World Neurosurg
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The purpose of this study was to identify risk factors for pseudarthrosis in patients undergoing anterior cervical discectomy and fusion (ACDF) with a focus on the role of bone mineral density (BMD) on arthrodesis. ⋯ The results of this study suggest that both osteopenia and osteoporosis are associated with increased rates of pseudarthrosis in patients undergoing elective ACDF.
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It remains unclear how type of insurance coverage affects long-term, spine-specific patient-reported outcomes (PROs). This study sought to elucidate the impact of insurance on clinical outcomes after lumbar spondylolisthesis surgery. ⋯ Despite adjusting for potential confounding variables, Medicaid coverage was independently associated with worse 24-month PROs after lumbar spondylolisthesis surgery compared with other payer types. Although all improved postoperatively, those with Medicaid coverage had relatively inferior improvements.
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Cerebral arteriovenous malformations (AVMs) can be treated by microsurgery, stereotactic radiosurgery (SRS) as a stand-alone procedure, or combining embolization and conservative management. This single-center, retrospective review explored the outcomes of patients treated with SRS alone, embolization before SRS (ESRS), or conservative management for cerebral AVMs. ⋯ Findings suggest that SRS and ESRS are safe and effective treatments for cerebral AVM (when quantified by obliteration, rebleed, and disease-specific mortality rates). With multinational, prospective, randomized controlled trials with long follow-up periods, the effectiveness and safety of SRS and ESRS compared with conservative management for AVM will be further clarified.
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Traditional Gamma Knife radiosurgery (GKRS) of brain arteriovenous malformations (AVMs) using digital subtraction angiography (DSA) requires head immobilization using a stereotactic frame. ⋯ This is the first study that integrates DSA in the treatment planning of brain AVMs using GKRS without utilizing a stereotactic head frame. Frameless GKRS provides numerous advantages over frame-based techniques including improved patient experience and the capability of fractionation and thus expanding the eligibility of more AVMs for radiosurgery, while maintaining high spatial resolution of the AVM using angiography data.
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The COVID-19 pandemic has had a profound impact on the global delivery of health care. Recent data suggest a possible impact of the pandemic on patterns of neurotrauma. The aim was to assess the impact of the pandemic on the incidence of neurotrauma, with a focus on cranial gunshot wounds (cGSWs) at a large Midwestern level 1 trauma center. ⋯ Despite the government-mandated shutdown, we observed an increase in the number of neurotrauma cases in 2020. There was a significant increase in the incidence cGSWs in 2020, with an increase in assaults and self-inflicted injuries. Further investigation into socioeconomic factors for the observed increase in cGSWs is warranted.