World Neurosurg
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Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar spondylolisthesis allows for surgical treatment of back and leg pain while theoretically minimizing tissue injury and accelerating overall recovery. Although the authors of previous studies have demonstrated shorter length of hospital stay and reduced blood loss with MIS versus open-TLIF, short- and long-term outcomes have been similar. No studies to date have evaluated the comprehensive health care costs associated with TLIF procedures or assessed the cost-utility of MIS- versus open-TLIF. As such, we set out to assess previously unstudied end points of health care cost and cost-utility associated with MIS- versus open-TLIF. ⋯ Although our limited sample size prevented statistical significance, MIS- versus open-TLIF was associated with reduced costs over two years while providing equivalent improvement in QALYs. MIS-TLIF allows patients to leave the hospital sooner, achieve narcotic independence sooner, and return to work sooner than open-TLIF. In our experience, MIS- versus open-TLIF is a cost reducing technology in the surgical treatment of medically refractory low-back and leg pain from grade I lumbar spondylolisthesis.
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Comparative Study
Cognitive changes in patients with aneurysmal subarachnoid hemorrhage before and early posttreatment: differences between surgical and endovascular.
The main purpose of occluding a ruptured aneurysm is preventing rebleeding, which may be fatal. Microsurgical or endovascular treatments are the main approaches adopted to prevent new bleeding. Among patients presenting with aneurysmal subarachnoid hemorrhage, about 50% had permanent injuries. Cognitive changes are one of the main morbidities from that illness. The type of treatment for the aneurysm (clipping or coil embolization) can also contribute to the genesis of those complications. ⋯ One hundred fifty-one patients were assessed, distributed as 122 surgical and 29 coil embolized. The performances in both groups did not differ in the initial assessment. However, endovascular treatment does not show additional cognitive impairment and had a better performance in language and verbal memory, compared with patients submitted to surgical treatment in an early postoperative period.
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We evaluated the effects of gamma-knife radiosurgery (GKRS) on the cognitive functioning of patients with a pituitary adenoma. ⋯ We found no evidence that GKRS impairs the neurocognitive functioning of patients with pituitary disease above any impairment caused by the disease itself. Further studies will require approximately 20 patients in each comparison group to confirm this result.
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To analyze qualitatively C2 nerve dysfunction after its transection in C1-2 posterolateral instrumented fusions. ⋯ This study is the first series to describe C2 nerve function after posterior atlantoaxial instrumented fusion in adults of all ages. Sacrifice of the C2 nerve root increases fusion surface, allows for better preparation and decortication of the atlantoaxial joint, improves visualization for screw placement, and decreases blood loss and operative time without major clinical consequences.
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Because the early risk of stroke recurrence in patients with posterior circulation infarctions is high, patients with vertebrobasilar events require active preventive treatment. Previous reports have described the use of balloon angioplasty and stenting or surgical revascularization to the vertebrobasilar artery area. To compensate for the disadvantages of these techniques, we combined endovascular and surgical treatments in a patient with symptomatic vertebrobasilar artery stenosis. ⋯ Our staged therapy may be an effective treatment for symptomatic vertebrobasilar artery stenosis.