Neurosurgery
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The safety and efficacy of spinal fusion in the elderly population remains uncertain with conflicting data. ⋯ Patients older than 65 years of age have significantly higher rates of complications after lumbar fusion when compared to younger patients. However, multivariable analysis revealed that age was not an independent risk factor for complication occurrence after lumbar fusion.
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Biography Historical Article
Johann Friedrich Horner and the Repeated Discovery of Oculosympathoparesis: Whose Syndrome Is It?
Disruption of cranial sympathetic tone leads to the symptom complex of miosis, ptosis, and hemifacial anhidrosis. It is widely believed that this phenomenon was discovered in 1869 by the Swiss ophthalmologist Johann Friedrich Horner, and as a result, the term Horner syndrome has become synonymous with the clinical presentation. However, the syndrome that would become Horner syndrome had actually been described several times before his report. ⋯ There were also 2 previous reports of ptosis and miosis resulting from sympathetic nerve damage in humans: 1 by Edward Selleck Hare in 1838 associated with brachial plexus tumor, and the other by Silas Weir Mitchell in 1864 associated with a gunshot wound to the neck. Although Horner was the first to objectively characterize the co-occurrence of vasomotor and ocular changes in a human patient, he did not identify the etiology of the condition, discuss its relationship to the sympathetic nervous system, or reference any of the previous studies in animals or humans. It is possible that a lack of familiarity with previous investigations delayed the full appreciation of the mechanism underlying this disorder.
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Occipital nerve stimulation (ONS) is a therapy that benefits one-third of medically refractory chronic migraine (CM) patients. How ONS affects sensory thresholds and whether modulation of thresholds could predict which patients respond to the therapy remains unclear. ⋯ We show that ONS improves mechanical thresholds in a rodent CM model, but not in shams. Our finding that mechanical but not thermal thresholds are altered with ONS suggests a more significant modulation of A-α/β fibers than of C fibers. Assessing the ability of ONS to reduce mechanical thresholds during a trial period could potentially be used to predict which patients respond.