Neurosurgery
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Carotid blowout syndrome (CBS) is a life-threatening emergency resulting from compromise of the carotid artery caused by malignancy in the head and neck. ⋯ The use of covered stents is a simple, safe, and effective method for treating or preventing carotid blowout syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice.
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Quality improvement projects have begun to standardize surgical work flow as a component to optimize operative room (OR) efficiency. Removing special cause variability resulting from nonsurgical waste is an obvious target; however, surgical resident education must be maintained even in the setting of process improvement. There are no published data describing the impact on operative time of resident-identified risky or uncomfortable procedural steps during posterior instrumented fusion (PIF). Self-identification of risk or discomfort in surgical steps may allow for shorter OR time and reduced cost, without sacrificing resident education. ⋯ Resident perception of surgical complexity can be evaluated for procedural steps using a risk matrix survey. For PIF, residents assign more risk and are less comfortable performing steps in a training-dependent manner. Identification of particular high-risk steps, which are uncomfortable, should prompt strict faculty oversight to improve patient safety, monitor resident education, and reduce operative time.
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Failed Back Surgery Syndrome (FBSS) is notoriously refractory to treatment resulting in high health care utilization and high health care costs. Given the recent emphasis of cost-conscious care in the United States, we examined the trends in imaging use in FBSS over the past decade. Furthermore, the role of different types of imaging modalities MRI vs non-MRI is of interest when considering potential therapeutic interventions, including spinal cord stimulation (SCS), a common therapy for treating neuropathic pain in the FBSS population. ⋯ We found a trend for increased imaging use between 2000 and 2009 in FBSS patients, a population with already immense health care utilization and health care costs. Rates of both MRI and non-MRI imaging increased by 35% to 40% in a period of 10 years. The role of frequency and type of imaging modality utilized in evaluating FBSS patients will have a significant impact on overall health care expenses and therapeutic options, including SCS, going forward.
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We showed that, after traumatic spinal cord injury (TSCI), the injured cord is compressed by dura. Here, we show that laminectomy + duroplasty decompress the injured cord more effectively than laminectomy alone. ⋯ After TSCI, laminectomy + duroplasty improves spinal cord radiological and physiological parameters more effectively than laminectomy.