Charlottesville, VA (May 21, 2013). Physicians at Monash University and The Alfred Hospital in Melbourne, Australia describe the logistic, medical, and societal challenges faced in treating spine trauma in morbidly obese patients. Based on a case series of six patients injured in high-speed motor vehicle accidents, the authors categorize difficulties faced in the care of morbidly obese patients from on-scene immobilization and medical transport through spinal imaging, surgery, and postoperative care. Details of the six cases and a thorough discussion of challenges posed by morbid obesity and possible solutions are covered in "Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series. Clinical article," by Hannah E. Rosenfeld and colleagues, published today online, ahead of print, in the Journal of Neurosurgery: Spine.
The obesity epidemic is spreading worldwide. When patients who are morbidly obese suffer spinal injury or other major trauma, they face greater risks of complications and death compared with non-obese individuals.
The patients described in this article—five women and one man, ages 18–69 years—ranged in weight from 276 pounds (125 kilograms) to 410 pounds (186 kilograms). All six patients had a body-mass index greater than 40. These particular patients were selected because of the problems posed by their large body mass before, during, and after spine sugery.
The authors describe each case separately and then break down the obstacles faced during care of these patients into separate categories, specifically
In addition to alerting other physicians about the many obstacles impeding quick and efficient health care in morbidly obese patients with spinal injuries, the authors offer commonsense suggestions for how to overcome many of the obstacles they describe. Some examples include: fashioning makeshift cervical collar extenders; increased vigilance in monitoring airways; use of open MRI units when available; clamping together two operating tables when a large table is not available; using hoist systems in the operating room and training staff in moving obese patients; selecting nonstandard surgical approaches, when appropriate, to provide adequate access to the spine while allowing morbidly obese patients to be positioned safely for the entire operation; creation of longer surgical instruments; additional use of Cell Saver, which lessens overall blood loss during surgery; adjusting the dose of prophylactic heparin; and use of adequately sized pneumatic calf compressors. The authors also suggest that new hospital guidelines and management techniques should be developed to improve overall outcomes in obese patients, as their number is on the rise.
Rosenfeld HE, Limb R, Chan P. Fitzgerald M, Bradley WPL, Rosenfeld JV. Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series. Clinical article. Journal of Neurosurgery: Spine, published online, ahead of print, May 21, 2013; DOI: 10.3171/2013.4.SPINE12876.
Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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The Journal of Neurosurgery: Spine is a monthly peer-reviewed journal focused on neurosurgical approaches to treatment of diseases and disorders of the spine. It contains a variety of articles, including descriptions of preclinical and clinical research as well as case reports and technical notes. The Journal of Neurosurgery: Spine is one of four monthly journals published by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons. Other peer-reviewed journals published by the JNS Publishing Group each month include the Journal of Neurosurgery, Neurosurgical Focus, and the Journal of Neurosurgery: Pediatrics. All four journals can be accessed at http://www.thejns.org.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 8,300 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, and peripheral nerves. For more information, visit http://www.AANS.org.
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