Neurosurgery
-
Low back pain (LBP) is one of the most common health problems, representing the second most frequent reason for primary care consultation and a frequent motive to neurosurgical referral. Lifetime prevalence of LBP ranges from 60% to 90%. Facet joints can be a source of chronic and persistent spinal pain and have been implicated in 15% to 40% cases of axial LBP. Lumbar facet joints are responsible for local and referred pain to adjacent areas. Sacroiliac joint pain is also a challenging condition accounting for approximately 20% of cases of chronic LBP. We aim to evaluate the efficacy over time of percutaneous radiofrequency neurotomy for lumbar facet syndrome and sacroiliac joint pain. ⋯ Radiofrequency neurotomy was useful for the treatment of lumbar facet syndrome and sacroiliac joint pain. Despite of gradual loss of efficacy, at 2 years 40% of patients maintained a 50% reduction of pain intensity. Therefore this procedure could be used for treatment of carefully selected patients with chronic LBP.
-
Radiation exposure from diagnostic imaging is a significant concern, particularly in the care of pediatric patients. Computed tomography (CT) scanning is a significant source of radiation. ⋯ Although replacing a CT with magnetic resonance imaging is ideal to completely avoid ionizing radiation, this is not always practical or preferred. Therefore, it is important to have CT protocols in place that minimize radiation dose without sacrificing diagnostic quality. The protocols in place at our institution could be replicated at other academic and community hospitals and imaging centers.
-
Neurosurgical treatments for refractory psychiatric disorders such as obsessive-compulsive disorder (OCD) are rapidly increasing. The National Institute of Mental Health has reclassified mental health disorders according to neurobiological mechanisms rather than traditional diagnostic categories. According to this Research Domain Criteria matrix, OCD would be classified as a disorder of cognitive control, with additional contributions from other axes. We bring together the neuroscientific literature on cognitive control and dorsal anterior cingulate cortex (dACC) function with human functional MRI (fMRI) and EEG data to demonstrate (1) the central role of the dACC in cognitive control; and (2) the relevance of this framework for the neurosurgical treatment of OCD. ⋯ We collect a breadth of data to illustrate the following points: (1) the dACC is central to cognitive control; (2) cognitive control is dysfunctional in OCD; (3) neuromodulatory treatment of OCD normalizes physiological measures of cognitive control. We discuss these findings within the framework of the recently proposed Expected Value of Control (EVC) model of dACC function. The development of neurobiological conceptualizations such as these will be critical to the advancement of our network-level understanding of neuropsychiatric disorders and their neurosurgical treatments.
-
With rising health care costs, clinical outcome data are becoming increasingly important. The concept of minimally clinical important difference (MCID) has been shown to be effective in spine surgery to differentiate between clinically insignificant and significant improvements and to measure the patient's perspective of quality of life and disability. We sought to determine the MCID for spinal cord stimulation (SCS) therapy for failed neck and back syndromes, which has not been established to date. ⋯ The MCID for SCS placement was calculated by using 4 methods. The results are similar to calculations for the MCID for traditional surgical procedures done for pain. Our results suggest that an improvement of 1.2 to 3.7 points on the VAS scale and 8.2 to 13.3 points on the ODI is clinically meaningful to the patient. Further defining the MCID for SCS therapy will remain of utmost importance in order to justify the cost of the procedure.
-
Surgical site infections (SSI) contribute significantly to patient morbidity and mortality and greatly increase health care costs. It has been postulated that increased traffic through operating rooms (ORs) during procedures increases SSI rates. ⋯ In conclusion, OR traffic can be significantly reduced by using a LT protocol like that used in this study. However, significantly reducing OR traffic does not meaningfully reduce the risk of SSI.