Neurosurgery
-
Transforaminal endoscopic approaches through Kambin's triangle traditionally require surgery to be performed without general anesthesia to allow live patient feedback. No reliable intraoperative neuromonitoring method specific to the dorsal root ganglion (DRG), the structure most at risk during this approach, currently exists. ⋯ We demonstrated for the first time the feasibility of direct intraoperative neuromonitoring within Kambin's triangle in transforaminal endoscopic surgery. Eight milliampere seems to be a reasonable compromise between sensitivity and specificity for this monitoring technique. In the future, larger-scale studies are required to refine safe stimulation thresholds.
-
Anxiety and depression are associated with suboptimal outcomes, higher complications, and cost of care after elective spine surgery. The effect of combined anxiety-depression and preoperative antidepressant treatment in spinal fusion patients is not known. ⋯ Spine surgeons should use appropriate measures/questionnaires to screen depressed patients for anxiety and vice versa because the presence of both adds significant risk of higher healthcare utilization and costs over patients with 1 diagnosis, especially anxiety alone.
-
The merit-based incentive payment system (MIPS) program was implemented to tie Medicare reimbursements to value-based care measures. Neurosurgical performance in MIPS has not yet been described. ⋯ Neurosurgeons performed well in MIPS in 2017 and 2018, although the program may be biased against surgeons who practice in small groups or take care of socially disadvantaged patients.