SOMATOSENSORY EVOKED POTENTIALS SUPPRESSION DUE TO REMIFENTANIL DURING SPINAL OPERATIONS; A PROSPECTIVE CLINICAL STUDY.
Asouhidou I, Katsaridis V, Vaidis G, Ioannou P, Givissis P, Christodoulou A, Georgiadis G.
Δημοσιεύτηκε στο Scoliosis. 2010 May 12;5:8.
Impact Factor: 1,31
Somatosensory evoked potentials (SSEP) are being used for the investigation and monitoring of the integrity of neural pathways during surgical procedures. Intraoperative neurophysiologic monitoring is affected by the type of anesthetic agents. Remifentanil is supposed to produce minimal or no changes in SSEP amplitude and latency. This study aims to investigate whether high doses of remifentanil influence the SSEP during spinal surgery under total intravenous anesthesia.
Ten patients underwent spinal surgery. Anesthesia was induced with propofol (2 mg/Kg), fentanyl (2 mcg/Kg) and a single dose of cis-atracurium (0.15 mg/Kg), followed by infusion of 0.8 mcg/kg/min of remifentanil and propofol (30-50 mcg/kg/min). The depth of anesthesia was monitored by Bispectral Index (BIS) and an adequate level (40-50) of anesthesia was maintained. Somatosensory evoked potentials (SSEPs) were recorded intraoperatively from the tibial nerve (P37) 15 min before initiation of remifentanil infusion. Data were analysed over that period.
Remifentanil induced prolongation of the tibial SSEP latency which however was not significant (p > 0.05). The suppression of the amplitude was significant (p < 0.001), varying from 20-80% with this decrease being time related.
Remifentanil in high doses induces significant changes in SSEP components that should be taken under consideration during intraoperative neuromonitoring.
DELAYED FOREIGN-BODY REACTION TO ABSORBABLE IMPLANTS IN METACARPAL FRACTURE TREATMENT.
Givissis PK, Stavridis SI, Papagelopoulos PJ, Antonarakos PD, Christodoulou AG.
Δημοσιεύτηκε στο Clin Orthop Relat Res. 2010 Dec;468(12):3377-83.
Impact Factor: 2,065
First-generation bioabsorbable implants have been associated with a high complication rate attributable to weak mechanical properties and rapid degradation. This has led to the development of stronger devices with improved durability. However, the modern implants have raised concerns about potential late-occurring adverse reactions.
This retrospective study addressed the following questions: Can absorbable implants consisting of trimethylene carbonate, L-lactide, and D,L-lactide provide adequate fixation for healing of a metacarpal fracture? Will these implants obviate a second removal operation? What complications can occur in the reaction to implant breakdown?
PATIENTS AND METHODS:
Twelve unstable, displaced, metacarpal fractures were studied in 10 consecutive patients (seven men, three women; mean age, 36.4 years; range, 18-75 years). The fractures were treated with absorbable plates and screws consisting of the aforementioned copolymers and designed to resorb in 2 to 4 years. Nine patients (10 fractures) were available for clinical and radiographic followups (mean, 45.7 months; range, 34-61 months).
Fracture healing was uneventful in all cases. Four patients experienced a foreign-body reaction during the second postoperative year and required surgical débridement to remove implant remnants. Histologic examination confirmed the diagnosis of a foreign-body reaction. Two other patients reported a transient local swelling that subsided without treatment.
Our results indicate these absorbable implants for metacarpal fractures achieved adequate bone healing but simply postponed the problem of foreign-body reactions. Patients treated with bioabsorbable implants should be advised of potential late complications and should be followed for at least 2 years, possibly longer.
IMPROVED CORTICOSTEROID TREATMENT OF RECALCITRANT DE QUERVAIN TENOSYNOVITIS WITH A NOVEL 4-POINT INJECTION TECHNIQUE.
Pagonis T, Ditsios K, Toli P, Givissis P, Christodoulou A.
Δημοσιεύτηκε στο Am J Sports Med. 2011 Feb;39(2):398-403. Epub 2010 Nov 3.
Impact Factor: 3,605
Previously described corticosteroid injection techniques for de Quervain tenosynovitis (DQT) refer to either 1-point or 2-point injection techniques, showing superiority of the latter.
The authors’ novel 4-point injection technique (point 4 technique) yields more favorable results than do the older techniques.
Randomized controlled trial; Level of evidence, 2.
The authors treated 2 groups (A and B), each including 24 high-resistance training individuals (randomly allocated to each group) with persistent DQT. Group A received the point 4 technique, and group B, the 2-point injection technique. Follow-up was in 2, 4, 8, and 52 weeks after the first treatment.
After 2 weeks of treatment, 7 group A patients were symptom-free, whereas the rest scored better than their group B counterparts on the DASH (Disabilities of the Arm, Shoulder and Hand) Outcome Measure, of whom only 1 was symptom-free. Ten group A patients received repeated injections, in contrast to 19 from group B. Four weeks after the first treatment, 13 group A patients were symptom-free, in contrast to 4 from group B. In group A, 2 patients received repeated injections, in contrast to 20 in group B. Eight weeks after the first treatment, 1 group A patient received repeated injection. One group B patient relapsed, whereas 4 opted for surgical decompression and 16 received repeated injections. Fifty-two weeks after the first treatment, 21 patients in group A were symptom-free, 1 was operated on, and 2 relapsed; in group B, 12 were symptom-free, 9 were operated on, 3 relapsed, and 3 received repeated injections.
In high-resistance training athletes, recalcitrant DQT responds more favorably to the novel point 4 technique than to the standard 2-point injection technique.
KNEE JOINT EFFUSION FOLLOWING IPSILATERAL HIP SURGERY.
Christodoulou AG, Givissis P, Antonarakos PD, Petsatodis GE, Hatzokos I, Pournaras JD.
Δημοσιεύτηκε στο J Orthop Surg (Hong Kong). 2010 Dec;18(3):309-11.
Impact Factor: 0,653
To correlate patellar reflex inhibition with sympathetic knee joint effusion.
65 women and 40 men aged 45 to 75 (mean, 65) years underwent hip surgery. The surgery entailed dynamic hip screw fixation using the lateral approach with reflection of the vastus lateralis for pertrochantric fractures (n = 49), and hip hemiarthroplasty or total hip replacement using the Watson-Jones approach (n = 38) or hip hemiarthroplasty using the posterior approach (n = 18) for subcapital femoral fractures (n = 28) or osteoarthritis (n = 28). Knee joint effusion, patellar reflex, and thigh circumference were assessed in both legs before and after surgery (at day 0.5, 2, 7, 14, 30, and 45). Time-sequence plots were used for chronological analysis, and correlation between patellar reflex inhibition and knee joint effusion was tested.
In the time-sequence plot, the peak frequency of patellar reflex inhibition (on day 0.5) preceded that of the knee joint effusion and the thigh circumference increase (on day 2). Patellar reflex inhibition correlated positively with the knee joint effusion (r = 0.843, p = 0.035). These 2 factors correlated significantly for all 3 surgical approaches (p < 0.0005). All 3 approaches were associated with patellar reflex inhibition on day 0.5 (p = 0.033) and knee joint effusion on day 2 (p = 0.051).
Surgical trauma of the thigh may cause patellar reflex inhibition and subsequently knee joint effusion
LETTER TO THE EDITOR
IMPROVED CORTICOSTEROID TREATMENT OF RECALCITRANT DE QUERVAIN TENOSYNOVITIS WITH A NOVEL 4-POINT INJECTION TECHNIQUE.
Karsten Knobloch, Thomas A.Pagonis, Konstantinos Ditsios, Paraskevi Toli, Panagiotis Givissis, Anastasios Christodoulou.
Δημοσιεύτηκε στο Am J Sports Med. 2011 Feb 7; 39(2):NP1
Impact Factor: 3,792
Karsten Knobloch, FACS, Hannover, Germany
I read with great interest the recent randomized controlled trial (RCT) by Dr Pagonis and coworkers3 comparing a 2-point and a 4-point injection technique in recalcitrant de Quervain tenosynovitis, which I would like to comment on.
First, I would be curious to know about the thresholds of Disabilities of the Arm, Shoulder and Hand (DASH) scores and pain on visual analog scale (at rest or at exercise) to guide repeat treatment in their RCT regarding de Quervain tenosynovitis. From a practical point of view, this threshold is important given the potential adverse effects of corticosteroid injections.
Second, the authors have highlighted the peritendinous 4-point injection technique without the guidance of ultrasound. I would be curious how to determine a peritendinous rather than an intratendinous injection without visual aids such as ultrasound. An ultrasound-guided injection technique has been highlighted for triamcinolone and bupivacaine injection in de Quervain tenosynovitis to enhance safety.1
Third, I would like to emphasize that, especially among high-level athletes, measures for early return to play are of utmost importance. Similar to the situation at the Achilles and patellar tendon level, we have applied power Doppler ultrasound on females suffering de Quervain tenosynovitis.2 In a pilot series, we found neovascularization similar to the Achilles and patellar tendon level within the first extensor compartment. Using power Doppler–guided sclerosing therapy, we were able to diminish the neovascularization instantaneously. In addition, all patients performed a painful eccentric training protocol using a Thera-Band FlexBar for supination and pronation over 12 weeks with favorable results.
In conclusion, I would like to thank the authors for their RCT and would appreciate a response to the aforementioned suggestions.
Karsten Knobloch, FACS
Thomas A. Pagonis, MD, PhD, Konstantinos Ditsios, MD, PhD, Paraskevi Toli, PhD, Panagiotis Givissis, MD, PhD and Anastasios Christodoulou, MD, PhD
Authors’ Response: In response to the well-written letter by Dr Karsten Knobloch, we express our gratitude for his kind comments and will try to clarify the subjects raised in his letter. We will respond to all comments in the order they appear in Dr Knobloch’s letter.
Response to the First Comment
Concerning the comment about the visual analog scale (VAS), we should point out that the VAS (although helpful) is not as accurate or refined2,3,13,14 as the DASH outcome measure,4 which is the best and most thorough way to evaluate any disabilities of the arm, shoulder, and hand as well as pain intervention and effect in the limb’s functionality. Questions 24, 25, and 26 in the DASH outcome measure further target pain issues, thoroughly and specifically, thus providing an in-depth analysis that has been proved to have an increased injury specificity compared with the VAS, which is a more generic tool.2,3,13,14 Moreover, the DASH outcome measure clearly incorporates a thorough investigation of pain and relevant thresholds delineating the effect in day-to-day activities. All data relevant to Dr Knobloch’s comment are neatly presented in the paper in the Methods section.
Response to the Second Comment
Concerning the comment about the use of ultrasound as a guiding tool,5 we stated that our paper is purely based on the clinical interface6 between patient and surgeon. We did not use any ultrasound apparatus. Nonetheless, recognizing the limitations to our study, in our Discussion section we stated the following: “Although the 4-point injection technique tries to introduce the cortisone solution to all possible compartments, its accuracy remains to be further validated in larger cohorts and multicenter studies, making anatomic variations a considerable factor.” Moreover, I should point out that currently there is no sufficient solid scientific evidence (derived from multicenter RCT studies of substantial volumes) forming a solid consensus about the necessary or obligatory use of ultrasound as a supreme guidance tool that would substitute knowledge of relevant intracompartmental anatomy, surgical skill, surgical experience, and clinical experience and would also address learning curve and patient safety issues (as set by the current literature). Concerning the comments regarding the nature of needle insertion and the proper placement of the injected solution, we must point out that all surgeons are made aware (during basic surgical skills training) of the subtle differences between tissues like tendon and the peritendinous sheath and the way they are “felt” through the probing of a fine needle, making injection in the proper anatomic space a common practice that is strongly supported by the current literature.1,4,7-12,15 Moreover, insertion in the tendon tissue is easily felt through the inserting fine needle but also causes great discomfort to the patient, thus alerting one to an intertendinous injection that might lead to severe complications and side effects.1,4,7-12,15 There were no side effects in our PFT (Point Four Technique) group.
Response to the Third Comment
We believe that this section of the letter does not consist of a comment, but rather acts as a citation. We cannot comment on either the use of commercial instruments such as the Thera-Band FlexBar (quoted by Dr Knobloch) or on the validity of pilot studies (also quoted by Dr Knobloch) that have yet to be concluded and published in full. The cited pilot study (reference 2 in Dr Knobloch’s letter) was published in 2008, involved a small group that is not comparable to our cohort, and refers to sclerotherapy by use of a compound that has acquired US Food and Drug Administration (FDA) approval for sclerotherapy in small varicose veins on March 2010 (FDA reports adverse events that include deep venous thromboses, necrosis, and ulceration at the treated site). The cited therapeutic approach is not comparable to our protocol and thus we cannot comment. Nonetheless, we strongly believe that when the reported pilot studies are complete and the completed results are published in peer-reviewed papers, we will all benefit from reading them and will be able to compare all relevant data. We strongly encourage and support the researchers to publish all relevant findings in a complete scientific paper.
In conclusion, we thank Dr Karsten Knobloch for his kind comments and his invaluable help with the clarification of the points discussed. We strongly believe that his comments were very helpful.
THE EFFECT OF STEROID-ABUSE ON ANATOMIC REINSERTION OF RUPTURED DISTAL BICEPS BRACHII TENDON.
Pagonis T, Givissis P, Ditsios K, Pagonis A, Petsatodis G, Christodoulou A.
Δημοσιεύτηκε στο Injury. 2011 Apr 8. [Epub ahead of print]
Impact Factor: 1,975
There is an increase in the number of anabolic-steroid (AS)-abusing trainees, who suffer from sports injuries, needing reconstruction surgery. Rupture of the distal biceps brachii tendon is a common injury in this group.
The study aimed to investigate the effect of AS abuse in the anatomic reconstruction of the ruptured distal biceps brachii tendon along with an immediate range-of-motion postoperative protocol.
We conducted an observation study of 17 male athletes suffering from distal biceps tendon ruptures. Six of them reported that they abused AS (group A), whereas the non-users comprised group B (n=11). Both groups were treated with the modified single-incision technique with two suture anchors and an immediate active range-of-motion protocol postoperatively. Follow-up was at 4, 16 and 52weeks postoperatively, with a final follow-up at 24 months.
Follow-up at 4, 16 and 52weeks postoperatively showed a statistical significance in favour of group A for therapeutic outcomes concerning flexion, supination, pronation, Disabilities of the Arm, Shoulder and Hand (DASH) Disability Symptom Scores, Mayo Elbow Performance Elbow Scores and isometric muscle strength tests for both flexion and supination. Twenty-four months postoperatively, statistical significance in favour of group A was recorded in isometric muscle strength tests for both flexion and supination and also in DASH Disability Symptom Score.
The results of our study suggest that there is a correlation between the effect of AS and the quicker and better recuperation and rehabilitation observed in group A. Nonetheless, these results must be interpreted with caution, and further in vivo research is needed to confirm these findings.
OSTEOPOROSIS ONSET DIFFERENCES BETWEEN RURAL AND METROPOLITAN POPULATIONS: CORRELATION TO FRACTURE TYPE, SEVERITY, AND TREATMENT EFFICACY.
Pagonis T, Givissis P, Pagonis A, Petsatodis G, Christodoulou A.
Δημοσιεύτηκε στο J Bone Miner Metab. 2011 Jun 14.
Impact Factor: 2,268
Osteoporosis is the prevalent cause of fractures in an ever-aging population, with an established correlation between daily activities and way of life. We aimed to delineate differences in onset of osteoporosis, T-score progression, quality of life, and correlation to prevalence, types, and severity of fractures in age-comparable populations of rural and metropolitan habitats in this multicenter, retrospective double-blind study. We evaluated data derived from the medical files of two comparable groups of osteoporotic patients: group A (n = 530, rural area) and group B (n = 171, metropolitan area). Both groups received comparable treatment for osteoporosis. Comparison was performed on the basis of osteoporosis onset, T-score in a maximum of 8 years follow-up, fracture types [American Academy of Orthopaedic Surgeons (AO) categorization], and type of treatment followed. Quality of life was assessed by use of specialized questionnaires. From the minimum 4-year follow-up of all patients included in the research, there was a statistically significant difference in favor of the rural population in all research parameters. Rural populations presented with osteoporosis at a later age than their metropolitan counterparts, exhibiting favorable T-scores with comparable treatments and simpler fractures (AO categorization). Metropolitan habitats and life therein have a deleterious effect on osteoporosis onset and response to treatment. Rural populations are diagnosed with osteoporosis on a later age, with better compliance and improved treatment outcome. Fracture categorization shows increased severity in the metropolitan populace and a suggested correlation between a poor-quality way of life and decreased activity levels.
COMPLICATIONS ARISING FROM A MISDIAGNOSED GIANT
LIPOMA OF THE HAND AND PALM: A CASE REPORT
Thomas Pagonis, Panagiotis Givissis and Anastasios Christodoulou.
Δημοσιεύτηκε στο J Med Case Rep. 2011 Nov 15;5(1):552.
Impact Factor: 0.350
Lipomas are benign tumors which may appear in almost any human organ. Their diagnosis rate in the hand region is not known.
Case Presentation: We present the case of a 63-year-old Greek Caucasian woman with a giant lipoma of the hand and palm which was not initially diagnosed. After repeated surgical decompression of the carpal tunnel the patient was referred with persisting symptoms of median and ulnar nerve compression and a prominent mass of
her left palm and thenar eminence. Clinical examination, magnetic resonance imaging, nerve conduction study and biopsy, revealed a giant lipoma in the deep palmar space (8.0 × 4.0 × 3.75 cm), which was also infiltrating the carpal tunnel. She had already undergone two operations for carpal tunnel syndrome with no relief of her symptoms and she also ended up with a severed flexor pollicis longus tendon. Definitive treatment was performed by marginal resection of the lipoma and restoration of the flexor pollicis longus with an intercalated graft
harvested from the palmaris longus. Thirty months after surgery the patient had a fully functional hand withoutany neurological deficit.
Conclusion: Not all lipomas of the wrist and hand are diagnosed. Our report tries to emphasize the hidden
danger of lipomas in cases with carpal tunnel symptoms. The need for a high index of suspicion in conjunction
with good clinical evaluation and the use of appropriate investigative studies is mandatory in order to avoid
unnecessary operations and complications. Marginal excision of these tumors is restorative.
STRUCTURAL AND MECHANICAL INTEGRITY OF TENDON-TO-TENDON ATTACHMENTS USED IN UPPER LIMB TENDON TRANSFER SURGERY
Vassiliki A. Tsiampa, Ioannis Ignatiadis, Apostolos Papalois, Panayiotis Givissis, Anastasios Christodoulou, Jan Fridén.
Δημοσιεύτηκε στο J Plast Surg Hand Surg, 05/23/12012
Improved tendon-to-tendon suturing techniques allow for consistent and immediate activation of transferred muscle after surgery. A prerequisite
for early training after tendon transfer surgery is sufficient mechanical integrity of the tendon-to-tendon attachment. This in vitro study
compared the mechanisms and magnitudes of load-to-failure response of two different repair techniques (side-to-side running, n = 7) and weave sutures (n = 8) in sheep front foot tendons. Tensile tests were performed by placing pre-conditioned tendons in a testing machine and stretching at a constant speed to failure. The length of the tendons overlap was the same (50 mm) for both repair techniques. The results of the load to failure tests showed that the side-to-side repairs were significantly stronger than the weave repairs. The failure mechanisms were also different. While the side-to-side attachment failed by longitudinal separation of tendon material of the donor tendon but with the fibres locked to the running sutures attached to the recipient tendon, the weave repairs failed by knot slipping or by suture pullout from the tendon substance. It is concluded that use of the side-to-side repair technique can provide early active training of new motors that not only prevent the formation of adhesions but also facilitate the voluntary recruitment of motors powering new functions before immobilisation-related swelling and stiffness restrain muscle contractions.
CHONDROBLASTOMA OF THE FEMORAL HEAD DISRUPTING THE ARTICULAR CARTILAGE. DESCRIPTION OF A NOVEL SURGICAL TECHNIQUE.
Panagiotis Givissis, Filon Agathangelidis, Evangelos Christodoulou, Anastasios Christodoulou.
Δημοσιεύτηκε στο Acta Orthop. Belg., 2012, 78, 414-417
Impact Factor: 0,401
Chondroblastoma is a rare benign tumour. Involve –
ment of the femoral head may often lead to a delayed
diagnosis. We present the case of a 15-year-old patient with
right hip pain which was first attributed to adductor
tendinitis. Following aggravation of the symptoms,
thorough investigation including a CT-guided biopsy,
revealed the diagnosis of chondroblastoma of the
femoral head. Removal of the lesion based on the
techniques described in literature was not possible,
mainly because the articular cartilage was breached.
A novel surgical technique was used in order to
address the rare location and behaviour of the tumour.
This technique offered the patient pain relief and
return to his previous every day and sports activities.
No recurrence was seen at two years follow-up.
FLOATING ELBOW INJURIES IN ADULTS: PROGNOSTIC FACTORS AFFECTING CLINICAL OUTCOMES.
Konstantinos Ditsios, MD, PhD, Achilleas Boutsiadis, MD,
Pericles Papadopoulos, MD, PhD, Dimitrios Karataglis, MD, PhD,
Panagiotis Givissis, MD, PhD, Ippokratis Hatzokos, MD, PhD,
Anastasios Christodoulou, MD, PhD
Δημοσιεύτηκε στο Journal of Shoulder and Elbow Surgery, 2013
Impact Factor: 2.747
Background: Floating elbow fractures in adults are rare and complex injuries with unpredictable outcomes. The present study was designed to assess our experience, analyze possible compilations and
illustrate prognostic factors of the final outcome.
Methods: Between 2002 and 2009, 19 patients with floating elbow fractures were treated in our department (mean follow-up, 26 months). The fractures were open in 10 patients (52.6%), and concomitant nerve palsy was present in 10 patients. Although the term ‘‘floating elbow’’ refers only to concomitant ipsilateral humeral and forearm shaft fractures, we also included injuries with intra-articular involvement. We
categorized the patients into 4 groups: group I (10 patients) included shaft fractures of humerus and forearm, group IIa (5 patients) and IIb (1 patient) included partial intra-articular injuries, and group III
(3 patients) involved only intra-articular comminuted fractures of the elbow region.
Results: Fracture healing was observed 14 weeks postoperatively, except in 2 patients, in which elbow arthroplasty was applied, and in 1 with brachial artery injury. Nine patients with nerve neuropraxia recovered 4 months postoperatively, and tendon transfers were necessary in 1 patient. Recovery in patients with nerve palsy was worse than in those without nerve injury (Mayo Elbow Performance Score, 73 vs 88.34; Khalfayan score, 72 vs 88.3). In addition, intra-articular involvement (groups II and III) negatively influenced
the final clinical outcome compared with isolated shaft fractures (group I; Mayo Elbow Performance Score, 71.1 vs 88.5; Khalfayan score, 72.67 vs 86.1).
Conclusions: Although the nature of floating elbow injuries is complex, the presence of nerve injury and
intra-articular involvement predispose to worse clinical outcomes.
Level of evidence: Level IV, Case Series, Treatment Study.
PERIOPERATIVE VARIATIONS OF THE INTRACOMPARTMENTAL PRESSURES OF THE PARASPINAL MUSCLES
Symeonidis, Panagiotis D. MD, PhD; Givissis, Panagiotis MD, PhD; Christodoulou, Evangelos MD, PhD; Chatzokos, Ippokratis MD, PhD; Christodoulou, Anastasios G. MD
Δημοσιεύτηκε στο Journal of Spinal Disorders & Techniques, 2013
Impact Factor: 1,503
Study Design: Study of the influence of thoracolumbar spinal surgery through a posterior approach to the intercompartmental pressure of the paraspinal muscles.
Objective: To create waveforms according to the pressure variations up to 24 hours postoperatively and relate these measurements to independent parameters.
Summary of Background Data: The existence of a paraspinal anatomic compartment and a relevant compartment syndrome has been supported theoretically, proven experimentally and confirmed in clinical cases. The perioperative variations of the intercompartmental pressures remain largely unknown.
Methods: Five measurements were taken from both paraspinal compartments in each operated patient: Preoperatively, intraoperatively, immediately after wound closure and at six and 24 hours postoperatively. The recorded pressures were grouped as normal, elevated, or suggestive of a paraspinal compartment syndrome. Abnormal pressures were correlated with patient and operation related parameters. Forty-two patients participated in the study, 21 males and 21 females aged 13 to 83 years (mean age 51[medium shade]y). Seventy compartments were included in the final analysis.
Results: Forty-two compartments developed abnormally elevated pressures postoperatively and in 22 of these, pressures suggestive of a compartment syndrome were recorded. In no case was there a clinical presentation of a true compartment syndrome. Different waveforms were created for the normal and elevated pressures group. In compartments with high measurements, pressures were likely to continue to rise at 6 and 24 hours postoperatively. The body mass index was greater in both the elevated pressures and compartment pressures groups. Procedures lasting more than two hours, extended approaches and instrumented posterior interbody fusion operations were related with lower postoperative pressures.
Conclusions: A large percentage of patients develop increased paraspinal muscle pressures up to 24 hours following posterior thoracolumbar spine surgery. These increases are related to patient and operation-related factors and may not present clinically as a compartment syndrome.
Χαρακτηριστικά των διεθνώς πλήρως δημοσιευμένων εργασιών.
Συνολικός αριθμός πλήρως δημοσιευμένων εργασιών 41
Πρώτο όνομα πλήρων δημοσιεύσεων 13
Δεύτερο όνομα πλήρων δημοσιεύσεων 11
Τρίτο όνομα πλήρων δημοσιεύσεων 3
Μετά το τρίτο όνομα πλήρων δημοσιεύσεων 14
Total Impact Factor: 70.954