Neurosurgery clinics of North America
-
Neurosurg. Clin. N. Am. · Apr 2014
ReviewEvidence basis/outcomes in minimally invasive spinal scoliosis surgery.
Traditional adult scoliosis surgery is associated with long-term patient improvement in clinical and radiographic outcome measures, significant blood loss, and high likelihood of medical complications. Because the patient population undergoing adult scoliosis surgery is often elderly with medical comorbidities, minimally invasive spinal surgery (MISS) for adult scoliosis is theoretically appealing, because it is associated with less tissue trauma and reduced blood loss. ⋯ MISS scoliosis correction is reviewed, specifically regarding outcomes and complications. Limitations of current techniques and future directions are discussed.
-
Neurosurg. Clin. N. Am. · Apr 2014
ReviewMinimally invasive lateral transpsoas approach to the lumbar spine: pitfalls and complication avoidance.
The lateral transpsoas approach to the lumbar spine has become an increasingly popular method to achieve fusion. Although this approach requires less tissue dissection, a smaller incision, decreased operative time, reduced blood loss and postoperative pain, and shorter hospital stay, it carries the potential for serious neurologic and visceral complications. This article reviews these complications in detail and proposes mechanisms for their avoidance.
-
Neurosurg. Clin. N. Am. · Jan 2014
ReviewNeuromodulation for depression: invasive and noninvasive (deep brain stimulation, transcranial magnetic stimulation, trigeminal nerve stimulation).
Major depressive disorder is among the most disabling illnesses and, despite best practices with medication and psychotherapy, many patients remain ill even after several treatment trials. For many of these patients with treatment-resistant or pharmacoresistant depression, treatment with neuromodulation offers an alternative. ⋯ This review surveys recent literature to update readers on 3 particular interventions: deep brain stimulation, transcranial magnetic stimulation, and trigeminal nerve stimulation. Additional comparative research is needed to delineate the relative advantages of these treatments, and how best to match individual patients to neuromodulation intervention.
-
Chronic neuropathic pain affects 8.2% of adults, extrapolated to roughly 18 million people every year in the United States. Patients who have pain that cannot be controlled with pharmacologic management or less invasive techniques can be considered for deep brain stimulation or motor cortex stimulation. These techniques are not currently approved by the Food and Drug Administration for chronic pain and are, thus, considered off-label use of medical devices for this patient population. Conclusive effectiveness studies are still needed to demonstrate the best targets as well as the reliability of the results with these approaches.
-
Peripheral nerve stimulation and peripheral nerve field stimulation are emerging as a viable neuromodulatory therapy in the treatment of refractory pain. Although the technology of percutaneous stimulation has been available for decades, recent advancements have broadened the number of indications. ⋯ Most results to date have come from case reports and retrospective studies. However, given the promising outcomes in reducing otherwise medically refractory pain, future randomized controlled studies are needed to assess this emerging technology.