Neurosurgery
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Limited data exist on the epidemiology of concussions in collegiate student athletes. This study uses the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) to describe the epidemiology of collegiate sports-related concussions (SRCs). ⋯ Concussion rates in collegiate athletes were highest during competition and among high-contact/collision sports. Rates were generally higher among women than men. Time trends in return to play time may indicate changing concussion management practices in which team medical staff are holding out players longer to ensure symptom resolution. Injury surveillance data can inform targeted interventions for concussion outcomes.
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Biochemical alterations associated with mechanical stress have been explored as an initiating step in the pathological progression of ligamentum flavum hypertrophy (LFH); however, this mechanism remains poorly understood. Recently, the inflammation induced after mechanical stress and the subsequent response of ligamentum flavum (LF) cells have been implicated in LFH pathology. ⋯ The LSCS group showed greater segmental motion, higher VEGF concentrations, and more CD34-positive capillaries than the control group. These data indicate that VEGF-mediated angiogenesis following mechanical stress may be a critical step within the series of pathological events in LFH.
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Ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. While ASCs offer significant cost advantages over hospital-based surgery, concern over the safety of outpatient anterior cervical discectomy and fusion (ACDF) has slowed its adoption. To date, only a few published series, each underpowered at less than 100 patients, make up the evidence basis for the safety of outpatient ACDF surgery. ⋯ Analysis of 1000 consecutive patients undergoing ACDF in an outpatient setting demonstrated surgical complications occur at a low rate (<1%) and can be appropriately diagnosed and managed in 4-hour ASC PACU window. Comparison with inpatient ACDF surgery cohort demonstrated similar results, highlighting that ACDF can be safely performed in an outpatient ambulatory surgery setting without compromising surgical safety. To decrease cost of care, surgeons can safely consider performing 1- and 2-level ACDF in an ASC environment.
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Mild traumatic brain injury (mTBI) results in variable clinical outcomes, which may be influenced by genetic variation. A single-nucleotide polymorphism in catechol-o-methyltransferase (COMT), an enzyme that degrades catecholamine neurotransmitters, may influence cognitive deficits following moderate and/or severe head trauma. However, this has been disputed and its role in mTBI has yet to be studied. ⋯ COMT Val158Met may exert domain-specific cognitive protection following mTBI.
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Chiari Malformation Type I (CM-I) is associated with syrinx in 25% to 85% of patients. Although posterior fossa decompression (PFD) without dural opening is an accepted treatment option for children with symptomatic CM-1, many surgeons prefer to open the dura if syrinx exists. The purpose of this study was to investigate the frequency and timing of syrinx resolution in children undergoing PFD without dural opening for CM-1. ⋯ In children with CM-I and syrinx undergoing PFD without dural opening, syrinx resolution occurs in approximately 70% of patients. Radiographic improvement of the syrinx is delayed, but does not correlate temporally with symptom improvement. Sensory symptoms or motor weakness on presentation are associated with syrinx resolution after surgery.