Neurosurgery
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Previous studies have demonstrated a profound dysfunction of cerebral metabolism following traumatic brain injury (TBI). Despite overall depression of cerebral metabolism, the cerebral metabolic rate (CMR) of oxygen is depressed out of proportion to the mildly reduced CMRglucose. This mismatch has raised the question, where does the missing glucose go if it is not metabolized oxidatively? We have previously demonstrated that an increased proportion of glucose is shunted through the pentose phosphate pathway prompting us to further investigate the total percentage of glucose metabolized by alternative pathways (the "missing glucose") in an attempt to understand the full milieu of altered or dysfunctional metabolism in the injured brain. ⋯ In addition to an overall depression of cerebral metabolism for oxygen and glucose, the percentage of glucose with alternative metabolic fates (missing glucose) was significantly higher in the posttraumatic brain than in the normal brain, almost a 3-fold elevation. Further study is needed to fully identify the alternative metabolic pathways involved.
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Operative management of adult spinal deformity (ASD) repeatedly demonstrates improvements in health-related quality of life over nonoperative treatment. However, little is reported regarding the quality-adjusted life-year (QALY) improvements following surgical correction of ASD. The purpose of this study was to evaluate the QALY increases following the operative treatment of ASD compared with nonoperative treatment. ⋯ The operative treatment of ASD results in significant increases in QALYs gained at minimum 2 years postoperatively as well as at the 1-, 2-, and 3-year time points compared with nonoperative management.
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The spine surgeon often encounters patients with a foot drop. It is the task of spine physicians to be able to determine the etiology and responsible pathological process based upon history, physical examination, electrophysiological testing, and radiographic studies. A detailed knowledge of the musculoskeletal anatomy of the lower extremity and of the peripheral nervous system is beneficial to interpret the aforementioned findings in order to arrive at an accurate diagnosis. Specifically, the spine surgeon needs to be able to identify whether a "foot drop" is the result of a central, radicular, or neuropathic etiology. Peroneal neuropathy must be differentiated from L5 radiculopathy, because the treatment strategies for each of the pathologies differ. ⋯ There may be a lack of knowledge among spine surgeons of the lumbosacral plexus and lower extremity anatomy. Medical education dedicated to the musculoskeletal system and neuroanatomy may be necessary so that gaps in knowledge may be minimized.
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Direct brain stimulation is thought to produce a temporary lesion effect to the surrounding tissue and the synaptically connected network. In the medial temporal lobe (MTL), application of electrical current has been shown to produce memory impairments, but the nature of this effect is unknown. ⋯ We interpret our findings as support for a rapid contextual change account of stimulation-induced forgetting. Stimulation of the MTL may have disrupted neural activity representing temporal context, and thus impaired the internally generated memory search. Alternatively, an interruption of list item maintenance may explain impaired performance. By continuing to refine the cognitive understanding of forgetting-induced MTL stimulation, future research may lead to selective pruning of unwanted memories.
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Both transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are effective surgical interventions for patients with degenerative lumbar spondylosis. We sought to compare health care costs by calculating the incremental cost-effectiveness ratio and, thereby, the difference in the total cost per quality-adjusted life-year (QALY) gained for TLIF vs LLIF for the treatment of degenerative spondylosis. We further calculated the thresholds for minimum clinically important difference (MCID) and minimum cost-effective difference (MCED) for patient-reported outcome measures at 2-year follow-up. ⋯ TLIF and LLIF produced equivalent 2-year patient outcomes at an equivalent cost-effectiveness profile.