World Neurosurg
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Cervical medial branch blocks (CMBB) are frequently used for the treatment of facet arthropathy. The present study compares the effectiveness of lidocaine and prilocaine in CMBB procedures. ⋯ CMMB achieved with either lidocaine or prilocaine decreased the recorded pain severity and disability scores to a similar degree. The selection of either lidocaine or prilocaine for CMBB is thus at the clinician's discretion.
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Distal junctional kyphosis (DJK) and distal junctional failure (DJF) are known complications of adult multilevel spinal fusion surgery. Previous literature has extensively investigated proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), but DJK and DJF are relatively under-studied. This study investigates the association between bone mineral density (BMD) and DJK/DJF via a Systematic Review (SR) and Meta-Analysis (MA). ⋯ Patients who developed DJK/DJF had significantly lower CT-measured HU as compared to those without DJK/DJF. Our findings highlight the potential importance of BMD evaluation with CT prior to multilevel spine fusion surgery, though further research would be helpful to evaluate the significance of DEXA-based BMD measurements on DJK/DJF development.
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Frailty is defined as a state in which depletion of physiologic reserves causes multisystem impairments independent of natural senescence. This phenomenon can be quantified by the 11-point modified frailty index (mFI-11). This study determines whether an 11-point patient questionnaire developed from the mFI-11 can be used as a predictor for discharge destination following multilevel lumbar interbody fusion surgery in elderly patients. ⋯ Increased frailty was significantly associated with nonhome discharge, discharge to home health, rehabilitation, or skilled nursing facility. This is likely due to the impact which comorbidities represented by the frailty questionnaire and mFI-11 have on patient healing and postoperative recovery. Frailty score may be incorporated into the informed consent process and shared decision-making between patients and their surgeons to better predict the likelihood of discharge home.
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Although the operating theatre offers unique didactic opportunities, it can be perceived as an uncomfortable environment by medical students due to the lack of theatre etiquette, time pressure and parallel work of different disciplines. We investigated whether virtual reality (VR) training can significantly reduce some of these fears and improve surgical education for medical students. ⋯ Routine VR use as part of clinical training could be beneficial in future medical education.