World Neurosurg
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Recently, there has been significant interest in understanding the cost-effectiveness of treatments in spine surgery as health care systems in the United States move toward value-based care and alternative payment models. Previous studies have shown comparable outcomes of cervical disc arthroplasty (CDA) and anterior cervical discectomy fusion; however, there is a lack of consensus on the cost-effectiveness of CDA to support full adoption. Evidence of the limitations of these cost-analysis studies also exists in the literature, including industry funding, potential selection bias, and varying methods of calculating value. The goal of this narrative review is to provide an overview of the cost-effectiveness of CDA compared with anterior cervical discectomy and fusion, and potential limitations with cost-analysis studies in spine surgery.
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Review Historical Article
A Forgotten Tale from the Great War: General Lorenzo Bonomo and the Birth of Italian War Neurosurgery.
Little is known of the advances in battlefield medicine achieved in Italy before and during the Great War. Some deserve wider recognition; this is especially true for the field of neurosurgery. There are a limited number of historical records currently available, fewer still in English, and most of the systematic investigations on field surgery have been in the form of monographs within science history reviews, which obviously lack a strictly clinical perspective. ⋯ Lorenzo Bonomo. His incredibly advanced and modern ideas had unfortunately been forgotten. He pioneered research in the ballistic and forensic medical fields, building on first-hand experience, as he performed surgeries himself before the conflict and even while on the frontline, actively working to improve the chances of survival for the Italian troops fighting in the Great War.
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A carotid web (CW), an atypical fibromuscular dysplasia, is rare and may cause ischemic stroke. It is challenging to recognize a CW promptly and treat it accordingly. We report a case of an initially misdiagnosed CW. ⋯ Clinicians should be aware of CW as a potential cause of ischemic stroke. Head and neck computed tomography angiography is a reliable imaging method to detect CWs.
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Review Historical Article
The Evolution of Minimally Invasive Lumbar Spine Surgery.
Spine surgery has evolved over centuries from first being practiced with Hippocratic boards and ladders to now being able to treat spinal pathologies with minimal tissue invasion. With the advent of new imaging and surgical technologies, spine surgeries can now be performed minimally invasively with smaller incisions, less blood loss, quicker return to daily activities, and increased visualization. Modern minimally invasive procedures include percutaneous pedicle screw fixation techniques and minimally invasive lateral approach for lumbar interbody fusion (i.e., minimally invasive transforaminal lumbar interbody fusion, extreme lateral interbody fusion, oblique lateral interbody fusion) and midline lumbar fusion with cortical bone trajectory screws. ⋯ The advent of computer image guidance has allowed spine surgeons to advance their ability to refine surgical techniques, increase the accuracy of spinal hardware placement, and reduce radiation exposure to the operating room staff. As the field of spine surgery looks to the future, many novel technologies are on the horizon, including robotic spine surgery, artificial intelligence, and machine learning to help improve preoperative planning, improve surgical execution, and optimize patient selection to ensure improved postoperative outcomes and patient satisfaction. As more spine surgeons begin incorporating these novel minimally invasive techniques into practice, the field of minimally invasive spine surgery will continue to innovate and evolve over the coming years.
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Acute stroke resolution via endovascular thrombectomy requires transcarotid access when transfemoral access is not possible. Although postoperative complications such as cervical hematoma and airway compression have been reported, an appropriate postprocedural management is largely unknown yet. We aim to provide new insights and learning points from our experience using the Jaw Elevation Device (JED) as a tool to facilitate recovery post surgery. ⋯ JED appears to be a reasonable option to facilitate patient recovery due to its capacity to maintain the airway, provide mild compression for hemostasis, and prevent cervical hematoma through a comfortable neck immobilization.