Neurosurgery
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Randomized Controlled Trial Multicenter Study
i-Factor™ Bone Graft vs Autograft in Anterior Cervical Discectomy and Fusion: 2-Year Follow-up of the Randomized Single-Blinded Food and Drug Administration Investigational Device Exemption Study.
i-Factor™ Bone Graft (Cerapedics Inc, Westminster, Colorado) is a composite bone substitute material consisting of P-15 synthetic collagen fragment adsorbed onto anorganic bone mineral suspended in an inert biocompatible hydrogel carrier. A pivotal, noninferiority, US FDA Investigational Device Exemption study demonstrated the benefits of i-Factor™ compared to local autograft bone in single-level anterior cervical discectomy and fusion at 1-yr postoperative. ⋯ Use of i-Factor™ in anterior cervical discectomy and fusion is effective and safe, and results in similar outcomes compared to local autograft bone at 2 yr following surgery.
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Traumatic brachial plexus injury (BPI) can result in debilitating sequelae of the upper extremity. Presently, therapeutic decisions are based on the mechanism of injury, serial physical examination, electromyography, nerve conduction, and imaging studies. While magnetic resonance imaging is the current imaging modality of choice for BPI, ultrasound is a promising newcomer that is inexpensive, accessible, and available at point of care. ⋯ Individual studies demonstrate ultrasound as an effective diagnostic tool for traumatic adult BPI. Sensitivity of lesion detection was noted to be greater in the upper and middle (C5-C7) than in the lower spinal nerves (C8, T1). Further standardized studies should be performed to confirm the utility of ultrasound in the diagnosis of traumatic adult BPI.
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Practice Guideline
Stereotactic Radiosurgery in the Management of Limited (1-4) Brain Metasteses: Systematic Review and International Stereotactic Radiosurgery Society Practice Guideline.
Guidelines regarding stereotactic radiosurgery (SRS) for brain metastases are missing recently published evidence. ⋯ A number of well-conducted prospective and meta-analyses studies demonstrate good LC, without compromising survival, using SRS alone for patients with a limited number of brain metastases. Some also demonstrated less impact on neurocognitive function with SRS alone. Practice guidelines were developed using these data with International Stereotactic Radiosurgery Society consensus.
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Neurosurgical procedures are necessary at all times of day. Other surgical specialties have examined the effect of surgical start time (SST) on morbidity and mortality; however, a similar study has not been performed for neurosurgical procedures. ⋯ Patients with SSTs between 21:01 and 07:00 are at an increased risk of developing morbidity compared to patients with an SST earlier in the day.