World Neurosurg
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Interlaminar endoscopic lumbar discectomy (IELD) is an efficient surgical treatment for lumbar disc herniation. However, this minimally invasive procedure requires a considerable learning curve that has not yet been standardized. This review aimed to evaluate the learning curve's characteristics, including the cutoff point required to achieve technical proficiency and to discuss appropriate training methods. ⋯ The evidence of published studies regarding the learning curve for the IELD technique is insufficient. The reported cutoff points may be significant only for task efficiency. Moreover, they may not represent the asymptote of the curve. Future studies should evaluate the actual plateau points using patient outcome data.
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Spontaneous spinal cerebrospinal fluid (CSF) leak is a condition that commonly presents with debilitating positional headaches. Often, the cause of the leak is located in the spine. ⋯ Treatment similarly involves multiple options, including targeted epidural blood and/or fibrin patching as well as surgical closure. In this article, we review the current literature regarding this challenging condition and present an algorithm for management.
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Comparative Study
A Comparison of Surgical Outcomes of Microdiscectomy Procedures by Patient Admission Status: Short Title: Patient Admission Status in Microdiscectomy Procedures.
We sought to compare the cost and in-hospital outcomes following lumbar microdiskectomy procedures by admission type. ⋯ Patients admitted as transfers and from the ED had significantly increased hospitalization lengths of stay and direct costs compared with electively admitted patients.
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A histiocytosis is a group of immunoproliferative disorders of clonal cells. The management protocols are still evolving, with chemotherapy as the mainstay of treatment. ⋯ The role of stereotactic radiosurgery needs to be further evaluated as the current cohort with only 9 cases (2 are Rosai-Dorfman disease) is insufficient to make conclusions. It may be a viable alternative in localized disease, along with chemotherapy and targeted surgery.
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Acute spinal cord injury (ASCI) is a devastating event that can have a profound impact on the lives of patients and their families. While no definitive medical treatment exists, the role of methylprednisolone (MP) in the management of ASCI and other spinal cord pathologies has been investigated in depth; however, its use remains contentious. While MP initially showed promise in the efficacy of ASCI treatment, more recent studies have questioned its use citing numerous systemic adverse effects. Pharmacologic treatments in this area are poorly understood due to the scarcity of knowledge surrounding the pathophysiology and heterogeneity of patients presenting with these conditions. Despite these shortcomings and due to the lack of alternative treatment options, MP is still widely used by physicians. ⋯ At present, evidence regarding use of dexamethasone for MSCC is contentious, especially regarding dose regiments. Ultimately, further investigation into the use of steroids is required to determine its utility in treating patients with spinal cord pathology.