World Neurosurg
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Despite the rising trend of medicolegal challenges in Italy, there is a significant lack of literature on this topic. To provide better understanding of awareness toward medicolegal aspects, defensive behavior, consent-taking practice, and general perceptions of Italian neurosurgeons on this issue, a cross-sectional survey was conducted. ⋯ This study marks the first survey to identify the perceptions among Italian neurosurgeons of medical legal issues and related "defensive medicine" practices: This is of relevance given its exorbitant cost in terms of public expenditure, psychologic burden, and its relevant impact on health care delivery.
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In this study, the morphologic characteristics and anatomic position of the dorsal root ganglion (DRG) were measured and analyzed in healthy people using magnetic resonance neurography (MRN), which provided an anatomical reference for minimally invasive spinal surgery. ⋯ The intervertebral foramen type and Intraspinal type were observed to be the main distribution forms of lumbar DRG. Due to the downward movement of lumbar segments, the position of the DRG was noted to gradually move to the spinal canal while its volume gradually increased. In addition, the distance from the upper pedicle was found to decrease gradually. MRN imaging can clearly show the shape, location, and adjacent relationship of the DRG, providing effective imaging guidance for the minimally invasive lumbar techniques.
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Conservative methods are the traditional options in the management of lumber spondylolysis whereas surgery is indicated for symptomatic patients not responding to medical treatment and cases with a multilevel pars defect. The aim of this prospective study was to evaluate the clinical, functional, and radiologic results of using bone graft and fixation with pedicular screw-rod-laminar hook construct in treatment of lumber spondylolysis. ⋯ Reconstruction fixation of pars defect using this construct is an effective, feasible procedure in the treatment of Lumbar spondylolysis regarding the preservation of lumbar motion and avoidance of adjacent-segment problems after fusion.
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To identify the apical vertebra is relate to the occurrence of vertebral rotatory subluxation (VRS) in degenerative lumbar scoliosis. ⋯ VRS is an important characteristic to consider in degenerative lumbar scoliosis that can affect the coronal and sagittal alignment. The apical vertebra is correlated with the occurrence of VRS; an apical vertebra translation greater than 23.2 mm and apical vertebra tilt angle greater than 11.8° are highly correlate with the occurrence of VRS.
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Lumbar Spine MRI Use for Low Back Pain (OP-8) is calculated by dividing the number of patients who received lumbar magnetic resonance imaging (MRI-L) before receiving alternative treatments (e.g., physical therapy) by the total number of patients receiving MRI-L in the outpatient setting at a given institution. Since the passage of the Post-Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), OP-8 scores became tied to hospital finances. This study aims to determine how MACRA has impacted OP-8 scores since its implementation. We also aim to investigate how regional designation, profit status (for-profit, government, and nonprofit), and hospital setting (critical access, non-critical access) affect OP-8 scores. ⋯ The implementation of MACRA seems to have been unsuccessful in altering practice patterns, given the minimal change in OP-8 scores over the last 4 years. Furthermore, institutional factors are clearly correlated with a lack of adherence to magnetic resonance imaging guidelines. Given these findings, there is a need to modify health policies.