Neurosurgery
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Obesity is a growing health problem worldwide and is responsible for a significant proportion of health expenditures in developed nations. It is also notoriously difficult to treat. Prior attempts at pharmacological or neurological modulation, including deep brain stimulation, have primarily targeted homeostatic mechanisms of weight control centered in the hypothalamus. ⋯ Multiple lines of independent data suggest that dysregulated reward circuitry in the brain underlies behaviors leading to obesity. Here, we review the existing data and related neurocircuitry, as well as the scope of obesity and currently available treatments. Finally, we suggest a neuromodulation strategy geared toward regulating these dysfunctional circuits, primarily by alteration of frontolimbic circuits.
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Multicenter Study
Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up.
Sagittal plane malalignment has been established as the main radiographic driver of disability in adult spinal deformity (ASD). ⋯ Best HRQOL outcomes for ASD patients with severe sagittal plane deformity were obtained with a correction >120 mm for SVA and at least 66% of correction. Although lesser amounts of SVA correction yielded clinical improvement, the rate of MCID threshold improvement was not significantly different for mild or modest corrections. These results underline the need for complete sagittal plane deformity correction if high rates of HRQOL benefit are sought for patients with marked sagittal plane deformity.