Neurosurgery
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Multicenter Study
Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up.
Sagittal plane malalignment has been established as the main radiographic driver of disability in adult spinal deformity (ASD). ⋯ Best HRQOL outcomes for ASD patients with severe sagittal plane deformity were obtained with a correction >120 mm for SVA and at least 66% of correction. Although lesser amounts of SVA correction yielded clinical improvement, the rate of MCID threshold improvement was not significantly different for mild or modest corrections. These results underline the need for complete sagittal plane deformity correction if high rates of HRQOL benefit are sought for patients with marked sagittal plane deformity.
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of infection rate with the use of antibiotic-impregnated vs standard extraventricular drainage devices: a prospective, randomized controlled trial.
External ventricular drainage (EVD) catheters provide reliable and accurate means of monitoring intracranial pressure and alleviating elevated pressures via drainage of cerebrospinal fluid (CSF). CSF infections occur in approximately 9% of patients. Antibiotic-impregnated (AI) EVD catheters were developed with the goal of reducing the occurrence of EVD catheter-related CSF infections and their associated complications. ⋯ AI-EVD catheters were associated with an extremely low rate of catheter-related infections. AI catheters were not associated with risk reduction in EVD infection compared to standard catheters. Use of AI-EVD catheters is a safe option for a wide variety of patients requiring CSF drainage and monitoring, but the efficacy of AI-EVD catheters was not supported in this trial.
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Multicenter Study
Motion preservation and clinical outcome of porous coated motion cervical disk arthroplasty.
Artificial cervical disk replacements are commonly used to treat radiculomyelopathy caused by degenerative disk disease. However, long-term disk mobility and an effect on adjacent segment disease have yet to be demonstrated. We report improvements in clinical outcome after disk replacement but also demonstrate potential limitations. ⋯ Clinical improvement was seen after PCM disk replacement, but adequate range of movement was sustained in only 21% of disk replacements over time. Unclear long-term results of this and other disk replacements suggest caution in adopting these new devices as the gold standard.
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Multicenter Study Comparative Study
Performing a cost analysis in spine outcomes research: comparing ventral and dorsal approaches for cervical spondylotic myelopathy.
Medical cost analysis is increasingly important, but the methodology is complex and varied. ⋯ The choice of cost methodology may substantially influence the final results of an economic study.
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Multicenter Study Clinical Trial
Gamma knife thalamotomy for Parkinson disease and essential tremor: a prospective multicenter study.
No prospective study of gamma knife thalamotomy for intractable tremor has previously been reported. ⋯ GK thalamotomy is an alternative treatment for intractable tremors of PD as well as for ET. Less invasive intervention may be beneficial to patients.