World Neurosurg
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This study aimed to clarify functional outcomes of facet joint distraction (FJD) and identify specific risk factors for excessive FJD during single-level anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). ⋯ Patients with an FJD of >0.905 mm had worse NDI and VAS pain scores, but not a poorer modified Japanese Orthopedic Association Score recovery rate. Our findings suggested that a ΔAIH > 2.28 mm, CPD > 12.45 mm, and post-CSCA < 0° were independent risk factors for excessive FJD after single-level ACDF for CSM.
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Currently, the treatment of spontaneous intracerebral hemorrhage (sICH) is limiting, especially in patients with midline shift and supratentorial hemorrhage. Here, we investigated the clinical value of minimally invasive surgery (MIS) in patients with midline shift and supratentorial sICH by observing the consciousness state, midline shift, and short-term mortality. ⋯ MIS could reduce early-stage midline shift, improve consciousness state and reduce short-term mortality in patients with supratentorial sICH.
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Intraoperative neuromonitoring (IONM) is useful during spinal cord operations, but whether IONM is necessary for posterior cervical surgeries for degenerative conditions is unknown. We evaluated the utility of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring as a tool for predicting new postoperative neurologic deficits during posterior decompression and fusion for degenerative cervical spine conditions. ⋯ IONM during posterior cervical operations for degenerative conditions of the spine is not reliable at predicting new postoperative neurologic deficits in patients treated for degenerative conditions, but may provide peace of mind to the surgeon intraoperatively when no abnormalities are detected.
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There is a paucity of evidence describing the price information that is publicly available to patients wishing to undergo neurosurgical procedures. We sought to investigate the public availability and usefulness of price estimates for non-emergent, elective neurosurgical interventions. ⋯ Under 10% of websites queried yield geographically relevant price information for non-emergent neurosurgical imaging and operative procedures. Even when this information is publicly available, its usefulness to patients may be limited by various factors, including obscure data sources and methods, as well as sparse information on discounts and bundled price estimates. Inconsistent availability and clarity of price information likely impede patients' ability to discern expected costs of treatment and engage in cost-conscious, value-based neurosurgical decision-making.
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Decompressive craniectomy (DC) is an important therapy for treating intracranial pressure elevation following traumatic brain injury (TBI). During this procedure, about one-third of patients become complicated with intraoperative hypotension (IH), which is associated with abruptly decreasing sympathetic activity resulting from brain decompression. This study aimed to identify factors associated with IH during DC procedures and the mortality rate in these patients. ⋯ GCS-M 1-3, higher PHR, and larger amount of intraoperative blood loss were the risk factors associated with IH during DC procedure in TBI patients. Patients who have these risk factors should be closely monitored and the attending physician be ready to apply prompt resuscitation and treatment for IH.