Kristian Høy

Background: Surgical postgraduate training is often debated in an economically squeezed health care system, particularly regarding the effectiveness of massed training, when considering the impact on Cognitive Load (CL). However, the relationship between CL and massed training in surgical education has not been extensively studied. Objective: This study aimed to explore how a five-day simulation-based orthopedic course affected cognitive load among orthopedic residents. Methods: Surgical residents (N = 40) in their final phase of medical specialization were enrolled in a surgical skill simulations course from spring 2022 till fall 2023. Questionnaires were administered to course participants to measure CL using NASA-TLX. Fluctuations in CL during the five-day course were analyzed using ANCOVA and Spearman correlation. Results: Forty out of the 41 course participants agreed to participate. The findings revealed fluctuations in CL among orthopedic residents during the five-day course. NASA-TLX scores increased significantly after day 1 ( P = .017, P < .001) and decreased on day 4. ANCOVA showed a significant effect of day on total workload scores ( P = .014), with no significant associations between workload and covariates. No specific factors were identified as key drivers of cognitive load variation. Conclusion: The findings revealed variations in perceived workload over the five days, with no single factor identified as the primary driver of changes in CL. While the study did not find a detrimental impact from massed training, further research is needed to understand the connection between training approaches and their impact on CL and learning outcomes.

The spinal instability neoplastic score (SINS) is used to evaluate spinal stability in patients with metastatic vertebrae and to guide treatment selection. SINSs of 13–18 indicate instability typically requiring surgery, while SINSs of 1–6 indicate stability and suitability for radiotherapy. However, the optimal approach for patients with SINSs of 7–12 remains unclear. This systematic review aimed to determine the optimal primary treatment for patients with intermediate SINSs (7–12) and potentially unstable metastatic vertebrae. A systematic literature search was conducted in PubMed, Embase, and Scopus, following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Twenty-six studies were included in this review (three A-class and 23 B-class). The A-class studies showed better outcomes with surgery±radiotherapy than radiotherapy alone. Two B-class studies indicated that patients with SINSs ≥10 more frequently underwent surgery, and one study found surgery was less effective for SINSs ≤9. Four studies showed good outcomes of surgery. In another study, 30% of patients became unstable after radiotherapy. In four studies, vertebral compression fractures developed in 20%–30% of patients after stereotactic body radiation therapy or stereotactic ablative body radiotherapy. One study showed that SINSs of 7–12 were correlated with radiotherapy failure, while another study found no such association. This systematic review suggests that surgical intervention alone or in combination with radiation may be superior for patients with SINSs of 7–12 and metastatic spinal tumors. The SINS 7–12 category might be divided into subgroups where surgery or radiotherapy is optimal. SINS ≥10 may indicate a need for surgery, and individual SINS components could be predictive. Further research is warranted to obtain more definitive evidence.

Background and PurposeOptimal antibiotic prophylaxis is crucial to prevent postoperative infection in spinal surgery. Sufficient time above the minimal inhibitory concentration (fT > MIC) for relevant bacteria in target tissues is required for cefuroxime. We assessed cefuroxime concentrations and fT > MIC of 4 mu g center dot ml(-1) for Staphylococcus aureus in the intrathecal (spinal cord and cerebrospinal fluid, CSF) and extrathecal (epidural space) compartments of the lumbar spine. Experimental ApproachEight female pigs were anaesthetized and laminectomized at L3-L4. Microdialysis catheters were placed for sampling in the spinal cord, CSF, and epidural space. A single dose of 1500 mg cefuroxime was administered intravenously over 10 min. Microdialysates and plasma were obtained continuously during 8 h. Cefuroxime concentrations were determined by ultra-high-performance liquid chromatography. Key ResultsMean fT > MIC (4 mu g center dot ml(-1)) was 58 min in the spinal cord, 0 min in the CSF, 115 min in the epidural space, and 123 min in plasma. Tissue penetration was 32% in the spinal cord, 7% in the CSF, and 63% in the epidural space. Conclusion and ImplicationsfT > MIC (4 mu g center dot ml(-1)) and tissue penetration for cefuroxime were lower in the intrathecal compartments (spinal cord and CSF) than in the extrathecal compartment (epidural space) and plasma, suggesting a significant effect of the blood-brain barrier. In terms of fT > MIC, a single dose of 1500 mg cefuroxime seems inadequate to prevent intrathecal infections related to spinal surgery for bacteria presenting with a MIC target of 4 mu g center dot ml(-1) or above.

Metastatic spinal cord compression can be due to the debut of cancer or terminally advanced disease, and symptoms are pain, limb weakness, hypoaesthesia and sphincter dysfunction. In patients with a cancer history, metastatic spinal cord compression must be suspected, which is why MRI is necessary. In case of neurological impairment, the patient must consult surgical and oncologic specialists at a university hospital, who can offer the best treatment, i.e. surgery in combination with radiotherapy or radiotherapy alone. Treatment gives higher one-year survival, preserved ambulatory function, increased life quality and less pain, as summarised in this review.

Introduction This study aims to describe a novel minimal invasive early-onset scoliosis (EOS) growth rod concept, the Cody Bunger (CB) Concept, which combines concave interval distraction and contralateral-guided growth with apical control and to investigate the 3D deformity correction, the spinal growth, and the pulmonary development. Method A series of 38 children with progressive EOS and growth potential, receiving a highly specialized surgical treatment, including primary and conversion cases. Mean age was 10.2 years (4.4-15.8) with a mean follow-up of 5.6 years, and they underwent 168/184 open/magnetic lengthening procedures. Outcomes were as follows: scoliosis, kyphosis, and lordosis angles; apical rotation; spinal length; apical translation; coronal and sagittal vertical alignment; complications; and pulmonary function in a subgroup. Results Scoliosis improved from mean 76 degrees (46-129) to 35 degrees (8-74) post-op and was 42 degrees (13-83) at end of treatment. Apical rotation was reduced by 30% but was partially lost during treatment. Thoracic kyphosis initially decreased by mean 15 degrees and was partially lost during treatment. Lordosis was largely unaltered during treatment. Mean T1-S1 height increased from 30.7 cm (22.7-39.2) to 34.6 cm (27.8-45.1) postop and further increased to 38.5 cm (30.1-48.1) during treatment. This corresponded to a T1-S1 growth rate of 12 mm/year, and positive growth rates were found in all height parameters evaluated. Frontal balance and apical translation improved, whereas sagittal balance was unaltered. Complications occurred in 22/38 patients, and 11/38 had an unintended reoperation. Pulmonary function (FVC and FEV) increased but the relative lung function was unchanged. Conclusion The new growth rod concept provided 3D correction and spinal growth at complication rates comparable with other growth-friendly techniques for EOS, while pulmonary function was preserved. Single magnetic rod distraction was incorporated successfully, replacing surgical elongations.

This case report describes a 63-year-old woman, who had an undiscovered os odontoideum for three years and underwent therapy by a chiropractor and a physiotherapist, before the diagnosis was made. Os odontoideum is unknown to most doctors, and increased knowledge of the disease is of great importance, since inappropriate treatment in the form of manipulation and neck exercises might worsen the disease. In case of prolonged or uncharacteristic neck symptoms, the diagnosis should be considered, and a normal cervical X-ray would provide the diagnosis. If os odontideum is suspected, the patient should be referred to a highly specialised spine centre at a university hospital.

Early-Onset Scoliosis (EOS) treatment aim to improve natural history and the child’s quality of life. Magnetically Controlled Growing-Rods (MCGRs) represented a major evolution in distraction-based management of EOS by eliminating the surgical elongations.