis: A consideration of a new anatomical site, drainage to multiple and non-adjacent neck levels, and the impact on the selectivity of neck dissection

xlomafota13 shared this article with you from Inoreader Continuing to establish the relationship between anatomical location of cutaneous head and neck melanoma primaries and locoregional sites of metastasis: A consideration of a new anatomical site, drainage to multiple and non-adjacent neck levels, and the impact on the selectivity of neck dissection Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Oct 7:S1748-6815(21)00460-5. doi: 10.1016/j.bjps.2021.09.022. Online ahead of print. NO ABSTRACT PMID:34756553 | DOI:10.1016/j.bjps.2021.09.022 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.