Neurosurgery
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High-dose or prolonged narcotic use is associated with altered pain perception and response to pain management strategies in patients with chronic pain syndromes. We set out to determine whether the amount of preoperative narcotic use for spine-related pain predicted short-term and 1-year outcomes after spine surgery. ⋯ Increasing levels of preoperative narcotic use were associated with worse short-term and long-term outcome after elective surgery for degenerative spine pathology. Preoperative narcotic use in MEAs may help hospitals and providers more appropriately risk stratify for surgical selection and indications. Efforts should be made to address narcotic dependence before elective spine surgery.
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The authors present the results of Gamma knife stereotactic radiosurgery performed in a series of children with arteriovenous malformations (AVMs). ⋯ Radiosurgery was successful in the majority of patients with minimal morbidity. Gamma Knife radiosurgery for AVMs can be a safe and successful method in pediatric patients.
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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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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.
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Shunt infection and failure are associated with significant medical costs and hospitalization days. Current practice relies on microbiology culture, which significantly delays definitive diagnosis. Complement activation in the cerebrospinal fluid (CSF) has been shown to be a reliable biomarker of meningitis but has not been evaluated in shunt infection or failure. A rapid diagnostic complement assay could aid in identifying patients with hydrocephalus-associated complications. ⋯ Preliminary results show CSF MAC levels may help differentiate between pyogenic infection, symptomatic ventricular enlargement, and asymptomatic/P acnes infected children. We are currently expanding this study with respect to patient number and complement biomarkers to establish predictive values that facilitate clinical decision making in this challenging population.