World Neurosurg
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Understanding postsurgical prescribing patterns and their impact on persistent opioid use is important for establishing reasonable opioid prescribing protocols. We aimed to determine national variation in postoperative opioid prescription practices following elective lumbar spine surgery and their impact on short-term refill prescriptions. ⋯ In analysis of filled opioid prescriptions, we observed a significant proportion of prescriptions >200 MMEs and wide regional variation in postdischarge opioid prescribing patterns following elective lumbar spine surgery.
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Presacral abscess is a common disease in the developing countries. Treatments include minimally invasive percutaneous drainage and open surgical debridement. Percutaneous drainage under computed tomography (CT) guidance has been recommended by the American College of Radiology as a good alternative to surgical drainage before elective surgical treatment. Because of the many anatomic obstacles, the presacral space can be one of the most difficult locations to access. There are several reported access routes like transabdominal, transgluteal, transvaginal, transperineal, transanal, precoccygeal, transpedicular, and so on. We introduce a novel approach, the trans-sacral-foramen approach, to drain presacral abscess under CT guidance. ⋯ Trans-sacral-foramen approach is the shortest path to reach the presacral abscess. The approach is easier and safer than the others for patients with indication.
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We aimed to evaluate the efficacy and safety of single-device flow diversion in patients with aneurysms measuring ≥15 mm in diameter. ⋯ Single-device flow diversion was shown to be ineffective for large or giant intracranial aneurysms with a high parent vessel angle.
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Post-traumatic syringomyelia develops years to decades after spinal trauma in up to 28% of patients. We report a case of a man who developed extensive syringomyelia 14 years after spinal trauma, but had only minimal symptoms. Presumed pathophysiology of this condition and options for surgical management are briefly reviewed.
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The purpose of this study was to examine the relationship between timing of preoperative surgical antibiotic prophylaxis and postoperative surgical site infections (SSIs) among patients with 1-level to 3-level lumbar fusion. ⋯ Our results show that preoperative antibiotic administration beyond 1 hour in patients who have undergone lumbar fusion is associated with higher rates of SSI.