Clinical Pearls Atlantoaxial joint opening, manual manipulation of the facets, denuding of the articular cartilage, packing of bone graft into the joint cavity, and direct screw fixation of the facets of atlas and axis form a biomechanically strong mode of…
Clinical Pearls Spinal cord injuries (SCIs) have devastating impacts on patients in both developed and developing countries and are associated with tremendous long-term morbidity, mortality, and staggering financial costs. SCI is a medical emergency where rapid diagnosis, imaging, and treatment…
Clinical Pearls Metastatic tumors to the spine mandate a multidisciplinary approach involving the surgeon, radiation oncologist, oncologist, and interventional radiologist. Patients presenting with metastatic tumors to the spine are stage 4 cancer patients, with poor systemic disease control. Management in…
Clinical Pearls Intramedullary spinal cord tumors (IMSCTs) are challenging lesions that cause significant neurologic morbidity and mortality in patients of all ages. Gross total resection should be the mainstay of treatment, if possible, as survival is directly related to extent…
Clinical Pearls The thoracolumbar junction is a flexible transition region in the spine, susceptible to injury due to the transfer of kinetic energy. Clinicians should maintain a high suspicion of injury with thoracolumbar trauma because the incidence of a second…
Clinical Pearls The cervical spine is mobile and highly prone to traumatic injury. Early immobilization of the cervical spine and its thorough evaluation with imaging allow identification of a cervical injury and minimize the risk of further injuries. The clinician…
Clinical Pearls Linear skull fractures require no stabilization or exploration when the scalp is closed and when there is no evidence of an underlying mass lesion. Management of comminuted fractures is the same as for linear skull fractures if the…
Clinical Pearls In the presence of penetrating brain injury, the first step is to initiate advanced trauma life support resuscitation with early transportation for definitive care. The major principles of management of penetrating brain injuries include early decompression with conservative…
Clinical Pearls The predominant aim in managing critically ill neurosurgical patients is to prevent cerebral ischaemia and exacerbation of neurological injury. This is achieved by manipulation of a variety of neurophysiological parameters including intracranial pressure (ICP), cerebral perfusion pressure (CPP)…
Clinical Pearls As with all trauma patients, traumatic brain injury (TBI) patients must be promptly resuscitated and surveyed. A focus on oxygenation, ventilation, blood pressure, and determination of the Glasgow Coma Scale should be the immediate priority followed by a…