Activities of daily living

[Guest of Corona]

Interested to hear the current practice at your program or other programs:

- steroids in acute spine trauma
- low dosage steroids in TBI
- Taper plan for brain tumors
- Using navigation for T1 or free hand
- Thoracolumbar braces for compression fractures 
- cervical collars and thoracolumbar braces after elective instrumentation and fusion

I know almost all of those points has some weak evidence but interested to hear the way you do it at your program.

[Guest]

I would love for the neurosurgery podcast to address these and other similar topics. It's episodes regarding the business side of neurosurgery are interesting, but I would love for there to be a podcast that covers patient management, surgical technique, case discussions, etc. Emergency medicine probably does this best. These podcasts are a great resource for med students and residents. They can even be beneficial for attendings as they tend to discuss the latest evidence.

[Guest]

(04-02-2020, 09:51 AM)Guest of Corona Wrote: Interested to hear the current practice at your program or other programs:

- steroids in acute spine trauma
- low dosage steroids in TBI
- Taper plan for brain tumors
- Using navigation for T1 or free hand
- Thoracolumbar braces for compression fractures 
- cervical collars and thoracolumbar braces after elective instrumentation and fusion

I know almost all of those points has some weak evidence but interested to hear the way you do it at your program.

Steroids in TBI are basically contraindicated at this point. We had a pediatric guy who did it, quoting no significant studies in kids, but no proven benefit and increased mortality make it a no-no.

Steroids in SCI a little more controversial despite the guidelines.  We would rarely do it if someone wasn't going to the OR right away for logistical reasons.

Never seen convincing evidence that any one taper plan for steroids in brain tumors is better than another. Exception may be cases with post op cranial neuropathies, we usually prolong those tapers at the low doses.

Spine navigation is rapidly becoming standard of care. Obviously use your common sense and knowledge of anatomy, like anything else, but soon you're not going to be able to stand in front of a jury and say you didn't use it.

Bracing for compression fractures are case-by-case.  Traumatic? More likely. Osteoporotic maybe not.

I put collars on cervical cases more to remind the patient and others that they recently had surgery, than anything else.  Reduces their activity level.  If pts find bracing more comfortable to increase ambulation, have at it.

[Guest]

We sometimes give steroids for cervical SCI. When it works, steroids can help recover 1, maybe 2, levels of function. In the cervical cord that can give someone a functional arm. Obviously no point to giving them for thoracic injuries, but for cervical you can maybe justify the risk. This is controversial and some would say this is crazy/malpractice.

[admin]

(04-02-2020, 09:51 AM)Guest of Corona Wrote: Interested to hear the current practice at your program or other programs:

- steroids in acute spine trauma
- low dosage steroids in TBI
- Taper plan for brain tumors
- Using navigation for T1 or free hand
- Thoracolumbar braces for compression fractures 
- cervical collars and thoracolumbar braces after elective instrumentation and fusion

I know almost all of those points has some weak evidence but interested to hear the way you do it at your program.

-never
-contraindicated CRASH trial
-2 days, lower rate first (e.g. qid, tid, bid..)
-if you can't do it freehand, you shouldn't do it
-TLICS and such
-Cervical if it's >2 levels it's braced.  lumbar, everything

[Guest]

(04-02-2020, 09:51 AM)Guest of Corona Wrote: Interested to hear the current practice at your program or other programs:

- steroids in acute spine trauma
- low dosage steroids in TBI
- Taper plan for brain tumors
- Using navigation for T1 or free hand
- Thoracolumbar braces for compression fractures 
- cervical collars and thoracolumbar braces after elective instrumentation and fusion

I know almost all of those points has some weak evidence but interested to hear the way you do it at your program.

- never
- never
- 2 weeks
- free hand
- almost always
- cervical yes; thoracolumbar no

[Guest]

(04-02-2020, 01:16 PM)Guest Wrote: We sometimes give steroids for cervical SCI. When it works, steroids can help recover 1, maybe 2, levels of function. In the cervical cord that can give someone a functional arm. Obviously no point to giving them for thoracic injuries, but for cervical you can maybe justify the risk. This is controversial and some would say this is crazy/malpractice.

interesting, I actually had a thoracic SCI at 12yo and was given steroids and recovery went well. young age likely being the major factor. Have rarely seen any steroids being given at all nowadays

[Guest]

(04-02-2020, 09:51 AM)Guest of Corona Wrote: never though if started at an outside facility the patient transfers in from we'll continue it

never-see above re crash

attending dependent with full range of no steroids postop for acoustics with one attending, to another who wants a two week taper starting at discharge

attending dependent but mostly free hand, agree that it is a problem if you cant free hand a standard t1 screw but also that nav is increasingly going to be seen as standard of care

usually, though if mild will often just brace for comfort, i.e. if patient wants it

always

Interested to hear the current practice at your program or other programs:

- steroids in acute spine trauma
- low dosage steroids in TBI
- Taper plan for brain tumors
- Using navigation for T1 or free hand
- Thoracolumbar braces for compression fractures 
- cervical collars and thoracolumbar braces after elective instrumentation and fusion

I know almost all of those points has some weak evidence but interested to hear the way you do it at your program.