- MedOne Spine
- ChapterSource: Theodoridis T, Krämer J, ed. Spinal Injection Techniques. 2nd Edition. Thieme; 2019. doi:10.1055/b-006-163720Comment: The methods used in the causal treatment of spinal pain are basically the same as those used in conservative orthopedic treatment, but with a different emphasis. Initial treatment relies on methods that are immediately available, such as positioning, orthopedic aids, and manual therapy. These are followed up by long-term measures such as postural and behavioral training (back school), physical therapy, and an exercise program. The primary aim of causal pain treatment is to reduce pain stimuli, reducing nociception or preventing it altogether in the bones, muscles, and joints.
Cervical Spine Trauma-Induced Vertebral Artery Injury, Selected From Cervical Trauma: Surgical Management, Robert F. Heary, 2019Source: Heary R, ed. Cervical Trauma: Surgical Management. 1st Edition. Thieme; 2019. doi:10.1055/b-006-163750Comment: Diagnosis of cervical spine trauma-induced vertebral artery injuries (VAIs) may explain late onset of vertebrobasilar insufficiency (VBI) symptoms and may alter proposed surgical treatment options. Imaging should be strongly considered in case of symptoms of VBI and cervical dislocation or high cervical spine fracture. Although many centers have advocated for computed tomography angiography as a screening tool in the initial screening of trauma patients, further research is needed to fully assess its efficacy in identifying VAI as compared to emerging modalities such as ultrasonography. Treatment may include close observation, administration of anticoagulation and antiplatelet agents, as well as endovascular treatments and surgery depending on the radiological severity and clinical presentation of injury. According to the consensus statement by the American Association of Neurological Surgeons/Congress of Neurological Surgeons Guidelines, anticoagulation is recommended in symptomatic VAI to lessen the risk of early recurrence of stroke. Consultation with vascular neurosurgeons and neurologists may prove beneficial when developing optimal treatment approaches for patients.
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