Neurosurgery
-
The first-pass effect in endovascular thrombectomy (EVT) has been associated with better clinical outcomes and decreased stroke progression in large vessel occlusion but has not been evaluated in distal, medium vessel occlusions (DMVOs). ⋯ The mFPE may be associated with better clinical outcomes and lower stroke progression in DMVO.
-
The modified Japanese Orthopedic Association (mJOA) score is a widely used and validated metric for assessing severity of myelopathy. Its relationship to functional and quality-of-life outcomes after surgery has not been fully described. ⋯ Improvements in mJOA correlated weakly with improvements in NDI and EQ-5D, suggesting that changes in mJOA may not be a suitable proxy for functional and quality-of-life outcomes.
-
Previous studies have characterized utilization rates and cost of adult spinal deformity (ASD) surgery, but the differences between these factors in commercially insured and Medicare populations are not well studied. ⋯ Rate of ASD surgery increased from 2007 to 2015 among commercial and Medicare beneficiaries. Despite increasing costs, Medicare payments decreased. Age, length of stay, and BMP usage were associated with increased payments for ASD surgery in both populations.
-
The management of atlas fractures is controversial and hinges on the integrity of transverse atlantal ligament (TAL). ⋯ LMD > 7 mm on CT is not sensitive for TAL injury. Some atlas fractures with TAL injury can be managed with a cervical collar. Nonunion rates are not different between halo immobilization and cervical collar, but a strong selection bias precludes directly comparing the efficacy of these modalities. Age independently predicts nonunion.