Neurosurgery
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The use of magnetic resonance imaging (MRI) for evaluation of headache remains excessive among physicians across many specialties according to both the American Headache Society and the American College of Radiology, despite recent attempts at limiting overuse of imaging and procedures. As part of the Choosing Wisely campaign, both of these organizations have explicitly recommended against imaging in patients with uncomplicated or typical migraine headaches. ⋯ Here, we debate the problematic use of MRI for uncomplicated headache and put forth a discussion of possible interventions that could promote more efficient use of imaging. Overuse of imaging has the potential to open a box that cannot readily be closed, and physicians upstream of surgical decision making must remain aware of the downstream effects of their clinical choices.
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Thoracic ossification of the posterior longitudinal ligament (T-OPLL) is treated surgically with instrumented posterior decompression and fusion. However, the factors determining the outcome of this approach and the efficacy of additional resection of T-OPLL are unknown. ⋯ Preoperative severe motor paralysis, nonambulatory status, positive prone and supine position test, radiographic spinal cord compression due to beak-type T-OPLL, and intraoperative residual spinal cord compression and deterioration of IONM were associated with ineffectiveness of posterior decompression and fusion with instrumentation. Our 2-stage strategy may be appropriate for beak-type T-OPLL surgery.
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Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. ⋯ Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).
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Although adult cervical spine deformity (ACSD) is associated with pain and disability, its health impact has not been quantified in comparison to other chronic diseases. ⋯ The health impact of symptomatic ACSD is substantial, with negative impact across all EQ-5D domains. The mean ACSD EQ-5D index was comparable to the bottom 25th percentile values for blindness/low vision, emphysema, renal failure, and stroke.
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Observational Study
Risk of Venous Thromboembolism and Operative Duration in Patients Undergoing Neurosurgical Procedures.
The association of operative duration with the risk of venous thromboembolism (VTE) has not been quantified in neurosurgery. ⋯ In a cohort of patients from a national prospective surgical registry, increased operative duration was associated with increased incidence of VTE for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management, and to stratify patients with regard to VTE risk.