In the Extraordinary Times of Coronavirus Disease 2019: Clinical Strategies for Performing Spinal Surgery

Barry Tan Wei Loong,Jeanette Tan Sze Lyn Jasmin,Ashokka Balakrishnan,Lopez Keith Gerard,Thambiah Joseph,Kumar Naresh 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.5

The coronavirus disease 2019 (COVID-19) pandemic has caused pronounced strain on global healthcare systems, forcing the streamlining of clinical activities and conservation of health resources. There is a pressing need for institutions to present discipline-specific strategies for the management of COVID-19 patients. We present the comprehensive considerations at the National University Hospital, Singapore from the surgeon’s and anesthetist’s perspectives in the performance of spinal surgery in COVID-19 patients. These are based on national guidelines and overarching principles of protection for the healthcare workers (HCWs) and efficiency in surgical planning. The workflow begins with the emergency department screening that has been adapted to the local epidemiology of COVID-19 in order to identify suspected/confirmed cases. If patient history cannot be obtained, demographic, clinical, and imaging data are used. Designated orthopedic “contaminated teams” are available 24/7 with an activation time of <30 minutes for review. In cases where sub-specialty spine surgeons were required, these professionals were inducted into the “contaminated team” and quarantined until cleared to return to work. Indications for emergency spine surgery were determined pre-emptively. Preoperative surgical considerations included the minimization of manpower, limited dissection, reduced operative time, and judicious use of equipment, leading to reduced aerosolization. Anesthesia considerations include preoperative screening for COVID-19–related concerns that influence surgery, operating room process planning and induction, intraoperative, reversal, recovery, and resuscitation considerations. Focused multi-disciplinary preoperative briefing facilitates familiarization. Surgical, anesthetic, and postoperative workflows were designed to reduce the risk of transmission and protect HCWs while effectively performing spinal surgery. The COVID-19 pandemic has necessitated paradigm shifts in healthcare planning, hospital workflows, and operative protocols. The viral burden does not discriminate between surgeons and physicians, and it is crucial that we, as medical professionals, adapt practices to be malleable and fluid to address the ever-changing developments.

Bone morphogenetic protein 7 (BMP7) gene polymorphisms are associated with inverse relationships between vascular calcification and BMD: the Diabetes Heart Study.

Freedman, Barry I,Bowden, Donald W,Ziegler, Julie T,Langefeld, Carl D,Lehtinen, Allison B,Rudock, Megan E,Lenchik, Leon,Hruska, Keith A,Register, Thomas C,Carr, J Jeffrey Mary Ann Liebert, Inc 2009 Journal of bone and mineral research Vol.24 No.10

<P>Inverse relationships have been observed between BMD and vascular calcification (VC), suggesting an underlying metabolic pathway linking these processes. Bone morphogenetic proteins (BMPs) are potential candidate genes that may mediate this relationship. Four single nucleotide polymorphisms (SNPs) in the BMP2 gene, 2 SNPs in BMP4, and 16 SNPs in BMP7 were tested for association with measures of VC using CT (coronary and carotid arteries, abdominal aorta), and BMD was measured using DXA (lumbar spine, hip, and distal radius) and quantitative CT (QCT; thoracic and lumbar spine) in 920 European Americans from 374 Diabetes Heart Study families: 762 with type 2 diabetes. Variance components quantitative trait locus association analysis was computed using SOLAR software, and a bivariate principal component analysis (PCA) assessed for genetic relationships between BMD and VC. Association was observed between several measures of BMD and BMP7 rs17404303 (thoracic spine QCT p = 0.03; lumbar spine QCT p = 0.02; hip DXA p = 0.06, dominant models). In addition, 6 of 16 BMP7 SNPs showed significant and opposing effects on the bivariate PCA for VC and BMD (two-sided exact test, p = 0.0143). Polymorphisms in BMP7 are associated with inverse relationships between bone mineralization and VC in the coronary, carotid, and abdominal aorta in a diabetes-enriched cohort of European Americans.</P>

Shu-gyo-ryoku:An Academic and Career Skills’ Enhancement Program for Engineering Students at Gunma University

Matsumoto Hiroyuki,Amagai Kenji,Yuminaka Yasushi,Keith Barry 한국공학교육학회 2012 공학교육연구 Vol.15 No.5

Shu-gyo-ryoku, a program to enhance students’ academic and career skills, was begun in the academic year 2011. Under the new program, “Career Planning” and “Career Design” were introduced as part of the liberal arts education for incoming freshmen. Approximately 500 students majoring in engineering enrolled in “Career Planning”, in which they study a “curriculum map” and how it relates to their future fields of employment. The curriculum map illustrates the connections between classes and increases students’understanding of the curriculum structure. In small groups, students discussed the curriculum in order to develop sketches of their career paths. In addition, students answered a career anchor test and though several communicative activities, improved their communication skills. A portfolio system was built into the university network to record the learning history of each student. Students are able to check their learning histories and reflect on the change in themselves during their academic careers.

Shu-gyo-ryoku: An Academic and Career Skills Enhancement Program for Engineering Students at Gunma University

Hiroyuki Matsumoto,Kenji Amagai,Yasushi Yuminaka,Barry Keith 한국공학교육학회 2012 공학교육연구 Vol.15 No.5

Shu-gyo-ryoku, a program to enhance students’ academic and career skills, was begun in the academic year 2011. Under the new program, “Career Planning” and “Career Design” were introduced as part of the liberal arts education for incoming freshmen. Approximately 500 students majoring in engineering enrolled in “Career Planning”, in which they study a “curriculum map” and how it relates to their future fields of employment. The curriculum map illustrates the connections between classes and increases students’understanding of the curriculum structure. In small groups, students discussed the curriculum in order to develop sketches of their career paths. In addition, students answered a career anchor test and though several communicative activities, improved their communication skills. A portfolio system was built into the university network to record the learning history of each student. Students are able to check their learning histories and reflect on the change in themselves during their academic careers.

Asymptomatic Construct Failure after Metastatic Spine Tumor Surgery: A New Entity or a Continuum with Symptomatic Failure?

Kumar Naresh,Patel Ravish,Tan Barry Wei Loong,Tan Jiong Hao,Pandita Naveen,Sonawane Dhiraj,Lopez Keith Gerard,Wai Khin Lay,Hey Hwee Weng Dennis,Kumar Aravind,Liu Gabriel Ka-Po 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.5

Study Design: Retrospective cohort study. Purpose: To study the incidence, onset, underlying mechanism, clinical course, and factors leading to asymptomatic construct failure (AsCF) after metastatic spinal tumor surgery (MSTS). Overview of Literature: The reported incidence rates for implant and/or construct failure after MSTS are low (1.9%–16%) and based on clinical presentations and revisions required for symptomatic failures (SFs). AsCF after MSTS has not been reported. Methods: We conducted a retrospective analysis of 288 patients (246 for final analysis) who underwent MSTS between 2005–2015. Data collected were demographics and peri/postoperative clinical and radiological features. Early and late radiological AsCF were defined as presentation before and after 3 months, respec­tively. We analyzed patients with AsCF for risk factors and survival duration by performing competing risk regression analyses where AsCF was the event of interest, with SF and death as competing events. Results: We observed AsCF in 41/246 patients (16.7%). The mean time to onset of AsCF after MSTS was 2 months (range, 1–9 months). Median survival of patients with AsCF was 20 and 41 months for early and late failures, respectively. Early AsCF accounted for 80.5% of cases, while late AsCF accounted for 19.5%. The commonest radiologically detectable AsCF mecha­nism was angular deformity (increase in kyphus) in 29 patients. Increasing age (p<0.02) and primary breast (13/41, 31.7%) (p<0.01) tumors were associated with higher AsCF rates. There was a non-significant trend towards AsCF in patients with a spinal instability neoplastic score ≥7, instrumentation across junctional regions, and construct lengths of 6–9 levels. None of the patients with AsCF underwent revision surgery. Conclusions: AsCF after MSTS is a distinct entity. Most patients with early AsCF did not require intervention. Patients who survived and maintained ambulation for longer periods had late failure. Increasing age and tumors with a bet­ter prognosis have a higher likelihood of developing AsCF. AsCF is not necessarily an indication for aggressive/urgent intervention.