World Neurosurg
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Multicenter Study Comparative Study
A prospective, multi-institutional comparative effectiveness study of lumbar spine surgery in morbidly obese patients: does minimally invasive transforaminal lumbar interbody fusion result in superior outcomes?
Obese and morbidly obese patients undergoing lumbar spinal fusion surgery are a challenge to the operating surgeon. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open-TLIF have been performed for many years with good results; however, functional outcomes after lumbar spine surgery in this subgroup of patients remain poorly understood. Furthermore, whether index MIS-TLIF or open-TLIF for the treatment of degenerative disc disease or spondylolisthesis in morbidly obese results in superior postoperative functional outcomes remains unknown. ⋯ MIS-TLIF is a safe and viable option for lumbar fusion in morbidly obese patients and, compared with open-TLIF, resulted in similar improvement in pain and functional disability. Postoperative complications rates between both cohorts were also not significantly divergent.
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The optimal surgical procedure (direct, indirect, or combined anastomosis) for management of moyamoya disease is still debated. We evaluated the outcome of our broad area revascularization protocol, the Tokyo Daigaku (The University of Tokyo) (TODAI) protocol, analyzing the relative importance of direct, indirect, and combination revascularization strategies to identify the optimal surgical protocol. ⋯ The TODAI protocol provided efficient revascularization and yielded excellent results in preventing strokes in patients with moyamoya disease with very few complications. EMS had a main role in revascularization in each of the combined techniques.
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Case Reports Comparative Study
Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation.
The vicinity of brainstem and cranial nerves as well as the limited operative working space make clip ligation of posterior inferior cerebellar artery (PICA) aneurysms challenging. The small caliber of the PICA and the broad neck often associated with these aneurysms also create challenges in preserving this artery during treatment. Few data exist to compare the 2 treatment approaches for aneurysms in this location. ⋯ PICA aneurysms are challenging and require a multimodality treatment paradigm. Although microsurgery is associated with more short-term postoperative complications, presenting grade and patient's age remain the primary predictors of long-term outcome.
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Surgery for the treatment of cervical spondylotic myelopathy is typically accompanied by complication rates between 11% and 38%. By determining clinical and surgical predictors of complications, clinicians can identify high-risk patients and plan accordingly. We conducted a survey of the AOSpine community to identify key predictors of postoperative complications. ⋯ This survey summarizes surgeons' perceptions of the most important clinical, imaging, and surgical risk factors for postoperative complications. Knowledge of these predictors allows clinicians to identify high-risk patients and institute prevention plans.
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Fractional anisotropy (FA) of the high cervical cord (C1-C2), rostral to the injury site, correlates with upper limb function in patients with chronic cervical spinal cord injury (SCI). In acute cervical SCI, this relationship has not been investigated. The objective of this study was to identify functional correlates of FA of the high cervical cord in a series of patients with acute cervical SCI. ⋯ FA of the whole cervical cord as well as the CST, rostral to the injury site, is associated with preserved upper limb motor function as well as superior ASIA grades after acute cervical SCI. FA of the high cervical cord is a potential biomarker of neural injury after acute cervical SCI.