World Neurosurg
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It remains unclear whether fusion for lumbar degenerative disc disease with positive discography produces better outcomes compared with nonoperative treatment. The aim of this study was to compare outcomes of patients with discography-concordant lumbar degenerative disc disease electing for fusion versus nonoperative treatment. ⋯ Comparison of long-term outcomes for patients with back pain and concordant discography did not demonstrate a significant difference in outcome measures of pain, health status, satisfaction, or disability based on whether the patient elected for fusion or nonoperative treatment.
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Bow hunter's syndrome is a rare vascular phenomenon characterized by insufficiency of the posterior cerebral circulation induced by rotation of the head within normal physiologic range. The neurosurgical literature on evidence-based diagnosis and management of the disease is scarce, and reports are largely limited to case studies. ⋯ Decompression without fusion is a safe, reliable surgical option in patients with bow hunter's syndrome. Decompression is performed via a posterior approach for atlantoaxial vertebral artery compression and via an anterior approach for subaxial compression. Long-term complications include cervical instability, which may necessitate internal fixation and fusion.
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Pituitary apoplexy is an infrequent occurrence that can require timely treatment. The term "pituitary apoplexy" as used in the literature describes a heterogeneous spectrum. There is controversy about which subsets require urgent as opposed to elective surgical treatment or even medical treatment alone. We present a retrospective series of 109 consecutive cases of pituitary apoplexy from a single institution from 1992-2012 and develop a comprehensive classification system to analyze outcome. ⋯ We offer a simple yet comprehensive grading system to classify the clinical spectrum of pituitary apoplexy, which has implications for management, outcomes, and categorization for future studies.