World Neurosurg
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Review Meta Analysis
Growth Factor Gene-Modified Cells in Spinal Cord Injury Recovery: A Systematic Review.
Numerous preclinical studies have been performed in recent years on the effects of the administration of growth factor gene-modified cells in spinal cord injury (SCI). However, findings of these studies are contradictory. ⋯ The results showed that transplantation of growth factor gene- modified cells significantly improved locomotion in SCI animal models. However, there is a major concern regarding the safety of transplantation of genetically modified cells, in terms of overexpressing growth factors. Further studies are needed before any effort to perform a translational and clinical study.
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Meta Analysis
Post Traumatic Amnesia: A Systematic Review and Meta-Analysis. Proposal for a New Severity Classification.
Posttraumatic amnesia (PTA) duration is used to predict outcome after traumatic brain injury (TBI): however, no meta-analysis exists. ⋯ PTA duration was reliable in predicting outcome when <7 days, and especially when >42 days but was often unreliable between 7 and 42 days duration.
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Hypertonic saline (HTS) is a widely used adjunct in the treatment of traumatic brain injury (TBI). However, there is significant variability in practice patterns. Toward the goal of optimality and standardization in the use of HTS in TBI, we performed a comprehensive review of clinical protocols reported in the neurosurgical and neurocritical care literature. ⋯ In addition, lower HTS concentrations strongly correlated with greater ICP reduction. Therefore, lower concentrations of HTS may be practical therapeutic agents for patients with TBI given their efficacy in ICP reduction and safer complication profile compared with greater HTS concentrations. Evidence-based parametric use of HTS stands to improve patient outcomes by standardization of varied clinical practice.
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Review
Perioperative Pain Management for Elective Spine Surgery: Opioid Use and Multimodal Strategies.
In recent years, physicians and institutions have come to recognize the increasing opioid epidemic in the United States, thus prompting a dramatic shift in opioid prescribing patterns. The lack of well-studied alternative treatment regimens has led to a substantial burden of opioid addiction in the United States. ⋯ Overall, there is a large incentive to better understand comprehensive multimodal pain management regimens, particularly in the spine surgery patient population. The goal of this review is to explore trends in pain symptoms in spine surgery patients, overview the best practices in pain medications and management, and provide a concise multimodal and behavioral treatment algorithm for pain management, which has since been adopted by a high-volume tertiary academic medical center.
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High-grade lumbar spondylolisthesis (HGLS) remains a challenging surgical entity, and there is no current consensus regarding optimal surgical approach. The purpose of this study was to systematically review the literature for studies utilizing the reverse or modified Bohlman technique for the treatment of HGLS to assess their safety and efficacy. ⋯ Our data demonstrate that reverse and modified Bohlman techniques appear to be effective in both improving slip angle/percentage and relieving symptoms with low risk of complications. These findings are limited by the small sample size of patients. The authors recommend larger series before formal recommendations can be made.