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World neurosurgery
Elsevier
World neurosurgery

Elsevier

1878-8750

World neurosurgery/Journal World neurosurgeryAHCISCIISTP
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    A Population-Based Study of Patients with Sleep-Wake Disorders Undergoing Elective Instrumented Spinal Surgery

    Becker K.N.Gifford C.S.Qaqish H.Alexander C....
    9页
    查看更多>>摘要：? 2022 Elsevier Inc.Background: Sleep-wake disorders (SWDs) are associated with multiple systemic pathologies; however, the clinical risk that such disorders carry for spinal surgery patients is not well understood. In the present population-based study, we comprehensively evaluated the significance of sleep-related risk factors on instrumented spinal surgery outcomes. Methods: National Inpatient Sample data for the hospitalization of patients who had undergone elective instrumented spine surgery from 2008 to 2014 were analyzed using national estimates. The cohorts were defined as those admissions with or without a coexisting SWD diagnosis identified by International Classification of Diseases, ninth revision, codes. Postoperative complications, mortality rate, length of stay, discharge status, and the total cost of admission were compared between the groups using bivariate and multivariate analyses. Results: A coexisting SWD was present in 234,640 of 2,171,167 instrumented spinal surgery hospitalizations (10.8%). Multivariate binary logistic regression accounting for these variables confirmed that a SWD is a significant risk factor for postoperative complications (odds ratio [OR], 1.160; 95% confidence interval [CI], 1.140–1.179; P < 0.0001), length of stay greater than the 75th percentile (OR, 1.303; 95% CI, 1.288–1.320; P < 0.0001), nonroutine discharge (OR, 1.147; 95% CI, 1.131–1.163; P < 0.0001), and death (OR, 1.533; 95% CI, 1.131–2.078; P < 0.01), but not for total charges greater than the 75th percentile (OR, 0.975; 95% CI, 0.962–0.989; P < 0.001). Conclusions: SWDs confer an increased risk of morbidity and mortality for elective instrumented spine surgery. Understanding the specific contributions of SWDs to postoperative morbidity and mortality will help physicians implement prophylactic measures to reduce complications and improve postoperative patient recovery.
      原文链接:
    • NSTL
    • Elsevier

    Pedicle Screw Placement Using Intraoperative Computed Tomography and Computer-Aided Spinal Navigation Improves Screw Accuracy and Avoids Postoperative Revisions: Single-Center Analysis of 1400 Pedicle Screws

    Hagan M.J.Syed S.Leary O.P.Persad-Paisley E.M....
    11页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Intraoperative computed tomography and navigation (iCT-Nav) is increasingly used to aid spinal instrumentation. We aimed to document the accuracy and revision rate of pedicle screw placement across many screws placed using iCT-Nav. We also assess patient-level factors predictive of high-grade pedicle breach. Methods: Medical records of patients who underwent iCT-Nav pedicle screw placement between 2015 and 2017 at a single center were retrospectively reviewed. Screw placement accuracy was individually assessed for each screw using the 2-mm incremental grading system for pedicle breach. Predictors of high-grade (>2 mm) breach were identified using multiple logistic regression. Results: In total, 1400 pedicle screws were placed in 208 patients undergoing cervicothoracic (29; 13.9%), thoracic (30; 14.4), thoracolumbar (19; 9.1%) and lumbar (130; 62.5%) surgeries. iCT-Nav afforded high-accuracy screw placement, with 1356 of 1400 screws (96.9%) being placed accurately. In total, 37 pedicle screws (2.64%) were revised intraoperatively during the index surgery across 31 patients, with no subsequent returns to the operating room because of screw malpositioning. After correcting for potential confounders, males were less likely to have a high-grade breach (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.10–0.59, P = 0.003) whereas lateral (OR 6.21; 95% CI 2.47–15.52, P < 0.001) or anterior (OR 5.79; 95% CI2.11–15.88, P = 0.001) breach location were predictive of a high-grade breach. Conclusions: iCT-Nav with postinstrumentation intraoperative imaging is associated with a reduced need for costly postoperative return to the operating room for screw revision. In comparison with studies of navigation without iCT where 1.5%–1.7% of patients returned for a second surgery, we report 0 revision surgeries due to screw malpositioning.
      原文链接:
    • NSTL
    • Elsevier

    Impact of Time to Surgery for Patients Using Workers' Compensation Insurance Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Preliminary Analysis of Clinical Outcomes

    Jacob K.C.Lynch C.P.Cha E.D.K.Patel S.D....
    9页
    查看更多>>摘要：? 2022Objective: To conduct a preliminary analysis on the impact of time to surgery (TTS) and duration of symptoms (DOS) on clinical outcomes in workers' compensation patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Methods: Patients using workers' compensation insurance undergoing primary, single-level MIS TLIF were identified. Patient-reported outcome measures (PROMs) were administered at preoperative/6-week/12-week/6-month postoperative time points and included visual analog scale (VAS) back/VAS leg/Oswestry Disability Index/12-Item Short-Form Physical Composite Score/12-Item Short-Form Mental Composite Score. Patients were grouped by TTS: <90 days, 90–179 days, and ≥180 days. Demographics were compared by χ2; perioperative characteristics, mean PROMs, and postoperative improvement (ΔPROM) were compared using 1-way analysis of variance. Minimum clinically important difference (MCID) achievement rates were compared using simple logistic regression. A secondary analysis was performed by grouping patients by DOS: <180 days, 180–364 days, and ≥365 days. Mean PROMs, ΔPROMs, and MCID achievement were similarly compared between DOS groups using 1-way analysis of variance and logistic regression. Results: A total of 193 patients were included. Prevalence of herniated nucleus pulposus and initial appointment type were significantly associated with TTS (P < 0.042, all). No significant differences in mean PROMs or ΔPROMs were observed among TTS groups. MCID achievement was significantly lower for VAS back at 6 months in the longest TTS group. Mean PROMs were significantly different based on DOS for VAS leg at 6 weeks only. MCID achievement was significantly lower for the longest DOS group for VAS leg at 6 months only. ΔPROMs did not significantly differ among DOS groups. Conclusions: Neither TTS nor DOS was significantly associated with MIS TLIF outcomes. Workers' compensation patients may achieve similar clinical improvement even with longer symptom burden and substantial delays in operative treatment.
      原文链接:
    • NSTL
    • Elsevier

    7-Year Experience with Automated Pupillometry and Direct Integration With the Hospital Electronic Medical Record

    Tran D.K.Poole C.Tobias E.Moores L....
    9页
    查看更多>>摘要：? 2022Introduction: Manual pupillary assessments are an integral part of the neurologic evaluation in critically ill patients. Automated pupillometry provides reliable, consistent, and accurate measurement of the light response. We established a computer interface that allows for direct download of pupillometer information to our hospital electronic medical record (EMR). Here, we report our single-center experience. Methods: An interface allowing direct download of pupillometer data to our EMR was developed. We then performed a prospective study using an electronic survey distributed to nurses that used pupillometers in 2015, 2018, and 2020 using a 5-point Likert-style format to evaluate the acceptance of this implementation. Results: In 2015, 22 nurses were surveyed, with 50% of the respondents citing lack of pupillometers and 41% citing the labor intensity associated with data entry as the reason for the reluctance to use the pupillometer. The number of nurse responses in 2018 increased to 123, with 78% of nurses finding that the direct download to hospital EMR improved the efficiency of their neurologic exams. In 2020, 108 nurses responded with similar responses to those in 2018. We added 3 additional questions regarding utility of the pupillometer during the COVID-19 pandemic. Fifty-eight percent of nurses were reassured of the neurologic exam when using the pupillometer in lieu of a full exam to limit infectious exposure. Conclusions: This is the first report of the implementation of a direct interface to download pupillometer data to the EMR. The positive effect on nursing workflow and documentation of pupillary findings is discussed.
      原文链接:
    • NSTL
    • Elsevier

    Does an Author's Social Media Presence Affect Dissemination of Spine Literature?

    Patel M.R.Jacob K.C.Vanjani N.N.Prabhu M.C....
    6页
    查看更多>>摘要：? 2022Objective: Our study assesses the impact of an author's social media presence on citation rates and readership of spine literature. Methods: The Altmetric database was queried for spine-related articles between 2016 and 2021; the top 100 by Altmetric Attention Score (AAS) were assessed. Public profile presence, number of followers, number of posts, and promotion of articles were assessed for Twitter/Instagram. Social media profiles were identified by searching for the author's name followed by “Twitter” or “Instagram” on Google.com or searching each platform. Descriptive statistics assessed social media use and attention metrics. Negative binomial regression assessed presence/promotion/number of followers/number of posts on Twitter/Instagram as predictors of Dimensions citation rates/AAS/Mendeley reader counts, while accounting for time passed since publication. Results: Twitter promotion was noted for 9.0% of articles and Instagram promotion for 1.0%. Mean number of Twitter and Instagram followers was 447.9 ± 1406.1(range: 0–9079) and 173.2 ± 1097.1(range: 0:10,700), respectively. Mean number of Twitter and Instagram posts was 411.6 ± 1210.5 and 18.4 ± 96.4, respectively. Dimensions citations ranged from 0–641, AAS from 79–2257, and Mendeley readers from 2–1854. Following negative binomial regression, Instagram presence was identified as a significant predictor of Mendeley readers (P = 0.043), number of Twitter posts was a significant predictor of AAS (P = 0.008). Additionally, Twitter presence was identified as a negative predictor of Mendeley readers (P = 0.005) and Twitter promotion was identified as a negative predictor of AAS (P = 0.003). Conclusions: Activity on Twitter and Instagram may have variable associations with altmetrics of literature visibility and readership but with citation rates. Interestingly, presence/promotion on Twitter predicted less attention/readership, while Instagram presence predicted higher Mendeley readership.
      原文链接:
    • NSTL
    • Elsevier

    Thrombocytopenia as an Independent Prognostic Indicator Following Extradural Spinal Tumor Resection

    Ansari D.Guntin J.A.Shah P.Patil S.N....
    10页
    查看更多>>摘要：? 2022Objective: Few studies have examined the prognosis for patients with baseline thrombocytopenia undergoing extradural spine tumor resection. Our objective was to evaluate mortality, readmission, and other 30-day outcomes in patients with varying degrees of preoperative thrombocytopenia undergoing osseous extradural tumor excision. Methods: A multicenter registry was queried for patients treated from 2011–2019. Patients were categorized according to baseline preoperative platelet count, in 25,000/μL increments: 125,000–149,000/μL, 100,000–125,000/μL, 75,000–100,000/μL, and <75,000/μL. These were compared to a control group with platelet count >150,000/μL. Outcomes in each cohort were analyzed using multivariate logistic regression analysis. Results: The database search revealed 3574 patients undergoing extradural tumor resection; 2171 (60.7%) patients with platelets 125,000–149,000/μL, 114 (3.2%) with 100,000–125,000/μL, 43 (1.2%) with 75,000–100,000/μL, and 42 (1.2%) with <75,000/μL. Platelet counts <100,000/μL was associated with perioperative blood transfusion, cardiac complications, non-home discharge, and 30-day mortality. On subgroup analysis for mortality, an interaction was present between individuals with moderate/severe thrombocytopenia and cervical tumors. Conclusions: In patients undergoing surgery for extradural spine tumor, degree of baseline thrombocytopenia—rather than presence alone—is an independent predictor of several adverse events. Wherever possible, optimization of preoperative platelet count to at least 100,000/μL may improve outcomes.
      原文链接:
    • NSTL
    • Elsevier

    Anatomical Factors That Impede Using the Radial Artery Approach for Carotid Artery Revascularization

    Uno T.Shojima M.Oyama Y.Yamane F....
    6页
    查看更多>>摘要：? 2022 Elsevier Inc.Objectives: We investigated the anatomical characteristics that complicate utilizing the radial artery approach (RAA) for craniocervical intravascular intervention. Methods: The data of 73 lesions in 65 consecutive patients who underwent transradial cervical carotid artery intervention was evaluated. We assessed the success rate of RAA in right-sided and left-sided lesions. The diameters and angles of the left and right common carotid arteries and the aortic, brachiocephalic, and right subclavian arteries, which constitute the paths of the guiding sheath, were assessed for each of the left- and right-sided lesions. Results: It was difficult to apply RAA in 10 cases (13.7%), of which 2 (5.0%) involved right-sided and 8 (24.2%) left-sided lesions. The approach was significantly more difficult to perform in left-sided than in right-sided lesions (P = 0.02). Although the treatments were successfully completed, crossover to the femoral artery approach was required in 4 cases (5.5%, 2 cases for left-sided lesions). Placement of the guiding sheath in the common carotid artery was successful for all right-sided lesions; however, the guiding sheath slipped off to the aorta during stent advancement in 2 cases. When the angle between the brachiocephalic artery and aortic arch was small, the introduction of the guiding sheath to left-sided lesions was difficult in eight cases (P = 0.0001). Conclusions: RAA was difficult to perform in cases involving left-sided lesions and a small angle between the brachiocephalic artery and aortic arch. This study could help delineate the factors associated with difficulty of catheter introduction and instability of RAA.
      原文链接:
    • NSTL
    • Elsevier

    Predictors of Good Clinical Outcome after Thrombectomy for Distal Medium Vessel Occlusions

    Hulscher F.Farouki Y.Mine B.Bonnet T....
    7页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: Good clinical outcome predictors have been emphasized in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) with large vessel occlusion. MT for distal, medium vessel occlusions (DMVO) is still debated. We sought to assess the factors associated with clinical outcome after MT for DMVO. Methods: We retrospectively analyzed the data of consecutive patients who underwent MT for a primary DMVO in 1 large academic center and aimed to identify the baseline clinical, imaging, and MT factors associated with good clinical outcome (defined as modified Rankin scale score of 0–2) at 3 months. Results: Between January 2018 and January 2021, 61 patients underwent a MT for an AIS with a primary DMVO. Overall, good clinical outcome was achieved in 56% (34 of 61) of our patients. In multivariate analysis, an older age (odds ratio [OR] 0.89 [95% confidence interval 0.83–0.96], P = 0.003), longer puncture to recanalization time (OR 0.97 [0.93–0.99], P = 0.033), and higher baseline core volume (OR 0.84 [0.75–0.94], P = 0.003) decreased the probability of good clinical outcomes, while a final complete (or near-) recanalization (modified Thrombolysis In Cerebral Infarction [mTICI] score 2c–3) increased the probability of good outcome (OR 14.19 [1.99–101.4], P = 0.008). Conclusions: An older age, a longer puncture to recanalization time, and a higher baseline core volume decreased the probability of good clinical outcomes, while successful recanalization (mTICI 2c–3) was associated with better outcomes after MT for DMVO.
      原文链接:
    • NSTL
    • Elsevier

    Biomechanical Evaluation of an Oblique Lateral Locking Plate System for Oblique Lumbar Interbody Fusion: A Finite Element Analysis

    Tu S.Li S.Yi J.Zhao H....
    16页
    查看更多>>摘要：? 2022 The Author(s)Objective: The oblique lateral locking plate system (OLLPS) is a novel internal fixation with a locking and reverse pedicle track screw configuration designed for oblique lumbar interbody fusion (OLIF). The OLLPS is placed in a single position through the oblique lateral surgical corridor to reduce operative time and complications associated with prolonged anesthesia and prone positioning. The purpose of this study was to verify the biomechanical effect of the OLLPS. Methods: An intact finite element model of L1-S1 (intact) was established based on computed tomography images of a healthy male volunteer. The L4-L5 intervertebral space was selected as the surgical segment. The surgical models were established separately based on OLIF surgical procedures and different internal fixations: 1) stand-alone OLIF (SA); 2) OLIF with a 2-screw lateral plate; 3) OLIF with a 4-screw lateral plate; 4) OLIF with OLLPS; and 5) OLIF with bilateral pedicle screw fixation (BPS). After validation of the intact model, physiologic loads were applied to the superior surface of L1 to simulate motions such as flexion, extension, left bending, right bending, left rotation, and right rotation. The evaluation indices included the L4/5 range of motion, the L4 maximum displacement, and the maximum stresses of the superior and inferior end plates, the cage, and the supplemental fixation. Results: During OLIF surgery, the OLLPS provided multiplanar stability similar to that provided by BPS. Compared with 2-screw lateral plate and 4-screw lateral plate, OLLPS had better biomechanical properties in terms of enhancing the instant stability of the surgical segment, reducing the stress on the superior and inferior end plates of the surgical segment, and decreasing the risk of cage subsidence. Conclusions: With a minimally invasive background, the OLLPS can be used as an alternative to BPS in OLIF and it has better prospects for clinical promotions and applications.
      原文链接:
    • NSTL
    • Elsevier

    Influence of Predominant Neck versus Arm Pain on Anterior Cervical Discectomy and Fusion Outcomes: A Follow-Up Study

    Patel M.R.Jacob K.C.Shah V.P.Prabhu M.C....
    8页
    查看更多>>摘要：? 2022 Elsevier Inc.Objective: To assess differences in postoperative patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) attainment following single-level anterior cervical discectomy and fusion based on predominant preoperative pain symptom. Methods: Patients undergoing primary, single-level anterior cervical discectomy and fusion were identified. PROMs included visual analog scale (VAS) arm and neck, 12-item short-form physical component summary (SF-12 PCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), and Neck Disability Index, collected preoperatively and postoperatively. Patients were placed in preoperative predominant arm pain (pAP) and preoperative predominant neck pain groups. χ2 test compared demographic and perioperative characteristics, and MCID attainment rates. Student t test evaluated change from preoperative to postoperative PROM values and compared PROMs between groups. Results: There were 110 patients assessed (52 neck pain, 58 arm pain). Patients with preoperative predominant neck pain improved significantly from preoperative to postoperative at 12 weeks to 1 year for PROMIS-PF, 6 months and 1 year for SF-12 PCS, 6 weeks to 1 year for VAS neck, 6 weeks to 6 months for VAS arm, and 6 weeks to 2 years for Neck Disability Index (all P ≤ 0.035). Patients with pAP improved significantly from preoperative to all postoperative time points for PROMIS-PF, 6 months to 2 years for SF-12 PCS, 6 weeks to 1 year for VAS neck, 6 weeks to 1 year for VAS arm, and 6 weeks to 6 months for Neck Disability Index (all P ≤ 0.040). Mean PROMIS-PF was higher at 6 weeks, preoperative VAS neck was lower, and preoperative VAS arm was higher for pAP patients (all P ≤ 0.013). MCID attainment was significantly higher in pAP patients for PROMIS-PF from 6 weeks to 6 months, SF-12 PCS 6 weeks, and VAS arm 12 weeks. Conclusions: Predominant pain symptom demonstrated little effect on perioperative characteristics and postoperative PROMs. Anterior cervical discectomy and fusion candidates will likely experience similar clinically meaningful postoperative improvements in physical function, disability, and pain.
      原文链接:
    • NSTL
    • Elsevier