World Neurosurg
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The impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated. ⋯ Medicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.
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Case Reports
Cervical Conjoined Nerve Root During Posterior Percutaneous Endoscopic Cervical Discectomy.
Cervical conjoined nerve root is rare, and medical imaging, such as magnetic resonance imaging and computed tomography, cannot give an accurate preoperative diagnosis.1 Treatment of cervical radiculopathy with root anomaly can be challenging. We report here a case of cervical conjoined nerve root with a 2-dimensional video. A 41-year-old woman without systemic disease presented with a 2-month history of neck and bilateral shoulder pain, upper back tightness, and left upper limb painful numbness, especially of the first to third fingers. ⋯ The 3-month postoperative follow-up Neck Disability Index was 1. Posterior percutaneous endoscopic cervical diskectomy has become a favored treatment for cervical disk herniation because it offers sufficient decompression, smaller incisions, minimal blood loss, shorter hospital stay, and less postoperative pain.2,3 Nonetheless, if unexpected variation of the nerve root is noted during decompressive procedures, iatrogenic nerve root injury is a risk. Seven cases of cervical nerve root anomalies have been reported; all were found during posterior cervical surgery, which may indicate that the posterior approach provides better visualization of nerve root variants, especially in endoscopic surgery.4.
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The COVID-19 pandemic forced neurosurgery residency application processes to adopt a virtual interview model. This study analyzes the trends in program and applicant residency match behavior due to virtual interviews. ⋯ Despite no change in the overall number of applications submitted per applicant, Black applicants submitted more applications virtually, suggesting potential benefits of virtual format for Black applicants. Interview format was strongly correlated to the use of perceived fitness by applicants in rank decision making. Virtual interviews provide major financial advantages to candidates and could help improve Black representation in neurosurgery. However, they impose limitations on ability access fitness.
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Endoscopic Discectomy of Rostrally and Caudally Migrated Lumbar Disc Herniations; A Technique Video.
Surgical treatment of extremely migrated caudal and rostral lumbar disk herniations is technically challenging. Traditional open technique often requires more bone resection, which can lead to rare but significant complications such as pars fracture or instability requiring fusion surgery. Endoscopic diskectomy is a safe alternative to traditional open surgery with acceptable complication rates.1-4 Endoscopic diskectomy provides the advantage of excellent visualization and maneuverability while minimizing soft tissue trauma and bony resection, which can result in less postoperative pain, less opioid consumption, and quicker recovery.5 We present a surgical technique guide (Video 1) for endoscopic diskectomy of 2 patients with very high rostral (grade 1) and caudal (grade 6) lumbar disk herniations as graded by Ahn's modification of the Lee-Kim grading classification.6,7 Risks, benefits, and alternatives to surgery were discussed with the patients, and they consented to the procedure. This video is not a replacement for hands-on training.