bluuebunny/crossref_metadata_2025 huggingface dataset:
317 Comparison of One-Day Combined Versus Staged Anterior and Posterior Cervical Decompression, Fixation and Fusion
Authors: Mozaffari Khashayar , Chalif Eric , Stellon Michael A. , Patrick Hayes , Sparks Andrew , Almeida Neil , Rosner Michael K.
Published: March 2022

INTRODUCTION:

Current management of cervical stenosis at times can involve both anterior and posterior decompression, stabilization and fusion. Although these procedures can be done in a combined or staged fashion, there is a scarcity of literature on this topic.

METHODS:

A retrospective cohort analysis was conducted on consecutive patients at a single institution between July 2015 and April 2019 who underwent either single day combined or separate day staged surgeries. Demographics, comorbidities, length of stay, perioperative complications, and inpatient medication use were compared between cohorts. Multivariable analysis was used to adjust for differences in demographics and other confounding covariates.

RESULTS:

80 patients were analyzed (combined = 58, staged = 22). Comparing combined versus staged, there were no differences in baseline demographics. The administration of morphine equivalents was similar comparing combined and staged (569 vs 681 morphine equivalents, P = 0.66). Staged patients had significantly longer time in the operating room (7.2 vs 8.5 hours, P < 0.01) and longer duration of general anesthesia (6.7 vs 7.6 hours, P < 0.01). Incidence of post-operation delirium was significantly higher in the staged group (13.2% vs 50.0%), with an adjusted odds ratio of 23.3 (95% CI: 2.6 – 212.1; P < 0.01). Dysphagia was the most common post-operative complication seen in 43 patients (53.7%). Patients age > 60 had total length of stay 39.1% ± 15.0% longer than those age = 60 (multivariable adjusted mean ± standard error; P = 0.02).

CONCLUSION:

Staging anterior and posterior cervical decompression, stabilization and fusion is associated with longer usage of the operating room, longer duration of general anesthesia, and increased incidence of perioperative complications.
319 Multi-level Stabilization Screws Prevent Proximal Junctional Failure and Kyphosis in Adult Spinal Deformity Surgery: A Comparative Cohort Study
Authors: Kaufmann Ascher , Claus Chad F. , Houseman Clifford M. , Tong Doris , Carr Daniel A. , Soo Teck M.
Published: March 2022

INTRODUCTION:

Proximal Junctional Kyphosis (PJK) and Failure (PJF) occurred in up to 40% of adult spinal deformity (ASD) patients who underwent open thoracolumbar fusion. Proximal stabilization techniques were studied to prevent PJK/PJF without conclusive results.

METHODS:

This is an observational longitudinal cohort study comparing MLSS with standard stabilization instrumentation. We reviewed the charts of consecutive ASD patients who underwent open thoraco-lumbar (TL) fusion (>3 levels, extending cranially above T6 and caudally below L1) from 2009-2017 and were followed for >2 years postoperatively. We defined PJF using International Spine Study Group (ISSG) criteria and PJK as a Cobb angle increase >10o. We defined the upper-instrumented-vertebra (UIV) as the most cephalad vertebral body with bilateral MLSS. Confounders, MLSS-specific complications, radiographic outcomes were collected. We evaluated comparability between groups using univariate analyses. We adjusted for covariates by using multivariable regressions modeling PJF and PJK separately with a p-value <.008 considered significant after Bonferroni correction. We used sensitivity analysis to account for those lost to follow-up.

RESULTS:

Seventy-six patients (50 MLSS vs 26 controls) were included. MLSS patients were significantly older (64.5 ± 8.9 vs. 54.8 ± 19.9 years, p = .024). MLSS patients had significantly lower PJF incidence (10.0% vs. 30.8%, p = .023) and less kyphosis (1.3o ± 5.3o vs. 5.2o ± 6.3o, p = .014). MLSS was independently associated with decreased kyphosis compared to controls (B: -4.5, 95% CI: -7.72 – -1.29, p = .007). MLSS-specific complications were not significantly different between the cohorts.

CONCLUSION:

MLSS is safe and efficacious in reducing PJF/PJK in ASD patients undergoing open, long-construct TL fusion.
320 The Effects of the COVID-19 Pandemic on Penetrating Neurotrauma at a Level 1 Trauma Center
Authors: Yang George L. , Johnson Mark D. , Solomon Daniel , Ferguson Andrew , Wright James Monroe , Johnson Reid A. , Gerges Christina , Parr Ann M. , Ngwenya Laura B.
Published: March 2022

INTRODUCTION:

The COVID-19 pandemic forced the implementation of social distancing guidelines to minimize spread of the coronavirus. However, it is not yet understood what effects these precautions had on the rates of penetrating neurotrauma.

METHODS:

We retrospectively analyzed neurotrauma data from our institutional trauma registry from distinct periods defined as pre-COVID-19 (March 2019-September 2019) and COVID-19 (March 2020-September 2020). Demographics, injury characteristics, mechanisms of trauma, and past medical history (including psychiatric diagnosis) were collected. Data were analyzed for between-group differences and presented as odds ratios.

RESULTS:

We observed a significant rise in the number of neurotrauma cases in 2020 (558 vs. 630, OR 1.129 [1.0071, 1.2657]). There was a decrease in the proportion of male victims (71.3% vs. 68.6%, p = 0.03). There were significant differences noted in the mechanism of injury between groups. Patients in 2020 were less likely to present with falls (42.3% vs. 34.3%, OR 0.7119 [0.5627, 0.9005]) and more likely to present with GSW (4.48% vs. 7.78%, OR 1.7981 [1.0951, 2.9523]). Of the patients with penetrating cranial injuries, the most common motive was assault (56.7% vs. 60.0%), followed by self-inflicted (13.3% vs. 20.0%) and accidental (20.0% vs. 18.3%) with a significant difference between years (p = 0.0043). The presence of comorbid psychiatric illness or substance abuse did not confer an increased odds of presenting with penetrating injuries. No significant differences were noted in mean arrival or discharge GCS or injury severity as measured by ISS. However we did observe significant increases in patients presenting with bilaterally reactive pupils (48.3% vs 59.3%, p = 0.0025), patients discharged home (27.6% vs 37.3%, p = 0.0002), and survival at 6 months (41.4% vs. 54.2%, p = 0.0188).

CONCLUSION:

We observed a higher rate of penetrating neurotrauma while social distancing measures were in place. It is unclear if the psychosocial effects of quarantine and social distancing had a causative relationship with the increased rates of assault and self-inflicted penetrating injuries.
323 Prevalence and Predictors of Inappropriate Pre-injury Antithrombotic Use in Patients Presenting with TBI
Authors: Mashouf Leila A. , Nieves Amber , Matos Jason , Yaffe Michael , Stippler Martina
Published: March 2022

INTRODUCTION:

A growing proportion of the US population is on antithrombotic therapy (AT), expanding most significantly within the elderly subpopulation. The intended benefits of AT are balanced by known increased bleeding risk, salient after traumatic brain injury (TBI). Inappropriate pre-injury AT (IAT) in patients presenting with TBI confers unbalanced risk of poor outcomes and has yet to be described in existing literature.

METHODS:

A retrospective chart review was performed on all patients with TBI and pre-injury AT who presented to our institution between January 2016 and September 2020. Demographic and clinical data was collected from the medical record. IAT status was determined through established clinical algorithms in combination with American College of Cardiology practice guidelines. Clinical predictors were determined by logistic regression.

RESULTS:

Of 169 included patients, 59% were male (n = 100) and mean age was 82 years. AT agents included aspirin (n = 46), clopidogrel (n = 45), coumadin (n = 77), dabigatran (n = 4), rivaroxaban (n = 17), and apixaban (n = 30). Overall surgical intervention, complication, and death rates were 7.7%, 15.4%, and 20.1%, respectively. IAT was found in 10.6% of patients overall: in 41% (n = 6) of patients with documented indication of pulmonary embolism, in 6.2% with documented indication of atrial fibrillation (AF) (n = 6), in 24% with documented indication of cardiac stents (n = 5). Age was a significant negative predictor of IAT use in patients with documented indication of AF (p=0.009). Gender, race, and AT agent were not significant predictors.

CONCLUSION:

1 in 10 patients presenting with TBI were found to be on IAT. Our study is the first to describe this population and warrants investigation into workflow interventions that initiate verification or deprescription of AT by neurosurgeons treating TBI and outpatient prescribers.
327 Prophylactic Antibiotics Do Not Prevent CNS Infection in Civilian Gunshot Wounds to the Head
Authors: Gilbert Olivia , Podet Adam , Hayden Ellery , Wilson John , Crutcher Clifford , Tender Gabriel C.
Published: March 2022

INTRODUCTION:

Civilian gunshot wounds to the head (GSWH) are an ongoing epidemic in the US, with incidence rising each year. They are frequently devastating, with case fatality rates approaching 91%, accounting for fatalities occurring in the hospital and at the scene of injury. Although military GSWH are robust, data and management guidelines for civilian GSWH is relatively lacking. Specifically, the administration of prophylactic antibiotics in GSWH patients remains controversial. Prior studies indicate the incidence of intracranial infection after civilian GSWH to be as high as 25%, with significant impact on morbidity and mortality.

METHODS:

We retrospectively reviewed survivable GSWH at our level 1 trauma center between 2012-2017. Patients were assessed for CNS infection, and categorized with regard to the use of prophylactic antibiotics, length of stay, GCS at presentation, bullet trajectory, and demographics.

RESULTS:

236 patients sustained survivable GSWH. 12/236 (5.1%) patients developed CNS infection following GSWH, and 3/12 (25%) of those patients had not received prophylactic antibiotics. Of the 133 patients who received prophylactic antibiotics, 10 (7.5%) subsequently developed CNS infection. Infection was diagnosed more commonly in patients who received antibiotics, but this was not statistically significant (p = 0.138). Bullet trajectories through the paranasal sinuses or oropharynx were significantly more likely to result in CNS infection (OR 3.04, p = 0.0624). Patients who underwent decompressive surgery and patients who underwent invasive ICP monitoring had significantly higher odds of developing CNS infections (OR 17.7, p = 0.00616; OR = 0.24, p = 0.048).

CONCLUSION:

Decompressive surgery, invasive ICP monitoring, and bullet trajectory were statistically significant factors associated with development of CNS infection following GSWH. Prophylactic antibiotics did not reduce the incidence of CNS infection, and may have increased the risk of infection.
332 Speech Dysfunction in Deep Brain Stimulation Patients
Authors: Chandra Vyshak , Wong Joshua , Hegland Karen , Herndon Nicole , Foote Kelly D.
Published: March 2022

INTRODUCTION:

Deep brain stimulation (DBS) is a neuromodulatory therapy that is predictably effective for treatment of Parkinson’s disease (PD). The precise effect of DBS on speech function is variable, however, and patients with more impaired speech function prior to surgery are thought to be at increased risk of worsening speech function post surgically.

METHODS:

Patients with a diagnosis of Parkinson's disease who are at least 40 years old (at first DBS surgery) that have had speech assessments as part of normal clinical care 12 or fewer months prior to DBS surgery (pre-DBS) and within 12 months after surgery completion (post-DBS) were included in the study - 130 total patients. Preoperative and postoperative speech testing data was compiled, along with DBS programming settings including lead type (directional or conventional), pulse width, frequency, amplitude, active contacts, and battery type at time of speech evaluations (estimated to be 6- and 12-months post DBS surgery).

RESULTS:

A mixed effect linear model with lognormal errors to analyze the speech pathology severity scores. Site (STN, GPi), and hemisphere involvement (Unilateral, Bilateral) were modeled as completely crossed between-patient fixed effects. Speech severity, respiratory severity, and laryngeal severity were found to be significantly worsened post-operatively in patients that obtained GPi DBS, contrary to our original hypothesis. Orofacial severity worsened post-operatively in patients that obtained STN DBS.

CONCLUSION:

GPI DBS patients had several categories of statistically significant worsening of speech, contrary to our hypothesis. A future study based on target alone will not be useful, but preliminary data studying specific neuroanatomic localization of stimulation and activation of fibers should prove more fruitful.
338 Disparate Use of Deep Brain Stimulation for Parkinson’s Disease in Black Patients is Driven by Barriers to Access that Arise Before Surgical Referral
Authors: Skelton Henry M. , Grogan Dayton , Laxpati Nealen , Miocinovic Svjetlana , Gross Robert E. , Yong Nicholas A.
Published: March 2022

INTRODUCTION:

Deep brain stimulation (DBS) is an effective therapy for Parkinson’s disease (PD) that can provide substantial improvements in quality of life for patients inadequately controlled with medication. However, there is severe racial disparity in its use, with Black PD patients being much less likely to be treated with DBS than White patients. We hypothesized that the extensive process of patient selection and workup limits access to DBS, and we analyzed the records of a major movement disorder and DBS center to determine if this barrier to access was apparent.

METHODS:

We reviewed a database that includes every patient considered for DBS between 2016 and February of 2021. We cross-tabulated the patients by race, as documented in the medical record, and progression to surgical intervention. We determined whether there was a significant difference in the proportion of patients who were not treated with DBS via Fisher’s exact test.

RESULTS:

Out of 211 PD patients evaluated by a DBS movement specialist and referred for preoperative workup since 2016, 10 (5%) were indicated to be Black, compared to 160 (76%) White, 7 (3%) Asian, and 34 (16%) Unknown. Of those, 7/10 (70%) Black patients were treated with surgery, compared to 123/160 (77%) White, 5/7 (71%) Asian, and 23/34 (68%) Unknown (p = 0.61, Fisher’s Exact Test).

CONCLUSION:

While very few Black patients were referred to DBS Clinic, there was no significant difference between racial groups in the likelihood of receiving surgery once referred. This suggests that the disparity arises before preoperative workup, with potential candidates for treatment never reaching DBS clinic. Future work should attempt to identify factors driving this disparity, with particular attention paid to referral patterns. Notably, these results do not exclude the possibility that the general burden of preoperative evaluation and postoperative management might influence decisions on whether to refer patients.
351 Dear Program Director: Evaluating Implicit Bias in Neurosurgery Residency Letters of Recommendation
Authors: Graves Erin , Coyle Anne , Erkmen Cherie , Erkmen Kadir
Published: March 2022

INTRODUCTION:

Despite comprising half of medical students, women represent 25% of neurosurgery applicants, 17% of residents and 12% of practicing neurosurgeons. This trend suggests “leaks” in the career pipeline for female neurosurgeons.

The NRMP Program Director Survey has shown that neurosurgery programs identify Step 1 score and letters of recommendation (LORs) as the most important factors in selecting applicants to interview. Other specialties have evaluated implicit biases in LORs, but no such study exists in neurosurgery.

METHODS:

Retrospective analysis of LORs for neurosurgery applicants interviewed between 2014-2020. LORs were evaluated using the Linguistic Inquiry & Word Count (LIWC) software and a Reader Scoring System. The LIWC dictionary and a custom dictionary containing additional categories (e.g. grindstone) and terms (e.g. hardworking) were used. Analyses were done using SAS.

RESULTS:

218 applications were reviewed (81.1% male, n=177), for a total of 827 letters. LIWC analysis showed significant differences in word count (331 females vs. 296 males, p = 0.017), ability words (6.61 females vs. 5.51 males, p = 0.018), and agentic words (6.31 females vs. 5.53 males, p = 0.020). Female letters showed a higher average number of grindstone, communal and commitment words. The Reader Scoring System showed similarities between candidates, but revealed a trend that in female letters writers mention personal attributes and “career” versus “residency” potential.

CONCLUSION:

This is the first study to evaluate for implicit gender bias within neurosurgery LORs. LORs are key in the selection process and therefore represent one area to target when it comes to increasing female representation in neurosurgery. Our study showed that female applicant’s letters were longer, had more ability and agentic terms, and trended towards more grindstone, communal and commitment words.
356 Patient-and-Hospital-Related Risk Factors for Non-Routine Discharge After Lumbar Decompression and Fusion for Spondylolisthesis
Authors: Elsamadicy Aladine A. , Freedman Isaac G. , Koo Andrew B. , David Wyatt , Hengartner Astrid , Havlik John , Hersh Andrew , Pennington Zach , Kolb Luis , Laurans Maxwell S. H. , Shin John H. , Sciubba Daniel
Published: March 2022

INTRODUCTION:

In various spinal surgeries, non-routine discharges have been associated with inferior outcomes. However, there exists a paucity of data regarding the relationship between non-routine discharge and quality of care among patients with spondylolisthesis.

METHODS:

A retrospective cohort study was performed using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2016. Adult patients (=18 years old) who underwent spinal decompression and fusion for lumbar spondylolisthesis were identified using ICD-9-CM diagnosis and CPT procedural coding systems. The study population was divided into two cohorts based on discharge disposition: routine (RD) and non-routine discharge (NRD). A multivariate logistic regression model was used to identify the independent predictors of non-routine discharge and 30-day unplanned readmission.

RESULTS:

A total of 5,252 patients were identified, of which of which 4,316(82.2%) had a RD and 936 (18.8%) had a NRD. The NRD cohort tended to be older (p<0.001) and have a higher BMI (p<0.001). Patients who experienced a NRD had a longer LOS (NRD: 4.7±3.7 days vs RD: 3.1±2.0 days, p<0.001), a higher proportion of adverse events (p<0.001), higher rates of reoperation (p=0.005) and unplanned 30-day readmission rates (p<0.001). On multivariate regression analysis, age [OR: 1.08, 95% CI (1.06–1.10),p<0.001], female sex [OR: 2.01, 95% (1.51–2.69),p<0.001], non-Hispanic Black race/ethnicity [OR: 2.10, 95% CI (1.36 – 3.24), p=0.001], BMI [OR: 1.03, 95% CI (1.01–1.05), p=0.007), dependent functional status [OR: 3.33, 95% CI (1.59 – 6.99),p=0.001], malnourishment [OR: 2.14, 95% CI (1.27 – 3.62, p=0.005], and LOS [OR: 1.26, 95% CI (1.18 – 1.33),p<0.001] were all independent predictors for NRD. However, NRD did not independently predict an unplanned 30-day readmission on multivariate analysis.

CONCLUSION:

In our study we found that on univariate analysis NRD was associated with increased adverse events, length of stay and 30-day unplanned readmission. When controlling for patient- and hospital-related factors, we found that female sex, non-Hispanic Black race, BMI, dependent functional status, malnourishment and longer LOS were independently associated with NRD.
402 Cost-Effectiveness Analysis on Small (<5 mm) Unruptured Intracranial Aneurysm Follow-up Strategies
Authors: Salih Mira , Salem Mohamed M. , Moore Justin M. , Thomas Ajith J. , Ogilvy Christopher S.
Published: March 2022

INTRODUCTION:

Unruptured intracranial aneurysms are frequently detected during routine clinical diagnostic processes. A significant portion is small aneurysms less than 5mm. While follow-up patients with small aneurysms have been advocated, the cost-effectiveness of such care and the optimal follow-up interval remain unknown.

METHODS:

A decision analysis study was performed utilizing a Markov model with Monte Carlo simulations to simulate patients undergoing follow-up by MRA at different time intervals (1-,2-,3-, 5-and 7-year intervals) for small (<5mm) unruptured intracranial aneurysms. Input data for the model was extracted from the current literature, primarily latest Meta-analysis. Probabilistic sensitivity analysis and deterministic sensitivity analyses were performed to evaluate the robustness of the Model.

RESULTS:

Given current literature and our model, following-up every 3 years with noninvasive imaging is the most cost-effective strategy (cost = $99611, effectiveness = 19.00 QALYs), showing the highest net monetary benefit. The conclusion remains robust in probabilistic sensitivity analysis and deterministic sensitivity analyses. As the annual rupture risk of small aneurysms exceeds 9.8% (base-case 3.1%), following up every 2 years becomes the optimal strategy.

CONCLUSION:

The most cost-effectiveness follow-up strategy for small (<5mm) unruptured aneurysms using MRA is follow-up every 3 years. More frequent follow-up strategies or prompt preventive treatment would be more appropriate in patients with a higher rupture risk of growing aneurysms.
405 Volumetric Quantification of Subarachnoid Hemorrhage Independently Predicts Hydrocephalus and Seizures
Authors: Daou Badih J. , Khalsa Siri S. S. , Anand Sharath , Williamson Craig , Rajajee Venkatakrishna , Sheehan Kyle , Pandey Aditya S.
Published: March 2022

INTRODUCTION:

Hydrocephalus and seizures greatly impact outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH); however, reliable tools to predict these outcomes are lacking.

METHODS:

Total hemorrhage volume following aneurysm rupture was retrospectively analyzed on presentation CT imaging using a custom semi-automated computer program developed in MATLAB that employs intensity-based k-means clustering to automatically separate blood voxels from other tissues. Volume data was added to a prospectively maintained SAH database. Through logistic regression analysis, we evaluated the association of hemorrhage volume with shunted-hydrocephalus and seizures and evaluated the diagnostic accuracy by evaluation of the area under the receiver operating characteristic curve (AUC).

RESULTS:

288 consecutive patients with aSAH comprised the study population. Mean total hemorrhage volume was 74.9 ml. Thirty-eight patients developed seizures (13.2%). Mean hemorrhage volume in patients who developed seizures was significantly higher than patients with no seizures (mean difference 17.3 ml, P=0.01). In multivariate analysis, larger hemorrhage volume on initial CT scan and hemorrhage volume >50 ml (OR 2.81, P=0.047 CI 1.03-7.80) were predictive of seizures. 48 patients developed shunt-dependent hydrocephalus (17%). The mean hemorrhage volume in patients who developed shunt-dependent hydrocephalus was significantly higher than patients who did not (mean difference 17.2 ml, P=0.006). Larger hemorrhage volume and hemorrhage volume >50 ml (OR 2.45, P=0.03, CI 1.08-5.54) were predictive of shunt-dependent hydrocephalus. Hemorrhage volume had adequate discrimination for the development of seizures (AUC = 0.635) and shunted hydrocephalus (AUC = 0.629).

CONCLUSION:

Hemorrhage volume is an independent predictor of seizures and hydrocephalus in aSAH. Further evaluation of quantitative volumetric analysis may complement existing scales used in clinical practice and assist in prognostication and management.
425 Defining the Optimal Thermal Parameters for Sub-threshold Testing With Focused Ultrasound
Authors: Krishna Vibhor , Sammartino Francesco , Snell John W. , Eames Matthew
Published: March 2022

INTRODUCTION:

Focused ultrasound ablation (FUSA) relies on accurate subthreshold testing to physiologically explore the presumed target before permanent ablation. However, the optimal thermal parameters for subthreshold testing (i.e., thermal dose and spot size thresholds) are not yet defined.

METHODS:

We performed a retrospective analysis of intraoperative testing data of essential tremor patients undergoing FUSA. Sonications with a thermal dose of less than 25 cumulative equivalent minutes (CEM) were classified as sub-threshold. The intraoperative writing samples were independently rated by two raters using the clinical rating scale for tremor. The association between thermal dose and tremor scores was statistically analyzed, and the thermal dose and spot size thresholds for tremor improvement were computed using leave-one-out cross-validation analysis.

RESULTS:

From the 331 pairs of sonications and tremor assessments, 97 sonications were classified as subthreshold sonications. Intraoperative tremor improvement was observed in 23 (24%) subthreshold sonications with a median tremor improvement of 20% (interquartile range = 41.6) from the baseline. The thermal dose threshold for tremor improvement was 0.67 CEM (equivalent to 30 seconds thermal exposure at 430C). The spot size threshold for tremor improvement was 2.46 mm. VIM was exposed to TN thermal dose during sub-ablative and ablative sonications.

CONCLUSION:

The optimal thermal dose and spot size thresholds for subthreshold testing are significantly higher than the current FUSA standard-of-care. We recommend long duration (>30 seconds), subthreshold sonications for intraoperative testing during FUSA. Future investigations should test whether the thermal dose threshold is tissue-specific and determine the mechanisms underlying focused ultrasound TN.
431 Chronic Opioid Use Prior to ACDF Surgery is Associated With Inferior Post-operative Outcomes
Authors: Rodrigues Adrian , Varshneya Kunal , Veeravagu Anand
Published: March 2022

INTRODUCTION:

Anterior cervical discectomy and fusion (ACDF) is widely used in patients with radiculopathy, myelopathy, or spondylosis. This patient population has a higher rate of opioid use than the general public, but dedicated studies on pre-operative ACDF opioid use have not been conducted.

METHODS:

The MarketScan Database was queried from 2007-2015 to identify adult patients who underwent an ACDF procedure using CPT codes. Patients were then classified into three separate cohorts based on the number of separate opioid prescriptions in the 12 months before their ACDF, excluding the 30 days immediately before their operation: (1) opioid naÏve if 0 prescriptions, (2) mild opioid use if 1-4 prescriptions, and (3) chronic opioid use if =5 prescriptions. Patients with a history of neck fracture or arthrodesis were excluded. Continuous insurance enrollment was confirmed for each patient. Short term outcomes were compared between groups, and nearest-neighbor propensity-score matching was employed to match patient cohorts across measured covariates.

RESULTS:

Of 81,671 ACDF patients, 31,312 (38.34%) were opioid naÏve, 30,302 (37.10%) were mild users, and 20,057 (24.56%) were chronic users. At baseline, chronic opioid users had more comorbidities than patients with less frequent opioid use (mean Charlson Comorbidity Index (CCI): 2.06; SD (2.06) vs. opioid naÏve mean CCI: 1.77; SD (1.79)). Chronic opioid users had higher rates of post-operative complications than mild and non-users (p < 0.0001), and higher rates of readmission and reoperation. After matching opioid naÏve vs. chronic opioid users along demographic, comorbidity, and intra-operative characteristics, post-operative complications remained elevated for chronic opioid users relative to opioid naÏve patients (9.13% vs. 5.29%; p < 0.0001). Rates of readmission and reoperation also remained higher for chronic opioid patients, as did inpatient costs.

CONCLUSION:

Chronic opioid users had longer hospitalizations and higher rates of post-operative complication, readmission, and reoperation, on average, than mild opioid and opioid naÏve users. After balancing patients across observed covariates, including comorbidity burden, the outcome differences persisted, suggesting a durable association between pre-operative opioid use and negative post-operative outcomes.
433 Efficacy and Safety of Surgical Decompression for Migraine: A Systematic Review
Authors: Shahid Adnan , Abbasi Mehdi , Madhani Sarosh , Larco Jorge A. , Liu Yang , Robertson Carrie , Chiang Chia-Chun , Savastano Luis E.
Published: March 2022

INTRODUCTION:

Migraine is a common disabling disease with high socioeconomic and personal impacts. Despite various medical options, many patients suffer refractory and chronic migraines. New surgical approaches are gaining traction as viable options to treat migraines.

METHODS:

The study was conducted in accordance with PRISMA guidelines. An inclusive search of several databases from January 1990 to December 2nd, 2020, was performed. Studies reporting various decompression approaches of peripheral nerves for chronic or refractory migraines were included and analyzed. The risk of bias of individual studies was assessed in accordance with the modified Newcastle-Ottawa Quality Assessment Scale. Only those studies representing their data of migraine with mean frequency and intensity of headache, as well as their complication event rate, were reported.

RESULTS:

Total, 22 studies comprising 1377 patients with migraines were included. Mean age of patients undergoing surgery was 44.22 (95% CI 42.96 - 45.48) years. Patients underwent surgery for migraine comprising decompression of supraorbital, supratrochlear, zygomaticotemporal, or occipital nerve. Most studies reported recovery from headache with improvement in mean headache frequency (range 4.4 to 16.6 days per month) and mean headache intensity (range 2.80 to 7.30 in visual analog scale). The risk of bias was high, with the bias being high in 10 studies and moderate in 11 studies. Total complication rate was 8.0% (95% CI 4.0%-13.0%) which included paresthesia, wound infection, and hypertrophic scarring in a follow-up duration of 2 to 66 months. Heterogeneity in outcome measures and moderate-to-high risk of bias in the majority of studies precluded for meta-analysis.

CONCLUSION:

Despite improvement in headache frequency and intensity reported on surgical decompression for migraine, available studies reported used variable outcome measures and had moderate-to-high risk of bias.
441 Prospective, Randomized, Double-Blinded Clinical Trial Comparing PEEK and Allograft Spacers in Patients Undergoing Transforaminal Lumbar Interbody Fusion Surgeries
Authors: Villavicencio Alan T. , Nelson Ewell L. , Rajpal Sharad , Burneikiene Sigita
Published: March 2022

INTRODUCTION:

Allograft and polyether-ether-ketone (PEEK) radiographic, biomechanical, histological properties have been extensively studied and both spacers have their advantages and shortcomings. There are no comparative randomized or double-blinded spinal fusion clinical trials reported to date.

METHODS:

A prospective, randomized, controlled, double-blinded clinical trial was initiated at a single center. All patients were followed for 2 years ± 2 months; radiographic and clinical outcomes were assessed at 3, 6, 12 and 24 months with an additional follow-up at 3 weeks for radiographic assessment.

RESULTS:

A total of 138 patients undergoing transforaminal lumbar interbody fusions (TLIF) were randomized (1:1) to receive either cortical allograft or PEEK interbody lordotic spacers. RhBMP-2 was used in 96.7% allograft and 98.4% PEEK group patients. Although no differences were detected between the allograft and PEEK patient groups at any of the follow-up time points, there was a highly significant (p<0.0001) improvement in all clinical outcome measures. Overall, evidence of radiographic fusion was achieved in 118 (97.5%) patients at the 24 months follow-up. Three patients, all in the allograft group, had pseudoarthrosis and underwent revision surgeries. Postoperative improvement of sagittal alignment, anterior (ABH) or posterior body height (PBH) was initially achieved, but it was mainly lost or reduced at the final follow-up and there were no statistically significant differences between the groups. At the end of the study, improvement and maintenance of lumbar lordosis were achieved in 43.3% and 49.2% patients and segmental alignment in 38.3% and 36.1% for the allograft and PEEK patient groups, respectively. Similarly, ABH was improved and maintained in 28.3% and 36.1% patients and PBH in 28.3% and 44.3% for the allograft and PEEK groups, respectively.

CONCLUSION:

Although allograft-assisted surgeries may have reduced fusion rates, the study findings demonstrated that TLIF surgery with two different types of cages and in conjunction with rhBMP-2 resulted in similar radiological or clinical outcomes and a highly statistically significant improvement in all clinical outcome measures at the end of the study regardless of the randomization group.
449 Correcting Spinopelvic Parameters in Lumbar Scoliosis With Single Level TLIF
Authors: Chieng Lee O. , Perez-Cruet Mick J.
Published: March 2022

INTRODUCTION:

Spinopelvic parameters are known to play important role in deformity correction. However, its long term implication in short segment degenerative lumbar pathology in the setting of lumbar scoliosis remains unknown. In this study, we sought to investigate the influence of single level TLIF on spinopelvic parameters for patients with degenerative lumbar scoliosis.

METHODS:

We performed retrospective analysis of patients who underwent single level TLIF for degenerative lumbar scoliosis. Medical comorbidities were included. Baseline and postop spinopelvic parameters were obtained from standing film. ODI and SF-36 were collected.

RESULTS:

107 patients with average age of 68.6 ± 12.7 years old underwent single level TLIF for degenerative scoliosis. 73.4% and 67.1% of the patients have symptomatic degenerative spinal stenosis and spondylolisthesis respectively. L4-5 was the most common level of fusion (70%). There was significant improvement of lumbar cobb angle from preop 21.6 ± 5.6 to 15.6 ± 3.6 (p < 0.05). Lumbar lordosis (LL) improved from 47.4 ± 14.4 to 55.9 ± 10.9 at 6 months postop. However no significant change in pelvic tilt, sacral slope or pelvic incidence (PI). Interestingly, significant improvement of PI- LL mismatch was observed from 16.3 ± 11.5 preop to 7.12 ± 12 postop. The ODI score improved from 38.1 preoperatively to 25.8 postoperatively at 1 year followup. Likewise SF-36 score increased significantly postop.

CONCLUSION:

Single level TLIF may be sufficient in treating selected cases of degenerative lumbar scoliosis with concurrent spinal stenosis and spondylolisthesis. Interestingly, there was robust improvement in both scoliotic curve and PI- LL mismatch with only 1 level fusion. Thereby, long segment lumbar fusion could be avoided or delayed.
451 Dural Tears in Full-Endoscopic Unilateral Laminotomies for Bilateral Lumbar Decompression
Authors: Kashlan Osama , Bergquist Julia , Prasse Tobias , Greil Madeline , Sivakanthan Sananthan , Williams John R. , Hofstetter Christoph P.
Published: March 2022

INTRODUCTION:

Full-endoscopic unilateral laminotomy for bilateral lumbar decompression (ULBD) for spinal stenosis has proven benefits when compared to microscopic technique. Intraoperative laceration of the dura may be encountered and their optimal technique and effectiveness of full-endoscopic dural repair remains unclear.

METHODS:

For this analysis, we utilize a prospectively collected database of all patients undergoing ULBD from 2015 to 2021 at our institution. We evaluate whether patient specific factors such as sex, age, body mass index (BMI), smoking status, ASA level, number of levels, or previous index level surgery affects durotomy risk. We then determine whether having an intraoperative durotomy affects length of stay (LOS), revision surgery risk, length of time on postoperative pain medications, or Oswestry Disability Index (ODI) scores.

RESULTS:

In 174 patients undergoing ULBD, there were 11 patients who sustained intraoperative dural tears (6.3%). Utilizing our novel bimanual technique, there was only one patient who required temporary CSF drainage via a lumbar drain. None required revision surgery for CSF leak repair. Durotomy risk was not significantly affected by any patient specific risk factors. Sustaining a durotomy did increase LOS (p=0.033). Intraoperative durotomies did not affect revision surgery risk, or length of time on postoperative pain medications. Utilizing MCID of 12.8 increase in ODI, 70.8% of non-durotomy patients achieved the MCID goal versus 60.0% of durotomy patients. However this trend did not achieve statistical significance (p = 0.605).

CONCLUSION:

Our novel method of bimanual repair of CSF leaks in full-endoscopic spine surgery appears to be a safe and feasible. There are no patient specific risk factors affecting durotomy risk. Sustaining a durotomy intraoperatively affects LOS but does not significantly alter any other aspect of the postoperative course for patients undergoing ULBD.
476 Does Anticoagulation or Antiplatelet Therapy Increase Risk of Traumatic Subarachnoid Hemorrhage Progression?
Authors: Harland Tessa , Prabhala Tarun , Nardolillo Annie , Boulos Alan S. , Adamo Matthew , Dalfino John C. , Paul Allie , Entezami Pouya
Published: March 2022

INTRODUCTION:

Isolated traumatic subarachnoid hemorrhage (tSAH) is a common finding of mild traumatic brain injury that often results in the transfer to a tertiary center. This is often done out of concern for patients on blood thinners (BT) who are thought to be at higher risk of clinical worsening.

METHODS:

A retrospective analysis identified patients over the age of 18 with isolated tSAH and a GCS of 15 on admission. Clinical information including use of BT, administration of reversal agents, radiographic progression, and need for neurosurgical intervention were collected. Patients on BT were divided into AP, AC and AP/AC groups based on drug type.

RESULTS:

384 patients were included with 203 in the non-BT group and 181 in the BT group. 2.1% had worsening scans and none required neurosurgical intervention. There was no difference in radiographic worsening between the non-BT and BT group (2.4% vs. 1.6%; p = 1.00). Crosswise comparison revealed no difference between the non-BT group and each BT subtype (AP, AP/AC, AC). The non-BT group was more likely to have radiographic improvement than the BT group (45.8% vs. 30.9%; p = 0.002).

CONCLUSION:

Neurologically intact patients on BT with isolated tSAH are not at increased risk of radiographic progression or need for neurosurgical management. Consequently, the presence of BT should not influence management decisions for increased surveillance.
492 Development of Subdural Hematomas According to Size of the Subarachnoid Space in Benign External Hydrocephalus
Authors: Holste Katherine , Wieland Clare , Parmar Hemant , Ibrahim Mohannad , Garton Hugh , Maher Cormac O.
Published: March 2022

INTRODUCTION:

Benign External Hydrocephalus (BEH) is a common condition seen by pediatric neurologists and neurosurgeons in macrocephalic infants. It is accepted that patients with BEH are at increased risk of spontaneous subdural hematoma (SDHs) formation.

METHODS:

A large retrospective chart review was performed at a single institution for patients 2 years or younger with a diagnosis of BEH by neurology or neurosurgery and head circumference >85th percentile. Demographic data, head circumference, and occurrence of subdural hematoma were extracted. MRIs were reviewed by two neuroradiologists and the SAS size measured. SAS size was graded per the Tucker et al grading system (<5 mm width is grade 0, 5-9 mm is grade 1 and > 10 mm is grade 2) for consistency.

RESULTS:

Over 2.5 million patients' charts were queried from a single institution and 480 patients met the inclusion criteria. Of that population, 187 children had an MRI of the brain available for review. The prevalence of spontaneous SDH in this BEH population over 25 years was 8.12% (39 patients of 480). The average size of the SAS was 5.86 mm (± 2.29 mm). A majority, 64.7%, had grade 1 SAS. About 39% had ventriculomegaly. There was no significant association between SAS grade and prevalence of SDHs (p = 0.124). SAS size was not significantly different between those with and without SDH (p= 0.402).

CONCLUSION:

BEH is a common condition seen by pediatric neurologists and neurosurgeons. Infants with BEH are thought to have increased risk of spontaneous SDH formation compared to the general population. A majority of infants had grade 1 SAS. The grade of SAS was not significantly associated with SDH formation and development of SDH was not associated with larger SAS size.
499 Seizures in a Dish: Demonstrating and Analyzing Coordinated Network Activity in Human and Mouse Brain Slice with Calcium Imaging
Authors: Alexander Allyson L. , Brzezinski Christine , Kushner Keenan , Hoffman Paige , Baca Serapio
Published: March 2022

INTRODUCTION:

Childhood epilepsy is a common and often devastating disease, and chronic seizures lead to a significant increase in premature mortality and developmental delay. Focal cortical dysplasia (FCD), a malformation of cortical development, is the primary cause of pharmacoresistant epilepsy in children undergoing resective surgery. There are no targeted medical or surgical therapies for FCD patients who have failed surgery or who are not surgical candidates.

METHODS:

Human tissue from patients with MCDs was resected during epilepsy surgery. Comparison tissue from CD1 mouse brains was also used. 400-µm brain slices were made with a vibratome. The slices were then incubated the slices in Fluo-8L, a low-affinity calcium-sensitive indicator for 40-180 minutes. Slices were imaged using an sCMOS imager at 15 fps on an upright microscope and standard patch-clamp rig with a custom-built temperature-controlled chamber with high aCSF flow rate (5-15mL per minute) to optimize tissue oxygenation. Network bursts are induced with a pro-ictal ACSF containing high potassium (8 mM) and 4-aminopyridine (100 micromolar).

RESULTS:

We developed a workflow for calcium imaging in human tissue as follows. Preliminary semi-manual analysis on each image stack was performed using ImageJ. Image stacks were motion corrected using the NoRMCorre algorithm and then processed using the calcium imaging analysis workflow (CaImAn) appropriate for 1-photon imaging. Hundreds of cells can be analyzed simultaneously. Ictal network activity may be induced with the pro-ictal ACSF, or with gabazine (1 mM, a GABA-A receptor antagonist, data not shown).

CONCLUSION:

We have demonstrated the feasibility of performing ex vivo calcium imaging to directly study the aberrant epileptic networks in human MCD tissue resected from children with intractable epilepsy. In future work, we will use this novel technique to uncover network anomalies underlying the epileptic networks in this disorder.
501 Radiomic Phenotypes Distinguish ATRT from Medulloblastoma
Authors: Zhang Michael , Wong Samuel , Lummus Seth , Han Michelle , Radmanesh Alireza , Ahmadian Saman , Prolo Laura M. , Lai Hollie , Eghbal Azam , Oztekin Ozgur , Cheshier Samuel H. , Ho Chang , Vogel Hannes , Vitanza Nick , Lober Robert , Grant Gerald A. , Jaju Alok , Yeom Kristen
Published: March 2022

INTRODUCTION:

Presurgical distinction of posterior fossa atypical teratoid/rhabdoid tumo (ATRTs) from medulloblastoma (MB) is challenging because of shared, low T1- and T2-weighted intensities, variable enhancement, and reduced diffusion.

METHODS:

The T2- and gadolinium-enhanced T1-weighted images of 48 posterior fossa ATRT and 96 match-paired MB were assembled from seven institutions. 1800 features were extracted from segmented tumor volumes. Feature reduction was performed by LASSO regression and cross-validation. Retained features were inputted to six training models, including support vector machine, logistic regression, k-nearest neighbor, random forest, eXtreme Gradient Boosting, and neural net. The optimal classifier maximized the area under the curve (AUC) on a holdout test set. Finally, two human experts reviewed the MRIs for categorical measurement of enhancement (0%; <50%, and =50% volume).

RESULTS:

The final feature set included one T1-MRI and five T2-MRI variables. Among classifier models, logistic regression produced the highest AUC of 0.858, with sensitivity, specificity, and F1 score of 0.800, 0.818, and 0.851, respectively. The top three predictive features were 90th Percentile Voxel Intensity, Inverse Difference Moment Normalized, and Kurtosis—all from T2-MRI. The last three features included T1-MRI and T2-MRI measurements for Elongation and Flatness. Separate qualitative human assessment identified greater volume enhancement for ATRT versus MB (p = 0.0135).

CONCLUSION:

Overall, T2-MRI-based features were more relevant for distinguishing ATRT from MB, with ATRT identified by brighter and more heterogeneous voxel intensities, consistent with ATRT’s myxoid and broad histologic composition. Additionally, ATRT were with more linear and planar morphology, consistent with ATRT flattening within the cerebellopontine angle and MB expansion within the fourth ventricle. Earlier distinction could aid family counseling and surgical planning.
514 A Data-driven Approach to Predicting 5-ALA-Induced Fluorescence and WHO Grade in Newly Diagnosed Diffuse Gliomas
Authors: Müther Michael , Jaber Mohammed , Johnson Timothy , Orringer Daniel A. , Stummer Walter
Published: March 2022

INTRODUCTION:

A growing body of evidence has revealed the potential utility of 5-aminolevulinic acid (5-ALA) as a surgical adjunct in select lower-grade gliomas. However, a reliable means of identifying which lower-grade gliomas will fluoresce has not been established.

METHODS:

We investigated a cohort of grades II and III glioma patients who received 5-ALA prior to resection at a single institution. Using a logistic regression-based model, we evaluated 14 clinical and molecular variables considered plausible determinants of fluorescence. We then distilled the most predictive features to develop a model for predicting both fluorescence and tumor grade. We also explored the relationship between intraoperative fluorescence and molecular markers.

RESULTS:

179 subjects were eligible for inclusion. Our logistic regression classifier accurately predicted fluorescence with 91.9% accuracy and revealed enhancement as the singular variable in determining fluorescence. There was a direct relationship between enhancement on MRI and the likelihood of observed fluorescence. Observed fluorescence correlated with MIB-1 index but not with IDH status, 1p19q co-deletion or MGMT promoter methylation.

CONCLUSION:

We demonstrate a strong correlation between enhancement on preoperative MRI and the likelihood of visible fluorescence during surgery in intermediate-grade glioma patients. Our analysis provides a robust method for predicting 5-ALA-induced fluorescence in grade II and grade III glioma patients.