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Neurosurgical Focus

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https://www.readbyqxmd.com/read/29191104/does-prior-spine-surgery-or-instrumentation-affect-surgical-outcomes-following-3-column-osteotomy-for-correction-of-thoracolumbar-deformities
#1
Darryl Lau, Andrew K Chan, Vedat Deverin, Christopher P Ames
OBJECTIVE Adult spinal deformity (ASD) develops in the setting of asymmetrical arthritic degeneration, and can also be due to iatrogenic causes, such as prior surgery. Many patients who present with ASD have undergone prior spine surgery with instrumentation. Unfortunately, contemporary studies that evaluate the effect of prior surgery or instrumentation on perioperative outcomes, readmission rates, and need for reoperation are lacking. METHODS All ASD patients who underwent a 3-column osteotomy performed by the senior author at the authors' institution for correction of thoracolumbar spinal deformity between 2006 and 2016 were identified...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191103/relative-lumbar-lordosis-and-lordosis-distribution-index-individualized-pelvic-incidence-based-proportional-parameters-that-quantify-lumbar-lordosis-more-precisely-than-the-concept-of-pelvic-incidence-minus-lumbar-lordosis
#2
Caglar Yilgor, Nuray Sogunmez, Yasemin Yavuz, Kadir Abul, Louis Boissiére, Sleiman Haddad, Ibrahim Obeid, Frank Kleinstück, Francisco Javier Sánchez Pérez-Grueso, Emre Acaroğlu, Anne F Mannion, Ferran Pellise, Ahmet Alanay
OBJECTIVE The subtraction of lumbar lordosis (LL) from the pelvic incidence (PI) offers an estimate of the LL required for a given PI value. Relative LL (RLL) and the lordosis distribution index (LDI) are PI-based individualized measures. RLL quantifies the magnitude of lordosis relative to the ideal lordosis as defined by the magnitude of PI. LDI defines the magnitude of lower arc lordosis in proportion to total lordosis. The aim of this study was to compare RLL and PI - LL for their ability to predict postoperative complications and their correlations with health-related quality of life (HRQOL) scores...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191102/impact-of-case-type-length-of-stay-institution-type-and-comorbidities-on-medicare-diagnosis-related-group-reimbursement-for-adult-spinal-deformity-surgery
#3
Pierce D Nunley, Gregory M Mundis, Richard G Fessler, Paul Park, Joseph M Zavatsky, Juan S Uribe, Robert K Eastlack, Dean Chou, Michael Y Wang, Neel Anand, Kelly A Frank, Marcus B Stone, Adam S Kanter, Christopher I Shaffrey, Praveen V Mummaneni
OBJECTIVE The aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery. METHODS Medicare's Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191101/despite-worse-baseline-status-depressed-patients-achieved-outcomes-similar-to-those-in-nondepressed-patients-after-surgery-for-cervical-deformity
#4
Gregory W Poorman, Peter G Passias, Samantha R Horn, Nicholas J Frangella, Alan H Daniels, D Kojo Hamilton, Hanjo Kim, Daniel Sciubba, Bassel G Diebo, Cole A Bortz, Frank A Segreto, Michael P Kelly, Justin S Smith, Brian J Neuman, Christopher I Shaffrey, Virginie LaFage, Renaud LaFage, Christopher P Ames, Robert Hart, Gregory M Mundis, Robert Eastlack
OBJECTIVE Depression and anxiety have been demonstrated to have negative impacts on outcomes after spine surgery. In patients with cervical deformity (CD), the psychological and physiological burdens of the disease may overlap without clear boundaries. While surgery has a proven record of bringing about significant pain relief and decreased disability, the impact of depression and anxiety on recovery from cervical deformity corrective surgery has not been previously reported on in the literature. The purpose of the present study was to determine the effect of depression and anxiety on patients' recovery from and improvement after CD surgery...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191100/preliminary-results-of-anterior-lumbar-interbody-fusion-anterior-column-realignment-for-the-treatment-of-sagittal-malalignment
#5
Pooria Hosseini, Gregory M Mundis, Robert K Eastlack, Ramin Bagheri, Enrique Vargas, Stacie Tran, Behrooz A Akbarnia
OBJECTIVE Sagittal malalignment decreases patients' quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191099/an-assessment-of-frailty-as-a-tool-for-risk-stratification-in-adult-spinal-deformity-surgery
#6
Emily K Miller, Brian J Neuman, Amit Jain, Alan H Daniels, Tamir Ailon, Daniel M Sciubba, Khaled M Kebaish, Virginie Lafage, Justin K Scheer, Justin S Smith, Shay Bess, Christopher I Shaffrey, Christopher P Ames
OBJECTIVE The goal of this study was to analyze the value of an adult spinal deformity frailty index (ASD-FI) in preoperative risk stratification. Preoperative risk assessment is imperative before procedures known to have high complication rates, such as ASD surgery. Frailty has been associated with risk of complications in trauma surgery, and preoperative frailty assessments could improve the accuracy of risk stratification by providing a comprehensive analysis of patient factors that contribute to an increased risk of complications...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191098/complication-rates-associated-with-open-versus-percutaneous-pedicle-screw-instrumentation-among-patients-undergoing-minimally-invasive-interbody-fusion-for-adult-spinal-deformity
#7
Khoi D Than, Praveen V Mummaneni, Kelly J Bridges, Stacie Tran, Paul Park, Dean Chou, Frank La Marca, Juan S Uribe, Todd D Vogel, Pierce D Nunley, Robert K Eastlack, Neel Anand, David O Okonkwo, Adam S Kanter, Gregory M Mundis
OBJECTIVE High-quality studies that compare outcomes of open and minimally invasively placed pedicle screws for adult spinal deformity are needed. Therefore, the authors compared differences in complications from a circumferential minimally invasive spine (MIS) surgery and those from a hybrid surgery. METHODS A retrospective review of a multicenter database of patients with spinal deformity who were treated with an MIS surgery was performed. Database inclusion criteria included an age of ≥ 18 years and at least 1 of the following: a coronal Cobb angle of > 20°, a sagittal vertical axis of > 5 cm, a pelvic incidence-lumbar lordosis angle of > 10°, and/or a pelvic tilt of > 20°...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191097/introduction-adult-spinal-deformity
#8
Christopher I Shaffrey, Justin S Smith, Christopher P Ames, Mitsuru Yagi, Ahmet Alanay, Yoon Ha
No abstract text is available yet for this article.
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191096/lumbar-computed-tomography-scans-are-not-appropriate-surrogates-for-bone-mineral-density-scans-in-primary-adult-spinal-deformity
#9
Eitan M Kohan, Venu M Nemani, Stuart Hershman, Daniel G Kang, Michael P Kelly
OBJECTIVE The authors examined the correlation between lumbar spine CT Hounsfield unit (HU) measurements and bone mineral density measurements in an adult spinal deformity (ASD) population. METHODS Patients with ASD were identified in the records of a single institution. Lumbar CT scans were reviewed, and the mean HU measurements from L1-4 were recorded. Bone mineral density (BMD) was assessed using femoral neck and lumbar spine dual-energy x-ray absorptiometry (DEXA). The number of patients who met criteria for osteoporosis was determined for each imaging modality...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191095/male-sex-may-not-be-associated-with-worse-outcomes-in-primary-all-posterior-adult-spinal-deformity-surgery-a-multicenter-analysis
#10
David B Bumpass, Lawrence G Lenke, Jeffrey L Gum, Christopher I Shaffrey, Justin S Smith, Christopher P Ames, Shay Bess, Brian J Neuman, Eric Klineberg, Gregory M Mundis, Frank Schwab, Virginie Lafage, Han Jo Kim, Douglas C Burton, Khaled M Kebaish, Richard Hostin, Renaud Lafage, Michael P Kelly
OBJECTIVE Adolescent spine deformity studies have shown that male patients require longer surgery and have greater estimated blood loss (EBL) and complications compared with female patients. No studies exist to support this relationship in adult spinal deformity (ASD). The purpose of this study was to investigate associations between sex and complications, deformity correction, and health-related quality of life (HRQOL) in patients with ASD. It was hypothesized that male ASD patients would have greater EBL, longer surgery, and more complications than female ASD patients...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29191094/potential-of-predictive-computer-models-for-preoperative-patient-selection-to-enhance-overall-quality-adjusted-life-years-gained-at-2-year-follow-up-a-simulation-in-234-patients-with-adult-spinal-deformity
#11
Taemin Oh, Justin K Scheer, Justin S Smith, Richard Hostin, Chessie Robinson, Jeffrey L Gum, Frank Schwab, Robert A Hart, Virginie Lafage, Douglas C Burton, Shay Bess, Themistocles Protopsaltis, Eric O Klineberg, Christopher I Shaffrey, Christopher P Ames
OBJECTIVE Patients with adult spinal deformity (ASD) experience significant quality of life improvements after surgery. Treatment, however, is expensive and complication rates are high. Predictive analytics has the potential to use many variables to make accurate predictions in large data sets. A validated minimum clinically important difference (MCID) model has the potential to assist in patient selection, thereby improving outcomes and, potentially, cost-effectiveness. METHODS The present study was a retrospective analysis of a multiinstitutional database of patients with ASD...
December 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088962/complications-of-invasive-intracranial-pressure-monitoring-devices-in-neurocritical-care
#12
Samon Tavakoli, Geoffrey Peitz, William Ares, Shaheryar Hafeez, Ramesh Grandhi
Intracranial pressure monitoring devices have become the standard of care for the management of patients with pathologies associated with intracranial hypertension. Given the importance of invasive intracranial monitoring devices in the modern neurointensive care setting, gaining a thorough understanding of the potential complications related to device placement-and misplacement-is crucial. The increased prevalence of intracranial pressure monitoring as a management tool for neurosurgical patients has led to the publication of a plethora of papers regarding their indications and complications...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088961/the-21st-century-challenge-to-neurocritical-care-the-rise-of-the-superbug-acinetobacter-baumannii-a-meta-analysis-of-the-role-of-intrathecal-or-intraventricular-antimicrobial-therapy-in-reduction-of-mortality
#13
Nasser Mohammed, Amey R Savardekar, Devi Prasad Patra, Vinayak Narayan, Anil Nanda
OBJECTIVE Neurosurgical infections due to multidrug-resistant organisms have become a nightmare that neurosurgeons are facing in the 21st century. This is the dawn of the so-called postantibiotic era. There is an urgent need to review and evaluate ways to reduce the high mortality rates due to these infections. The present study evaluates the efficacy of combined intravenous plus intrathecal or intraventricular (IV + IT) therapy versus only intravenous (IV) therapy in treating postneurosurgical Acinetobacter baumannii infections...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088960/acute-subdural-hematoma-in-patients-on-oral-anticoagulant-therapy-management-and-outcome
#14
Sae-Yeon Won, Daniel Dubinski, Markus Bruder, Adriano Cattani, Volker Seifert, Juergen Konczalla
OBJECTIVE Isolated acute subdural hematoma (aSDH) is increasing in older populations and so is the use of oral anticoagulant therapy (OAT). The dramatic increase of OAT-with direct oral anticoagulants (DOACs) as well as with conventional anticoagulants-is leading to changes in the care of patients who present with aSDH while receiving OAT. The purpose of this study was to determine the management and outcome of patients being treated with OAT at the time of aSDH presentation. METHODS In this single-center, retrospective study, the authors analyzed 116 consecutive cases involving patients with aSDH treated from January 2007 to June 2016...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088959/traumatic-brain-injury-and-intracranial-hemorrhage-induced-cerebral-vasospasm-a-systematic-review
#15
Fawaz Al-Mufti, Krishna Amuluru, Abhinav Changa, Megan Lander, Neil Patel, Ethan Wajswol, Sarmad Al-Marsoummi, Basim Alzubaidi, I Paul Singh, Rolla Nuoman, Chirag Gandhi
OBJECTIVE Little is known regarding the natural history of posttraumatic vasospasm. The authors review the pathophysiology of posttraumatic vasospasm (PTV), its associated risk factors, the efficacy of the technologies used to detect PTV, and the management/treatment options available today. METHODS The authors performed a systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following databases: PubMed, Google Scholar, and CENTRAL (the Cochrane Central Register of Controlled Trials)...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088958/a-systematic-review-of-perioperative-seizure-prophylaxis-during-brain-tumor-resection-the-case-for-a-multicenter-randomized-clinical-trial
#16
Vyshak Chandra, Andrew K Rock, Charles Opalak, Joel M Stary, Adam P Sima, Matthew Carr, Rafael A Vega, William C Broaddus
OBJECTIVE The majority of neurosurgeons administer antiepileptic drugs (AEDs) prophylactically for supratentorial tumor resection without clear evidence to support this practice. The putative benefit of perioperative seizure prophylaxis must be weighed against the risks of adverse effects and drug interactions in patients without a history of seizures. Consequently, the authors conducted a systematic review of prospective randomized controlled trials (RCTs) that have evaluated the efficacy of perioperative seizure prophylaxis among patients without a history of seizures...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088957/introduction-critical-care
#17
Gregory W J Hawryluk, Perry A Ball, Zachary L Hickman, Joshua E Medow
No abstract text is available yet for this article.
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088956/management-of-raised-intracranial-pressure-in-aneurysmal-subarachnoid-hemorrhage-time-for-a-consensus
#18
Naif M Alotaibi, Justin Z Wang, Christopher R Pasarikovski, Daipayan Guha, Fawaz Al-Mufti, Muhammad Mamdani, Gustavo Saposnik, Tom A Schweizer, R Loch Macdonald
Elevated intracranial pressure (ICP) is a well-recognized phenomenon in aneurysmal subarachnoid hemorrhage (aSAH) that has been demonstrated to lead to poor outcomes. Despite significant advances in clinical research into aSAH, there are no consensus guidelines devoted specifically to the management of elevated ICP in the setting of aSAH. To treat high ICP in aSAH, most centers extrapolate their treatment algorithms from studies and published guidelines for traumatic brain injury. Herein, the authors review the current management strategies for treating raised ICP within the aSAH population, emphasize key differences from the traumatic brain injury population, and highlight potential directions for future research in this controversial topic...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088955/real-time-ultrasound-guided-external-ventricular-drain-placement-technical-note
#19
James H Manfield, Kenny K H Yu
In the United Kingdom, ultrasound-guided external ventricular drain (EVD) insertion is becoming the standard of care to mitigate the morbidity associated with catheter malposition and multiple passes. Many neurosurgeons routinely use ultrasound to check the preinsertion trajectory, although real-time visualization of ventricular cannulation is preferable since minor deviations can be significant in patients with smaller ventricles, and live visualization further enables the catheter tip to be adjusted away from the choroid plexus...
November 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/29088954/morbidity-and-mortality-associated-with-hypernatremia-in-patients-with-severe-traumatic-brain-injury
#20
Aditya Vedantam, Claudia S Robertson, Shankar P Gopinath
OBJECTIVE Hypernatremia is independently associated with increased mortality in critically ill patients. Few studies have evaluated the impact of hypernatremia on early mortality in patients with severe traumatic brain injury (TBI) treated in a neurocritical care unit. METHODS A retrospective review of patients with severe TBI (admission Glasgow Coma Scale score ≤ 8) treated in a single neurocritical care unit between 1986 and 2012 was performed. Patients with at least 3 serum sodium values were selected for the study...
November 2017: Neurosurgical Focus
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