1. Anterior vs posterior decompression/fusion for cervical stenosis: ACDF procedures address the real cause of the problem in cases of disk herniation, by removing the faulty disk, but to do it you have to be able to remove the PLL without damaging the dura. So if there is excessive ossification of the PLL so bad that it actually impinges on or involves the dura, you have to do a posterior procedure. Posterior approaches temporarily relieve symptoms, but because they don't address the real problem, the disk will continue to herniate and the symptoms will eventually recur. Depending on how well you select your patients, ACDF procedures may alleviate pain for years, but the pain will also eventually return as well as for all spine surgery for pain.
2.ACDF complications
-Retracting on the longus coli, sometimes your retractor will slip upwards and catch the sympathetic chain, leading to ipsilateral horner's that may be irreversible.
-Retracting on the esophagus will cause brief (~1 day) postoperative difficulty swallowing, especially for thin liquids like water. For the time after surgery, it is good to stick to thickened liquidy things like mashed potatoes or yogurt and avoid thin liquids to prevent aspiration
-Retracting on recurrent larygneal can cause hoarseness.
3. CT w/o contrast to look at bony structures, CT w/contrast to look at things that take up contrast-- tumors, infection, bleed.
4. For spine and brain procedures, it is a good idea to have an a-line because these structures are very intolerant of ischemia, even brief ischemia, so you want to know immediately if there is hypotension.
5. Before bariatric surgery, you want people to attempt non-surgical weight loss regime, specifically a supervised exercise and diet program; the success of these programs at sustained, significant weight loss is relatively low (2-3%) but if it works the person will avoid surgery. More importantly, these programs will teach people the skills and knowledge necessary to maintain a healthy diet and exercise program after surgery.
6. Jejunoileal bypass surgery was one of the first bariatric surgeries developed, and has since fallen out of favor because it causes blind-loop syndrome, where bacterial overgrowth of the remnant jejunum leads to obstruction and nutrient malabsorption, esp B12 and fat-soluble vitamins. Additionally, there is an estimated 21% risk of cirrhosis at 15 years, so make sure to screen liver function in patients known to have had this procedure done.
7. Roux en Y procedures are associated with a 60-70% success rate (defined as >50% loss of excess body weight). Rough order of effectiveness: duodenal switch > roux en y > gastric sleeve > vertical banding > gastric banding. Increasing effectiveness also means more complications, including malnutrition complications.
8. Vasospasm after SAH: middle aged women tend to have the worst vasospasm, possibly hormonal role? However studies publish conflicting data about whether estrogen/progesterone promote or prevent vascular spasm/elasticity. Current recommendations: HRT has no cardiovascular benefit
9. Bypass grafts do not experience vasospasm, only native intracerebral vessels.
10. MRI
-T1: CSF is dark, fat is bright;
-T2: CSF is bright
-FLAIR: T2 where the CSF is factored out mathematically, so other things like bleeds and anomalous structures are easier to see.