World Neurosurg
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Epidural extramedullary hematopoiesis (EMH) is a rare, underreported phenomenon in which hematopoiesis occurring outside of the medullary environment can cause spinal cord compression. In this systematic review, we evaluate clinical characteristics and evidence-based guidelines for clinical management of EMH and present an illustrative case. ⋯ Epidural EMH is a pathology with limited reporting; this systematic review is the most comprehensive to date. Although available case series data were heterogeneous, our analysis suggested that multimodal treatment with surgical intervention was beneficial. Given the young patient population, we recommend prompt surgical management via decompression of the spine because of the associated low risk of complications and recurrence, and better neurological recovery.
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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 uses 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 radiologic outcomes of these 2 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 aimed to identify risk factors for major adverse events (AEs) after lumbar fusion surgery in patients aged 75 and older and evaluate the role of several common geriatric comprehensive assessment items in predicting postoperative major AEs. ⋯ Preoperative frailty, hypoalbuminemia, female sex, greater body mass index, and higher Charlson comorbidity index 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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To investigate the potential of composite inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), in predicting outcomes in patients with posterior circulation large vessel occlusion who underwent mechanical thrombectomy (MT). ⋯ Among the assessed markers, NLR emerged as the strongest predictor of clinical outcomes following MT for posterior circulation large vessel occlusion.