domingo, 27 de janeiro de 2013

SCALES AND CLASSIFICATIONS - NEUROSURGERY

Coletânea das escalas e classificações mais úteis em neurocirurgia
Collection of more useful scales and classifications in neurosurgery
 
Karnowsky:
100% – normal, no complaints, no signs of disease
90% – capable of normal activity, few symptoms or signs of disease
80% – normal activity with some difficulty, some symptoms or signs
70% – caring for self, not capable of normal activity or work
60% – requiring some help, can take care of most personal requirements
50% – requires help often, requires frequent medical care
40% – disabled, requires special care and help
30% – severely disabled, hospital admission indicated but no risk of death
20% – very ill, urgently requiring admission, requires supportive measures or treatment




Wiltse Classification

Classification of Spondylolisthesis
1.) Dysplastic : Congenital malformation of the sacrum or neural arch of L5.
2.) Isthmic: Stress fracture, elongation, or acute fracture of the pars.
3.) Degenerative: Long-standing arthritic process of the zygapophyseal joints.
4.) Traumatic: Neural arch fracture excluding the pars region.
5.) Pathologic: Bone disease – Paget’s, Metastatic disease, or Osteopetrosis.
6.) Iatrogenic: Following lumbar spine surgery

Reference: Wiltse LL, Newman PH, Macnab I. “Classification of spondylolysis and spondylolisthesis.” Clin Orthop Relat Res. 1976 Jun;(117):23-9.




WFNS grade for SAH


Grade
GCS
Motor deficit
I
15
-
II
14-13
-
III
14-13
+
IV
12-7
+/-
V
6-3
+/-




Simpson grade for meningioma resection:

 
 
 
MRC scale
0 – no movement
1 – flicker is perceptible in the muscle
2 – movement only if gravity eliminated
3 – can move limb against gravity
4 – can move against gravity & some resistance exerted by examiner
5 – normal power
 
MODIC CHANGES:
 
Modified Rankin Scale
The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke.'
 
 
0
No symptoms at all
1
No significant disability despite symptoms; able to carry out all usual duties and activities
2
Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance
3
Moderate disability; requiring some help, but able to walk without assistance
4
Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance
5
Severe disability; bedridden, incontinent and requiring constant nursing care and attention
6 Dead
 
Escala de McCormick modificada para tumors espinhais
Modified McCormick scale
I
Intact neurologically, normal ambulation, minimal dyesthesia
II
Mild motor or sensory deficit, functional independence
III
Moderate deficit, limitation of function, independent w/external aid
IV
Severe motor or sensory deficit, limited function, dependent
V
Paraplegia or quadriplegia, even w/flickering movement
 
Meyerding grade
Spondylolisthesis
Categorises severity of spondylolisthesis based upon measurements on lateral X-ray of the distance from the posterior edge of the superior vertebral body to the posterior edge of the adjacent inferior vertebral body. This distance is then reported as a percentage of the total superior vertebral body length:
§  Grade 1 is 0–25%
§  Grade 2 is 25–50%
§  Grade 3 is 50–75%
§  Grade 4 is 75–100%
§  Over 100% is Spondyloptosis, when the vertebra completely falls off the supporting vertebra.
 
Facial palsy in acoustic neuromas: House-Brackmann
 
 
 
 
Glasgow Outcome Scale
Outcome after sever brain damage
1. Dead
2. Persistent vegetative state (no obvious cortical function)
3. Severe disability (conscious but diabled)
 
4. Moderate disability (disabled but independent)
5. Good recovery (return to normal activities wvwn with minor neuro or psychological deficits)
 
 
Frankel Grade
Spinal Cord Function
A complete paralysis
B sensory function only below the injury level
C incomplete motor function below injury level
D fair to good motor function below injury level
E normal function
 
Fischer:
 
Cervical Myelopathy
1. Nurick’s classification system for myelopathy on the basis of gait abnormalities
Grade
Root signs
Cord involvement
Gait
Employment
0
Yes
No
Normal
Possible
I
Yes
Yes
Normal
Possible
II
Yes
Yes
Mild abnormality
Possible
III
Yes
Yes
Severe abnormality
Impossible
IV
Yes
Yes
Only with assistance
Impossible
Reference: Nurick S. The pathogenesis of spinal cord disorder associated with cervical spondylosis. Brain 1972; 95: 87-100
2. Ranawat Classification of Neurologic Deficit
Asia
Muscle strength is graded as
§  0 Total paralysis
§  1 - Palpable or visible contraction
§  2 - Active movement, full range of motion, gravity eliminated
§  3 - Active movement, full range of motion, against gravity
§  4 - Active movement, full range of motion, against gravity and provides some resistance
§  5 – Active movement, full range of motion, against gravity and provides normal resistance [Muscle able to exert, in examiner’s judgement, sufficient resistance to be considered normal if identifiable inhibiting factors were not present]
§  NT – not testable. Patient unable to reliably exert effort or muscle unavailable for test-ing due to factors such as immobilization, pain on effort or contracture.
 
 
ASA
  Presurgical condition for anaesthesia
§  1. Normal healthy patient
§  2. Mild systemic disease
§  3. Severe systemic disease
§  4. Severe systemic disease that is a constant threat to life
§  5. Moribund patient, not expected to survive the operation
§  6. Declare brain-dead patient whose organs are being removed for donor purposes
 
Hunt-Hess
Spetzler e Martin:
 
The Spetzler-Martin AVM grading system allocates points for various features of intracranial AVM's to give a score between 1 and 5. Grade 6 is used to describe inoperable lesions. The score correlates with operative outcome.

The grading system

  • size of nidus
    • small (<3cm) = 1
    • medium (3 - 6cm) = 2
    • large (> 6cm) = 3
  • eloquence of adjacent brain
    • non-eloquent = 0
    • eloquent = 1
  • venous drainage
    • superficial only = 0
    • deep = 1
 
 
 
 
 
Dr. Bernardo de Andrada
 

3 comentários:

  1. Wow, love your blog very much. It offers more useful and effective information to the neurosurgeons. The neurological problems were once considered fatal.The
    neurologist singapore also is necessary to cooperate with the plastic surgeons, Radiation Oncologists.

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  2. Thank you for giving such a valuable information on spine surgery,This information is really helpful for my grandmother who is suffering from spine problems and will undergo neurosurgery india.
    Once again thank you.

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