World Neurosurg
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Few researchers have verified the clinical efficacy and safety of the modified unilateral extrapedicular approach (mUEP) applied to the percutaneous kyphoplasty (PKP) in comparative studies with other puncture techniques. Compared with the bilateral transpedicular approach (BTP), whether mUEP PKP is a preferred treatment for lumbar osteoporotic vertebral compression fracture (OVCF) remains unclear. ⋯ mUEP PKP could be clinically and radiographically equivalent to BTP PKP. However, it has advantages in reducing operation time and fluoroscopy times, lowering the risk of intraspinal cement leakage, and preventing the presence of facet joint violation. Compared with BTP PKP, the mUEP PKP seems to be an effective and alternative puncture technique for the treatment of lumbar OVCF after appropriate patient selection.
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Ankylosing spondylitis (AS) often results in progressive spinal stiffness, making patients prone to spinal fractures. Cervical spine fractures in AS mostly occur in the lower segment and cause progressive neurological deficits. However, the optimal approach to treating this patient population is still controversial, and it is unclear what factors have an impact on prognosis. Thus, this study aimed to investigate the choice of surgical approach and prognostic factors in AS patients with cervical spine fractures. ⋯ All approaches can provide good clinical results, and thus, the surgical approach should be individualized. It remains unclear whether the operation should be performed as soon as possible. Basic AS treatment is an independent factor that affects the prognosis of cervical spine fracture patients with AS.
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Superior semicircular canal dehiscence (SSCD) is defined by a bony defect overlying the superior semicircular canal (SSC) in the middle cranial fossa floor, causing a myriad of vestibular and auditory symptoms. Patients with thin bone without full dehiscence overlying the SSC also present with similar symptoms. There are currently no guidelines for surgical management of patients with thin bone. The authors offer their experience with thin bone patients to characterize their symptomatology and explore whether these patients benefit from surgical intervention typically offered to SSCD patients. ⋯ Surgical management of thin bone patients via middle fossa craniotomy, a similar technique to SSCD repair, provides significant symptomatic resolution. Therefore, surgery should be considered in thin bone patients with debilitating symptoms, albeit not having a true dehiscence.
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Convolutional neural networks (CNNs) are being increasingly used in the medical field, especially for image recognition in high-resolution, large-volume data sets. The study represents the current state of research on the application of CNNs in image segmentation and pathology detection in spine magnetic resonance imaging. ⋯ State-of-the-art CNNs can detect and segment-specific anatomical landmarks and pathologies across a wide range, comparable to the skills of radiologists and experienced clinicians. With rapidly evolving network architectures and growing medical image databases, the future is likely to show growth in the development and refinement of these capable networks. However, the aid of automated segmentation and classification by neural networks cannot and should not be expected to replace clinical experts.
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External ventricular drain (EVD) and intracranial pressure (ICP) monitor placements are among the most common critical care procedures for severe brain injury. Quality improvement initiatives have streamlined similar processes. The aim of the project was to decrease the time to collect supplies for EVD or ICP monitor placement by 25% by April 1, 2021. ⋯ The time reduction and enthusiasm are likely associated with the simplicity and comprehensiveness of the intervention design. Including key stakeholders in decision-making and succinct communications reduced resistance to change.