World Neurosurg
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Little published data exist regarding normal values of disc height. Current literature relies on plain radiographs making accurate measurements of individual lumbar disc height difficult. ⋯ Variation in disc height is determined much more by sex than age. The maximum height of the interbody space in the adult lumbar spine was at the L4/5 level (8.9 ± 1.7 mm [men], 8.6 ± 1.8 mm [women]). Based on our findings, >10 mm cage height will result in supraphysiologic interbody space restoration and potentially predispose to complications.
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We studied the effect of different cervicothoracic construct design variables on biomechanical stability in vitro. ⋯ We found that the rod diameter of a construct does not appear to significantly influence the biomechanical stability of subaxial constructs. The screw-rod construct resulted in certain biomechanical advantages compared with the screw-connector-rod construct, and both were significantly superior to the hook-rod construct.
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Although reducing 30-day hospital readmissions is now a priority in neurosurgical quality improvement, postoperative emergency room (ER) visits have remained poorly understood, in particular, in populations with limited access to outpatient care. After endoscopic transsphenoidal surgery, the unique pathologic entities treated can engender a variety of surgical and metabolic complications-often dangerous, delayed, and nonspecific in presentation. We sought to characterize the causes and timing of ER visits-with or without readmission-in a socioeconomically disadvantaged population. ⋯ Delayed hyponatremia accounts for a large proportion of ER visits and unplanned readmissions. Close follow-up with diligent, multidisciplinary care might reduce the number of ER visits and readmission in this population.
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Control of bleeding in the confined area of the skull is imperative for successful neurosurgery and the prevention of devastating complications such as postoperative hemorrhage. This paper reviews the historical evolution of methods to achieve successful hemostasis in neurosurgery from the early1800s to today. The major categories of hemostatic agents (mechanical, chemical and thermal) are delineated and discussed in chronological order. The significance of this article is in its detailed history of the kinds of hemostatic methods that have evolved with our accumulating medical and surgical knowledge, which may inform future innovations and improvements.
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Surgery for spontaneous primary intracerebral hemorrhage (ICH) remains controversial. Previous surgical trials have primarily focused on short-term mortality while studies on long-term functional outcome are rare. We therefore conducted this retrospective study of long-term outcome on all ICH patients who underwent craniotomy at a single neurosurgical center during a 10-year period. ⋯ The case fatality in our study was comparatively low, but most survivors lived dependently several years after surgery. Heart disease and level of consciousness were the most consistent predictors of mortality.