Dominik Baschera

Background There is debate regarding criteria to select patients for lumbar fusion surgery who have chronic low back pain (CLBP) and corresponding degenerative changes, but without nerve root compression or neurogenic claudication. The aim of this study was to compare patterns in current practice. Method A total of 143 printed questionnaires containing 51 questions were distributed at the German Spine Societies' (DWG) annual congress, 6–8 December 2018. Results We received 127 (89%) surveys (64 orthopedic surgeons and 63 neurosurgeons). Excluding the 22% who do not perform lumbar fusion for CLBP, 41.4% reported performing 1–10 lumbar fusion procedures for patients with CLBP per year, 20.2% reported 11–20, 10.1% reported 21–30 and 17.2% reported performing more than 50. A total of 44.9% of surgeons reported treating patients for at least 6–12 months conservatively before considering surgery; 65.6% considered postoperative pain reduction of 50–70% a treatment success; 32.6% of respondents believe that <50% of patients showed good outcomes after fusion in CLBP and only 15.5% believed that 70% or more showed good outcomes. Orthopedic surgeons perform more lumbar fusion surgeries than neurosurgeons (p = 0.05), fuse more lumbar segments than neurosurgeons (p = 0.02) and are more likely to suggest that their patients with CLBP cease smoking preoperatively (p = 0.02). Conclusions Despite discouraging evidence in the literature, the majority of respondents still perform fusion surgery in patients with CLBP. The use of preoperative diagnostics and tests vary widely among spine surgeons.

Background Head and face injuries are the second most frequently reported injuries among bicyclists. Recently, helmet usage has increased, and in some countries, helmet laws have been introduced. However, subsequent changes in the incidence and severity of traumatic brain injury (TBI) are unknown, and data on neurosurgical interventions are lacking. Therefore, we analyzed a cohort of bicyclists with TBI, in a state with an enforced helmet law, and compared our results with the available literature. Methods Patient data of bicycle accidents that occurred between January 2008 and January 2015 were extracted from the state trauma registry, and the corresponding patient files and CT scans were comprehensively reviewed. Results Of the 1019 patients admitted due to bicycle accidents, 187 patients suffered from TBI. Most cases were mild; however, 72 involved intracranial hemorrhages. Of the TBI patients, 113 were wearing helmets. CT scans were performed on 168 TBI patients, 120 of whom had a Rotterdam CT score of 1, with no difference between helmeted and non-helmeted patients. Open head injury (p < 0.05) and epidural hematomas were significantly less frequent among helmet wearers (p = 0.03). Ten patients required surgery; helmet use and neurosurgical involvement were not significantly correlated. Conclusions Patients who wore helmets were significantly less likely to suffer from epidural hematomas and open head injuries. While TBI severity was not significantly different between helmeted and non-helmeted bicyclists, the overall occurrence of TBI and moderate to severe TBI among all admissions was lower than that seen in comparable studies from countries without helmet laws.

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms commonly involving visceral or parietal pleura. We present the first report of tumor-to-tumor metastasis involving a pulmonary adenocarcinoma donor and an intradural SFT recipient. The patient presented with a 1 year history of diffuse back pain. A spinal intradural contrast-enhancing mass at the T9/10 level and a tumor of the lung were diagnosed radiologically. Bronchoscopic biopsy confirmed pulmonary adenocarcinoma in the right upper lung lobe. Due to deteriorating neurological status with conus medullaris syndrome, we performed a neurosurgical excision of the lesion. Histological analysis of the tumor revealed tumor-to-tumor metastasis of the adenocarcinoma to the SFT.

Background and Study Aims Perioperative use of anticoagulant and platelet-inhibiting agents by patients undergoing spine surgery poses the dilemma of increased risk of hemorrhage. We examined the standards of use for these medications and expert opinions through a nationwide survey. Materials and Methods An online-based survey was conducted by invitation. A personal token to access the survey was sent to one representative of each neurosurgical and orthopaedic unit performing spine surgery and to all other active members of the Swiss Society of Neurosurgery and the Swiss Society of Spinal Surgery. A total of 97 e-mail invitations were sent to 19 representatives of neurosurgical or orthopaedic units and 78 registered neurosurgeons and orthopaedic surgeons who potentially perform spine surgery. Results From February to April 2016, 40 surgeons (26 neurosurgeons, 14 orthopaedic surgeons) completed the survey (41%). Among the respondents, 55% prescribed prophylactic heparin preoperatively; depending on the procedure, 83 to 95% prescribed heparin postoperatively. Depending on the type of surgery, 23 to 48% discontinued acetylic acid preoperatively, and 80 to 87% always discontinued clopidogrel preoperatively. On average, platelet inhibition was resumed 4 ± 2.5 days postoperatively. Orthopaedic surgeons recommenced platelet inhibition earlier than neurosurgeons (p = 0.013). Anticoagulation with rivaroxaban was discontinued 3 ± 2 days before surgery. Depending on the indication, 72 to 98% of respondents temporarily replaced traditional anticoagulation therapy (vitamin K antagonists) with heparin perioperatively. Conclusion Administration and discontinuation of anticoagulant and platelet-inhibiting medications in the perioperative setting of spinal surgery differ vastly between different units and surgeons. Recommendations from the spine surgeon societies may be helpful to develop nationwide guidelines.

Our aim was to examine the specific dimensions of cervical pedicles in a large Caucasian cohort on high dissolving CT scans.

Background: Clinical training concepts of medical students differ in the various European countries. The goal of this paper is to study the differences at the beginning of medical practice in specific clinical skills on an international level. Methods: The data were collected by a publically accessible online questionnaire online from February to June 2010. The participants in the study were recruited through the official letter sent by deaneries and student organisations. Two thousand nine hundred and seven medical students participated in the online survey. From study years 1 to 6, 2406 valid data records (67.3 percent female; 32.7 percent male) from four different European countries were sent. The skills in the questionnaire included patient consultation and anamnesis, physical examination, auscultation, gypsum and bandage dressing, suture techniques, venepuncture, and laying of indwelling catheters. Results: One thousand six hundred and twenty-nine data records of medical students in their training years 3 to 6 were assessed. The average age of the students was 24.7 years. On a scale from 1 to 10, the average satisfaction of the students with theirmedical faculty was 6.47 (+/- 2.07); the assessment of the preparation for the clinical activities was 4.72 (+/- 2.13). By comparison, British students indicated most satisfaction with their training (6.70 +/- 1.85). With respect to the clinical skills, the students interviewed felt safest in patient consultation and anamnesis (7.63 +/- 2.13) followed by blood sampling (7.46 +/- 2.29). The topics of surgical suturing techniques (4.40 +/- 2.81) and the gypsum and bandaging techniques (2.63 +/- 2.23) were taught worst subjectively. Discussion: The training of medical students in basic clinical skills is an essential part of the studies. This study was able to demonstrate that the subjective trust of medical students in their personal skills positively correlated with the satisfaction with their own university. The results pointed out that future curricula of universities could profit from an increased focus on clinical skills.