World Neurosurg
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Levodopa has long been the standard of care for Parkinson disease (PD); however, the eventual onset of motor fluctuations and levodopa-induced dyskinesia (LID) complicates its utility in advanced PD. Current neurosurgical interventions remain some of the best options for LID. Deep brain stimulation (DBS) is currently the procedure of choice for patients with advanced PD, patients refractory to medical management, and patients with motor complications from levodopa therapy. ⋯ Transcranial magnetic stimulation, which can induce local and distant effects in cortical and subcortical areas, has shown efficacy in managing certain PD and LID symptoms in early studies. Finally, direct stimulation of the motor cortex and the cerebellum has shown therapeutic effects in PD and LID patients in certain studies. Taken together, many of these new techniques have shown great promise in early studies and may eventually be preferred treatment options for LID patients.
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We evaluated the clinical efficacy of the Biocage in lumbar fusion surgery and its safety and effectiveness. ⋯ The Biocage has excellent clinical efficacy in the treatment of lumbar degenerative disease. Although the Biocage achieved good therapeutic effects, it did not show obvious advantages compared with the PEEK cage. Therefore, the Biocage can only be used as a choice of bone graft materials for lumbar fusion surgery and should not completely replace the PEEK cage.
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Comparative Study
Comparison of Segmental Lordosis and Global Spinopelvic Alignment after Single-Level Lateral Lumbar Interbody Fusion or Transforaminal Lumbar Interbody Fusion.
Lateral lumbar interbody fusion (LLIF) has steadily increased in popularity. Compared with the traditional transforaminal lumbar interbody fusion (TLIF), LLIF is thought to allow for greater improvement in lordosis. However, there are limited direct comparison data on the degree of regional and global alignment change after single-level LLIF and TLIF procedures. This study compared the changes in spinal sagittal alignment in patients who underwent either procedure. ⋯ LLIF achieved greater improvements in SL than TLIF. However, regionally and globally, there were no significant differences with either procedure after a single-level intervention. The increased lordosis from LLIF compared with TLIF may be more impactful globally in multilevel fusions.
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Solitary brain tumors can propose a diagnostic dilemma owing to the difficulty in differentiating between primary brain tumors and metastatic disease. The similar radiologic appearance on routine magnetic resonance imaging will necessitate the need for additional noninvasive testing. We sought to determine the clinical utility of preoperative whole body screening with computed tomography (CT) to detect metastatic disease in patients with solitary brain tumors. ⋯ Preoperative whole body CT had a positive predictive value of 88% and negative predictive value of 97% in the present study and was both sensitive (92%) and specific (95%) for the detection of extracranial tumors. The identification of extracranial tumors on whole body CT screening might alter management.
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It has been reported the distribution of bone cement in percutaneous kyphoplasty (PKP) has an impact on the curative effect. No studies have compared between confluent and separated cement pattern of bilateral bone cement in PKP for patients with osteoporotic vertebral compression fractures. ⋯ Patients achieved rapider pain relief with confluent rather than separated bilateral bone cement pattern in PKP for osteoporotic vertebral compression fracture.