World Neurosurg
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The scarcity of implants during the economic crisis partially has replaced decompression and instrumented fusion for the treatment of cervical spondylotic myelopathy with implant-less expansile cervical laminoplasty (ECL). The aim of the study was to compare the results obtained with instrumented anterior cervical corpectomy and fusion with implant-less ECL. ⋯ Our results created a nidus for further research of postdecompression spinal cord relaxation.
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Cervical sagittal alignment parameters are essential to plan stages of surgery. The aims of this study were to evaluate the relationship between cervical sagittal alignment parameters and surgical outcomes after anterior cervical arthrodesis; to identify parameters linked to a better outcome; to determine the role of the T1 slope, C7 slope, cervical lordosis, and C2-C7 plumb line; and to describe an innovative method to calculate cervical lordosis. A cohort of 70 patients without cervical kyphosis was included in our retrospective study. We analyzed C7 slope, T1 slope, cervical lordosis, and the C2-C7 sagittal vertical axis (SVA). Clinical postoperative outcomes were evaluated with the Neck Disability Index (NDI) and Visual Analog Scale (VAS) score. ⋯ Sagittal parameters are directly correlated with clinical outcome. If C7 slope increases, higher cervical lordosis is necessary to obtain a good outcome. CL/C7 slope (0.7) multiplied by C7 slope can determine the ideal lordosis.
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Jehovah's Witnesses (JW) are a Christian faith with >1 million members in the United States who do not accept autologous blood transfusions. The optimal management of these patients undergoing neurosurgical procedures is not well defined. Here, we examined the feasibility and safety of JW undergoing neurosurgery in a blood management program. ⋯ Neurosurgical procedures in Jehovah's Witnesses are feasible, safe, and have similar outcomes to patients willing to accept transfusion when managed within a multidisciplinary blood-management program.
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Comparative Study
Endoscopic versus microscopic transsphenoidal approach for pituitary adenomas: Comparison of outcomes during the transition of methods of a single-surgeon.
The transition from microscopic to fully endoscopic transsphenoidal surgery requires a surgeon to assess how the change in technique will affect the extent of tumor resection (EOR), outcomes, and complications. We compared a single surgeon's experience transitioning from one technique to the other and examined the operative outcomes and EOR between microscopic versus endoscopic transsphenoidal surgery. ⋯ During the transition from the microscopic to the endoscopic approach, similar surgical outcomes and EOR were achieved in the 2 cohorts. In our experience, the endoscopic approach offers the advantage of shorter operative times and lengths of hospital stays after the surgeon has developed more experience with the technique.
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Case Reports
Dural Traction A Possible Cause Of Hemodynamic Changes During Single Level Transforaminal Lumbar Interbody Fusion.
Lumbar spinal surgery may be associated with electrophysiologic and hemodynamic abnormalities during the procedure. ⋯ Anesthesia providers should be aware of electrophysiologic and hemodynamic abnormalities during lumbar spinal surgery and the need to respond appropriately with sympathomimetic or vagolytic interventions.