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Alan T. Villavicencio, Sigita Burneikienë, Theresa D. Hernández, and Jeff Thramann

Object

As the sport of triathlon has continued to grow, increasing numbers of triathletes have presented in the neurosurgery clinics with various spinal disorders. This epidemiological study was undertaken to establish the lifetime incidence of neck and back pain, to gauge the prevalence of discogenic pain, and to identify risk factors among triathletes in the Boulder, Colorado, area.

Methods

A live online questionnaire was developed that was used to collect information about physical characteristics, training habits, athletic status, number of races completed, and back pain among triathletes. The incidence of cervical and/or lumbar discogenic back pain was defined according to the duration of symptoms for the most recent pain episode.

The lifetime incidence of low-back pain was 67.8%, with 23.7% of cases possibly being discogenic in origin. The number of triathlons in which the respondents had participated and the presence of previous sports-related injuries were predictive of low-back pain (p = 0.02 and p < 0.00001, respectively). The lifetime incidence of neck pain was 48.3%, with 21.4% of cases being consistent with intervertebral disc involvement. The number of previous sports-related injuries was predictive of neck pain (p < 0.00001), and a strong tendency toward neck pain was observed for athletes with more total years of participation in sports (p = 0.06).

Conclusions

The two main risk factors for long-term spinal problems include sports-related injuries and overuse. The study results definitely support the influence of both mechanisms for low-back pain. Neck pain was associated with an injury event, and a strong (although not statistically significant) tendency toward neck pain was observed in respondents with overuse injuries.

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Alan T. Villavicencio, Theresa D. Hernández, Sigita Burneikiene, and Jeff Thramann

Object

The sport of triathlon is very physically demanding and has experienced rapid growth in recent years. The number of triathletes seen for spine disorders at neurosurgery clinics is increasing. Neck pain and overuse injuries have not been adequately studied in multisport athletes. The authors undertook an epidemiological study to establish the lifetime incidence of neck pain and the prevalence of possible discogenic pain, and to identify risk factors among triathletes in the Boulder, Colorado area.

Methods

An online questionnaire was developed to collect information about physical characteristics, training habits, athletic status, number of races completed, and neck pain among triathletes. The incidence of possible cervical discogenic pain was defined according to the duration of symptoms for the most recent pain episode.

Results

One hundred and sixty-four athletes responded to the questionnaire. The lifetime incidence of neck pain was 47.6% (78 athletes), with 15.4% possibly being of discogenic origin based on the duration of symptoms. Approximately 64% of responding athletes reported that their neck pain was sports related. Although the number of previous triathlons was not predictive of neck pain, total years in the sport (p = 0.029) and number of previous sports-related injuries (p < 0.0001) were.

Conclusions

Two major risk factors for long-term spinal problems in triathletes are sports-related injuries and overuse. This report is one of the first comprehensive studies of neck pain and overuse injury in multisport athletes.

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Frances A. Carr, Kyle M. Healy, Alan T. Villavicencio, E. Lee Nelson, Alexander Mason, Sigita Burneikiene, and Theresa D. Hernández

Object

The primary purpose of this study was to analyze what effect preoperative patient expectations and 36-Item Short Form Health Survey (SF-36) Mental Component Summary (MCS) scores have on clinical outcomes. To the authors' knowledge, there are no prospective studies that have examined the effects of both preoperative pain expectations and SF-36 MCS scores on clinical outcomes and satisfaction with results following anterior cervical discectomy and fusion (ACDF).

Methods

This study analyzed 79 patients (38 men, 41 women) undergoing 1- to 3-level ACDF surgery. Preoperatively, patients were divided into 2 groups for the expectation analyses: patients who expected complete resolution of pain postoperatively (44 total) and those who expected some residual pain (35 total) postoperatively. Preoperative SF-36 MCS scores were used to test the possible effects of mental health on clinical outcomes and satisfaction. Clinical outcomes were evaluated using visual analog scales (VASs) for neck/arm pain, Neck Disability Index (NDI), SF-36 Physical Component Summary (PCS)/MCS, and patient satisfaction with results scales. The mean follow-up duration was 38.8 months (range 7–59 months).

Results

All postoperative measures depicted significant improvement overall. Patients who expected no pain reported lower postoperative neck/arm pain scores (p < 0.02), higher SF-36 MCS scores (p = 0.04), and higher satisfaction with results scores (p = 0.01) compared with patients who expected some pain, after controlling for their respective preoperative scores. Higher preoperative SF-36 MCS scores predicted significantly lower postoperative neck pain (p = 0.003) and NDI (p = 0.004) scores, as well as higher postoperative SF-36 PCS (p = 0.002), SF-36 MCS (p = 0.001), and satisfaction (p = 0.03) scores, after controlling for their respective preoperative scores.

Conclusions

Patients who expected no pain postoperatively reported better scores on the nonstandardized outcome measure scales (VAS arm/neck, satisfaction with results), and higher SF-36 MCS scores. Higher preoperative MCS scores were related to better overall (standardized and nonstandardized) clinical outcomes (VAS neck, NDI, SF-36 PCS/MCS, and satisfaction with results). The results suggest that optimism in patients' expectations as well as mental well-being are related to improved clinical outcomes and higher patient satisfaction.

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Sergio Díaz-Bello, Alan Hernández-Hernández, Gerardo Y. Guinto-Nishimura, Michel G. Mondragón-Soto, Monica Lem-Carrillo, Alberto González-Aguilar, Juan M. Calleja-Castillo, Adolfo Leyva-Rendón, Pablo León-Ortiz, Carmen M. Chávez-Piña, Gustavo A. Pando-Tarín, Sonia I. Mejía-Pérez, Jesús Taboada-Barajas, Elsa D. Zavala-Álvarez, José L. Soto-Hernández, Graciela Cárdenas, and Juan L. Gómez-Amador

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic has forced the modification of surgical practice worldwide. Medical centers have been adapted to provide an efficient arrangement of their economic and human resources. Although neurosurgeons are not in the first line of management and treatment of COVID-19 patients, they take care of patients with neurological pathology and potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, the authors describe their institutional actions against the pandemic and compare these actions with those in peer-reviewed publications.

METHODS

The authors conducted a search using the MEDLINE, PubMed, and Google Scholar databases from the beginning of the pandemic until July 11, 2020, using the following terms: “Neurosurgery,” “COVID-19/SARS-CoV-2,” “reconversion/modification,” “practice,” “academy,” and “teaching.” Then, they created operational guidelines tailored for their institution to maximize resource efficiency and minimize risk for the healthcare personnel.

RESULTS

According to the reviewed literature, the authors defined the following three changes that have had the greatest impact in neurosurgical practice during the COVID-19 pandemic: 1) changes in clinical practices; 2) changes in the medical care setting, including modifications of perioperative care; and 3) changes in the academic teaching methodology.

CONCLUSIONS

The Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” is one of the major referral centers for treating highly complex neurosurgical pathologies in Mexico. Its clinical and neurosurgical practices have been modified with the implementation of specific interventions against the spread of COVID-19. These practical and simple actions are remarkably relevant in the context of the pandemic and can be adopted and suited by other healthcare centers according to their available resources to better prepare for the next event.