World Neurosurg
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Disparities in access and delivery of care have been shown to disproportionately affect certain racial groups. Studies have been conducted to assess these disparities within the spinal metastasis population, but the extent of their effects in the setting of other socioeconomic measures remains unclear. The purpose of this study was to perform a systematic review to understand the effect of racial disparities on outcomes in patients with metastatic spine disease. ⋯ Although some studies suggest race to be associated with presenting characteristics, treatment type and outcome of patients with spinal metastases, there was significant variability in the inclusion of measures of socioeconomic status in study analyses. As such, the association between race and outcomes in oncologic spine surgery remains unclear.
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Comparative Study
What is the True Cost of Motion Preservation? A Time-driven Activity-Based Cost Analysis of Anterior Cervical Discectomy and Fusion Versus Disc Replacement.
Total disc replacement (TDR) has become a viable alternative to anterior cervical discectomy and fusion (ACDF) for select patients. Although most comparative studies have assessed outcomes, cost differences remain largely uninvestigated. This information is critical as we move towards value-based reimbursement. To address this knowledge gap, we used time-driven activity-based costing to compare total intraoperative costs between the 2 procedures. ⋯ Time-driven activity-based costing is a highly useful methodology for estimating differences in true costs between procedures and determining cost drivers. TDRs were associated with an additional $3885 of total intraoperative cost as compared to ACDFs, the majority of which was driven by the cost of implants.
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Although magnetic resonance imaging is the primary modality of investigation for determining the extent of posterior ligamentous complex (PLC) injuries in lower lumbar fractures (LLF) (L3-L5), the reliability of computed tomography (CT) has not been well defined. The main objective of this study is to analyze the diagnostic accuracy of combined CT findings for detecting PLC injury in patients with LLF. ⋯ Among the various CT parameters, facet joint diastasis (FJDS > 4.2 mm and FJDA > 3.5 mm) is the most reliable factor in determining PLC injury.
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This study investigates the predictive values of the Risk Analysis Index (RAI), the modified 5-item Frailty Index (mFI-5), and advanced age for predicting 30-day extended length of stay (LOS), 30-day complications, and readmissions in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD). ⋯ This study suggests that the utility of RAI and mFI-5 in predicting extended LOS patients undergoing PSF for ASD. RAI was found to be superior to mFI-5 for predicting 30-day readmissions, while mF-5 was greater for 30-day complications. These findings highlight the need for future studies to identify optimal methods in incorporating frailty assessments into preoperative surgical planning and patient discussions.
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Comparative Study
Intraoperative comparison between strain elastography and pre-operative MRI features in high-grade gliomas using fusion imaging: a pilot study.
To compare the elastographic patterns of high-grade gliomas (HGGs) solid portions and those of adjacent healthy brain parenchyma, on intraoperative ultrasound, with magnetic resonance image (MRI) characteristics. ⋯ Three major SE patterns defined HGGs and adjacent healthy brain parenchyma. SE patterns varied according to HGG histotypes and Gd-T1 MRI/FLAIR characteristics.