Neurosurgery
-
On reviewing the database of patients with craniovertebral junction anomalies, the authors identified 70 patients with a bifid posterior arch of atlas. ⋯ Understanding of the pathogenesis and mechanical alterations in cases with a bifid arch of atlas can assist in evaluating the clinical implications and in conduct of surgery.
-
Failed back surgery syndrome (FBSS) is a type of neuropathic pain where extremity symptoms persist despite structurally corrective spinal surgery. This implies more substantial nerve damage rather than simply dysfunction whereby correcting the inciting structural derangement does not provide for clinical resolution. What remains unclear is how to predict which patients are likely to derive benefit from surgical intervention, and whether specific pain characteristics are associated with different likelihoods of good outcome. ⋯ While FBSS was more common among younger and female patients, this occurred with low overall frequency. Higher neuropathic pain screening scores correlated strongly with the likelihood and severity of significant postoperative leg pain. Further work is required to develop more accurate prognostication tools for patients undergoing structural spinal surgery for lumbar radiculopathy.
-
Occipital nerve stimulation (ONS) is utilized to manage chronic migraine (CM) symptoms. Our knowledge of neural activity evoked during optimal (O-ONS) and suboptimal ONS (S-ONS) is limited, and, in this study, we aim to elucidate the differences in central activation patterns during these stimulation conditions using functional positron emission tomography (PET) imaging. ⋯ Difference in central activation by optimal and suboptimal ONS for migraine in this study echoes functional imaging studies demonstrating persistent dysfunctional activity in pons, as well as increased activity during headache attacks in orbitofrontal area, anterior cingulate cortex, and insular/temporal area involved in anticipation and fear/anxiety toward perceived pain. Cerebellum was also previously found to be involved in pain modulation. Occipital nerve stimulation seems to decrease migraine-related headache intensity by modulating activity in areas involved in processing the affective, emotional, and cognitive aspects of pain as well as the anticipation of pain.
-
Direct cellular reprogramming has emerged as an innovative alternative to generating neurons in the brain after injury. We were among the first to recently demonstrate in vivo reprogramming of nonneuronal cells into neurons in the brain of rodents following stroke. Human clinical trails will require an adeno-associated virus (AAV) with a greater safety profile. ⋯ We have demonstrated for the first time the capacity to generate reactive astrocyte cultures in vitro from adult canine neocortex after stroke. Using this culture model we have found that AAV8 has the highest transduction efficiency.
-
Value-base purchasing and pay-for-performance models are driving the development of bundle payment systems for reimbursement. To build a sustainable bundling system, it is important to identify the contributions of each component of index surgery total cost and determine the domain where targeted savings can occur. We determined the percent contribution of health care resource utilization, hospital fee, surgeon's fee, and readmission to total cost of index surgery following elective spine surgery. ⋯ Hospital fee had the largest contribution (75%) to the total cost of index surgery, followed by readmissions (21%). Surgeon's fee and health care resource utilization had much smaller contributions to total cost. True cost savings can occur through engagement and partnering between hospital and surgeon to decrease hospital fees. Reducing readmission episodes and understanding and reducing modifiable drivers of hospital fees have the potential to decrease total direct cost for elective spine surgery.