World Neurosurg
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Spinal injuries occur in 3% of all trauma patients, most commonly in males, and often due to high-velocity impact followed by abrupt deceleration. The most affected region following spinal trauma is the thoracolumbar junction due to the anterior center of gravity at T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus non-operative management of traumatic injuries at this site. ⋯ Ignoring this aspect of thoracolumbar management often contributes to the development of post-traumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the injured vertebra's level, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to demonstrate the importance of segmental sagittal alignment and the vertebral level on patient outcomes.
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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. ⋯ 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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To analyze the complications and long-term follow-up results of endovascular treatment for ruptured intracranial posterior circulation aneurysms and identify outcome predictors. ⋯ Endovascular treatment is feasible and effective for treating ruptured intracranial aneurysms; however, there are still risks of complications and unfavorable clinical outcomes. The involvement of the BA trunk increases the risk of complications, and the use of closed cell design laser cut stents is associated with unfavorable outcomes. Clinicians should be cautious to avoid the risk factors when treating ruptured posterior circulation aneurysms and strive to minimize the occurrence of complications and unfavorable clinical outcomes.
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CSF leaks are a known complication of lumbar fusion surgery. There is a scarcity of literature describing the management of this complication. The aim of this study was to identify patients who are at risk of requiring further intervention for managing CSF leaks. ⋯ Spine surgeons should be aware of certain patient and procedure-specific characteristics that increase the risk of requiring an intervention for CSF leak management after lumbar fusion to improve patient outcomes.
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3D printing technology presents a promising avenue for the development of affordable neurosurgical simulation models, addressing many challenges related to the use of cadavers, animal models, and direct patient engagement. The aim of this study is to introduce and evaluate a new high-fidelity neurosurgical simulation model targeted for both burr hole and craniotomy procedures. ⋯ The findings indicate that widely accessible and economical desktop stereolithography 3D printers can provide an effective solution in neurosurgical training, thus promoting their integration in hospitals.