World Neurosurg
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This study aimed to identify risk factors for major adverse events (AEs) after lumbar fusion surgery in patients aged 75 and over and evaluate the role of several common geriatric comprehensive assessment items in predicting postoperative major AEs. ⋯ Preoperative frailty, hypoalbuminemia, female sex, greater BMI, and higher CCI grade were risk factors for 90-day major AEs after lumbar fusion surgery in older patients. The predictive nomogram that we developed using this data can enhance preoperative risk counseling and optimization for older patients.
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Adult isthmic spondylolisthesis(AIS) results in the anterior translation of the vertebral body with neural encroachment. Although oblique lumbar interbody fusion(OLIF) is minimally invasive technique that use a retroperitoneal plane to achieve indirect decompression compared to transforaminal lumbar interbody fusion(TLIF), research on OLIF for AIS remains limited. Therefore, we aimed to compare the clinical and radiological outcomes of these two surgical techniques for AIS. ⋯ OLIF is more advantageous than TLIF in terms of blood loss, operative time, hospital stay and anterolisthesis correction. In addition, good clinical outcomes were obtained with indirect decompression alone, regardless of the severity of foraminal stenosis. Therefore, OLIF is a good surgical option for the treatment of AIS.
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This study aims to compare the impact of three surgical techniques-stand-alone cage placement (SAC), anterior cervical plate (ACP) fixation, and total disc replacement (TDR)-on cervical lordosis restoration and segmental height after anterior cervical discectomy at C5-6 level. To eliminate the effect of lordosis between different levels, patients operated on at the same level were included in the study. Restoring cervical lordosis is crucial for improving patient outcomes, including pain reduction and preventing mechanical complications. ⋯ Stand-alone cage placement, anterior cervical plate fixation, and total disc replacement all effectively restore cervical lordosis and segmental height after anterior cervical discectomy at the C5-6 level. Despite early differences, the long-term results were similar, suggesting that the choice of technique should be based on individual patient needs and specific surgical considerations.
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This study aimed to identify surgical, patient-specific, and radiographic risk factors for proximal junctional failure (PJF), a complex complication following adult spinal deformity (ASD) surgery. ⋯ In ASD patients, the presence of concurrent osteoporosis or paravertebral muscle wasting significantly increases the risk of developing PJF. The use of bicortical screws, UIV screw angle exceeding 1°, and positioning the UIV in the lower thoracic or lumbar region also further elevate this risk. Lower preoperative SS, higher preoperative PI-LL, higher preoperative pelvic tilt, higher preoperative SVA, higher postoperative LL, and a greater change in LL characterize patients with PJF.
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The study aims to evaluate the efficacy of neuromodulatory strategies for people who have drug-resistant epilepsy (DRE). ⋯ Regarding long-term efficacy, RNS and DBS outperformed inVNS. While transcranial direct current stimulation and transcutaneous auricular VNS showed promise for treating DRE, further studies are needed to confirm their long-term efficacy.