bluuebunny/crossref_metadata_2025_split huggingface dataset:
343 Regional Variability in the Management of Aneurysmal Subarachnoid Hemorrhage for Black Patients: An Analysis of Treatment Patterns, Outcomes, and End-of-life Care.
Authors: Kabangu Jean-Luc , Bhargav Adip Guruprasad , Fry Lane , Masri Ahmad , Heskett Cody , Bah Momodou G. , Peterson Jermey , Ebersole Koji C. , Eden Sonia Veronica , Camarata Paul J. 
Published: March 2024

INTRODUCTION:
Disparities in the care of Black Americans with aneurysmal subarachnoid hemorrhage (aSAH) have been described. However, regional variations for Black patients with aSAH have yet to be delineated, particularly in end-of-life care.

METHODS:
We analyzed aSAH data from the Nationwide Inpatient Sample (NIS) from 2016-2020. Controlling for covariates, multivariate logistic regression models were used to assess U.S. Census region differences between Black and White patients in treatment, adverse outcomes, mortality, use of palliative care as well as do not resuscitate (DNR) and of life-sustaining interventions (mechanical ventilation, tracheostomy, gastrostomy, blood transfusion).

RESULTS:
Black patients in the East-North Central (ENC) division were less likely to have inpatient morality following aSAH (OR 0.68, 95% CI 055 – 0.83, p <0.001), yet more likely to have tracheostomy (OR 1.83, 95% CI 1.39 - 2.49, p < 0.001) and gastrostomy (OR 1.66, 95% CI 1.31 - 2.11, p < 0.001) tube placement than the national average. Furthermore, Black patients in the ENC were less likely to have palliative care (OR 0.42, 95% CI 0.22 - 0.80, p = 0.008) This trend continued in the West South-Central (WSC) division for tracheostomy (OR 1.86, 95% CI 1.29 - 2.66, p = 0.001), gastrostomy (OR 1.95, 95% CI 1.44 - 2.63, p < 0.001), and palliative care (OR .67, 95% CI 0.51 - 0.87, p = 0.003).

CONCLUSIONS:
Geographic variations exist in the treatment of Black patients with aSAH. Nationally and regionally Black patients have lower mortality rates than White patients, due in part to disparities in end-of-life care. Black patients receive more life-sustaining interventions, and less palliative care and DNR; this is most evident in the ENC and WSC regions. Paradoxically, regions with more Black residents fare worse.
344 The World Neurosurgery Global Champions Program: First-year Experience of a Model Initiative for Reducing Disparities in Global Neurosurgical Literature
Authors: Shlobin Nathan A. , Savage Simon , Savage Alexander , Torbati Tania , Wang Zhe , Salas-Vega Sebastian , Mota Marcella , Pando Alejandro , Sheldon Breanna , Westrup Alison Megan , Ogulnick Jonathan , Zreik Jad , Alkahtani Nada Ayedh , Jesuyajolu Damilola , Larrey Kasereka Kamabu , Fadalla Tarig , Mahajan Uma V. , Manjila Nihal , Singh Rohin , Wang Andrew , Kanmounye Ulrick Sidney , Moore Christine , Benzel Edward C. , Rosseau Gail Linskey 
Published: March 2024

INTRODUCTION:
Most surgical journals are published in English, representing a challenge for individuals from non-Anglophone countries and contributing to disparities in research globally.

METHODS:
The GCP was advertised via the journal website and social media. Applicants were selected to be a reviewer for the GCP if they demonstrated English proficiency. Authors received information about the program if their article was rejected on the basis of poor English language. The workflow is shown.The demographics of GCP members and characteristics and outcomes of articles edited by the GCP during its first year were reviewed. Surveys of GCP members and authors who used the service were conducted.

RESULTS:
Twenty-one individuals became part of the GCP, representing 8 countries and 16 languages apart from English. A total of 380 manuscripts were peer-reviewed and a final decision given by the editor-in-chief to have potentially worthwhile content but rejected due to poor language. The authors of these manuscripts were informed of the existence of this language assistance program. Forty-nine articles (12.9%) were edited by the GCP in 41.6 ± 22.8 days. Of 40 articles resubmitted to World Neurosurgery, 24 (60.0%) were accepted. GCP members and authors understood the purpose and workflow of the program and recognized improvements in article quality and the probability of acceptance through their participation.

CONCLUSIONS:
The World Neurosurgery Global Champions Program mitigated a critical barrier to publication in an English language journal for authors from non-Anglophone countries and promoted research equity by providing a free, largely medical student and trainee operated, English language editing service. This model or a similar service can be replicated by other journals.
346 Durable Responses at 24 Months With High-Frequency Spinal Cord Stimulation for Nonsurgical Refractory Back Pain
Authors: Patel Naresh P. , Kapural Leonardo , Jameson Jessica , Johnson Curtis , Kloster Dan , Calodney Aaron K. , Kosek Peter , Pilitsis Julie G. , Bendel Markus A. , Petersen Erika A. , Wu Chengyuan , Cherry Taissa , Lad Nandan P. , Yu Cong , Sayed Dawood , Province-Azalde Rose 
Published: March 2024

INTRODUCTION:
Chronic refractory back pain causes significant disability and is one of the most common reasons for patients seeking health care. Few treatment options exist for chronic back pain patients who have failed conventional medical management (CMM) and who have not had and are not candidates for spine surgery, a condition we refer to as non-surgical refractory back pain (NSRBP).

METHODS:
Patients with NSRBP were evaluated after 1:1 randomization to 10kHz SCS plus CMM or CMM alone. Primary endpoint and secondary endpoints were assessed, and optional crossover was allowed at 6 months, with observational follow-up over 12 months (Kapural, 2022). All patients treated with 10kHz SCS were eligible for follow-up through 24 months after implantation. Outcomes included pain, Oswestry Disability Index (ODI), quality-of-life (EQ-5D-5L), 3-item Pain Sleep Questionnaire (PSQ-3), opioid use, patient’s global impression of change (PGIC), and safety.

RESULTS:
Of the 125 patients who received a permanent implant, 121 completed 12-month follow-up, 101 reconsented for extended follow-up, and 98 completed 24-month follow-up. At 24 months after implantation 82% achieved =50% pain relief. All outcome measures improved by at least double the minimal clinically important difference. Ninety-percent of patients met at least one of the multidimensional outcomes. Of those who reported opioid use during the study, and 62% of decreased or stopped. Through 24 months, 3 of 125 (2.4%) devices were explanted due to patient dissatisfaction with SCS therapy.

CONCLUSIONS:
The addition of 10kHz SCS to CMM in patients with NSRBP offers profound improvements at 24 months in pain, function, quality-of-life, and reduced opioid use. This study provides much-needed evidence to inform current clinical practice for managing patients with NSRBP.
349 Brain Functional Imaging of Pain States Using Resting-State fMRI and Multi-Delay PCASL in Chronic Low-Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation
Authors: Oghli Yazan Shamli , Ashok Arjun Balaji , Ailes Isaiah , Syed Mashaal , Kang KiChang , Naghizadehkashani Sara , Fayed Islam , Matias Caio M. , Mohamed Feroze , Krisa Laura , Alizadeh Mahdi 
Published: March 2024

INTRODUCTION:
A treatment of chronic low-back pain is implantation of a thoracic spinal cord stimulator (tSCS), which has been shown to reduce pain. The functional changes in pain processing regions of the brain as assessed by resting-state fMRI and multi-delay pseudocontinuous arterial spin labeling (PCASL) have never been studied.

METHODS:
PCASL data based on 5 post-label delays (0.5–2.5s) as well as rsfMRI were acquired in five patients (1F) post-tSCS with cLBP and five healthy subjects (2F). Patient MRI scans were taken post-implantation with the SCS device turned off. Three PCASL measures and four rsfMRI measures were derived and normalized into MNI space and smoothed. Averaged values for each measure from the pain ROI atlas were extracted and compared between patients and controls. Statistics were conducted following Box-Cox transformation of data.

RESULTS:
Arterial transit time derived from PCASL showed a significant difference in the OFC, SMA, and PSG of patients, but other ASL measures showed no effect. Several regions across the rs-fMRI measures showed significant differences, including those involved in cognition (DLPFC, PCC), and pain processing (PSG) and sensation (S2).

CONCLUSIONS:
Functional imaging showed that cLBP patients treated with SCS display differences in resting-state function and brain perfusion across several pain regions of the brain. These areas are mainly part of the cognitive and behavioral components of the pain circuitry.
351 Comparing SCS and Conventional Medical Management in Patients With No Prior Back Surgery (SOLIS RCT)
Authors: North James , Paez Julio , Calodney Aaron K. , Loudermilk Eric , McCormick Zachary , Trainor Drew , Noles John , Yang Michael Ishu , Phillips Gregory , Wilson Derron , Rosen Steven , Guirguis Maged , Chen Lilly , Jain Roshini 
Published: March 2024

INTRODUCTION:
Spinal Cord Stimulation (SCS) as a treatment for chronic pain has been historically designated for patients who have had at least one prior spinal surgery. Modern SCS devices though now offer more novel technological capabilities and neurostimulative approaches than older-generational SCS systems.

METHODS:
This is a prospective, multicenter, randomized controlled trial (RCT) that compares therapeutic effectiveness of SCS versus CMM only, in patients with chronic low back and/or leg pain with no prior spinal surgery (SOLIS, Clinicaltrials.gov: NCT04676022). Enrolled NSBP patients are randomized to SCS combined with CMM (SCS + CMM arm) or a CMM-only arm. Those receving SCS are implanted with a multimodal system capable of engaging multiple mechanisms of action (Wavewriter Systems, Boston Scientific). Key inclusion criteria include diagnosis of chronic low back pain, with or without leg pain, for =6 months, and documented care of chronic pain for =90 days. The primary endpoint is responder rate (=50% reduction in pain) with no increase in baseline opioid medications to treat pain at 3-months following treatment activation.

RESULTS:
The primary endpoint (p < 0.0001) was met based on a prespecified cohort of 60 treatment-activated subjects. This analysis demonstrated that multimodal SCS combined with CMM was superior to CMM alone (p < 0.0001) in treating NSBP patients at 3-months follow-up (SCS: 88% versus CMM: 8%). Additionally, a 27-point reduction in Oswestry Disability Index score (improvement in disability) was noted in the SCS group versus a 6-point reduction in the CMM group.

CONCLUSIONS:
The data obtained in this RCT demonstrates that utilization of multimodal SCS provides for superior outcomes when compared to use of CMM alone for treatment of NSBP.
359 Low-Intensity Focused Ultrasound to Human Dorsal Anterior Cingulate Cortex and Insula Attenuates Measures of Central Sensitization
Authors: In Alexander , Strohman Andrew , Legon Wynn 
Published: March 2024

INTRODUCTION:
Central sensitization is the abnormal amplified response to pain and is associated with chronic pain. Increased insula and dorsal anterior cingulate cortex (dACC) activity is associated with central sensitization. Low-intensity focused ultrasound (LIFU) is a novel form of non-invasive neuromodulation that can precisely target the anterior insula (AI), posterior insula (PI) and dACC.

METHODS:
N = 18 healthy participants underwent conditioned pain modulation (CPM) and temporal summation of pain (TSP) tasks before and after 10 minutes of LIFU or sham stimulations. For CPM, the conditioning stimulus (CS) was a cold pressor test to the left hand and the test stimulus (TS) was a brief transient heat stimulus to the dorsum of the right hand. For TSP, 10 transient heat stimuli (>0.33 Hz) were administered to the dorsum of the right hand. The primary outcome measure for both tasks was perceived pain ratings (0-9). Electrodermal response and electrocardiogram was collected to evaluate the effect of LIFU on autonomic reactivity.

RESULTS:
LIFU to PI increased CPM 0.5 ± 0.181 compared to sham (p = 0.024). LIFU to PI also significantly reduced perceived pain during the TSP task compared to sham (p < 0.001). We also found a significant difference between dACC and sham conditions during TSP by -0.55 ± 0.05 (p < 0.001). LIFU to the AI increases frequency domain measures of heart-rate variability.

CONCLUSIONS:
LIFU to the insula and dACC affects pain processing in measures of central sensitization. This demonstrates the neuromodulation abilities of LIFU and is a promising tool to develop noninvasive clinical therapies for chronic pain conditions.
360 Diffusion Imaging-Derived Structural Changes in Cerebral Pain Regions of Chronic Low-Back Pain Patients Implanted With Thoracic Spinal Cord Stimulation
Authors: Oghli Yazan Shamli , Ashok Arjun Balaji , Ailes Isaiah , Syed Mashaal , Kang KiChang , Naghizadehkashani Sara , Fayed Islam , Matias Caio M. , Mohamed Feroze , Krisa Laura , Alizadeh Mahdi 
Published: March 2024

INTRODUCTION:
Thoracic spinal cord stimulation (tSCS) is an effective treatment of chronic low-back pain (cLBP). Although diffusion imaging has been conducted in this group of patients, the study of diffusion-derived structural imaging of regions involved in pain processing has not been conducted.

METHODS:
Diffusion-weighted imaging scans were acquired in five patients (1 female) post-tSCS with cLBP and five healthy subjects (2 female). Patient MRI scans were taken post-implantation with the SCS device turned off during the MRI session. Four DTI maps and four MAP maps were derived and normalized into MNI space and smoothed. DTI and MAP values for each measure from the pain ROI atlas were extracted and compared between patients and controls.

RESULTS:
Statistically significant differences were found in regions involved with sensory processing of pain (ASG, PSG) as well as affective pain experience (ACC) across the DTI measures. MAP measures showed significance across five ROIs involved with sensory processing of pain, affective pain experience, and fear response (AMYG).

CONCLUSIONS:
Diffusion-derived structural imaging of pain regions suggests that cLBP patients receiving SCS have differences in diffusion imaging-derived structural parameters involved with pain processing, cognition, and fear response.
367 Postoperative Opioid Use Among Cannabis Users Following One-, Two-, and Three-Level Lumbar Fusions
Authors: Khalid Syed Ibad , Mirpuri Pranav , King Patrick J. , Mehta Ankit Indravadan , Adogwa Owoicho 
Published: March 2024

INTRODUCTION:
Opioids are critical for pain management following spine surgery. Given the devastating consequences of the opioid epidemic, strategies to minimize dosing and chronic use of opioids should be developed.

METHODS:
This retrospective study used medical coding to identify patients who had undergone 1-3 level lumbar fusions between January 2010 and October 2020. Propensity score matching based on demographics and comorbidities created two equal cohorts concerning cannabis use history. Opioid utilization rates (morphine milligram equivalents/day) and overuse rates six months after the index procedure were assessed.

RESULTS:
1,216 patients were matched and distributed equally into cannabis and non-cannabis user cohorts. Lower rates of opioid utilization were found among cannabis users versus control as early as two months after fusion (47.7% versus 41.1%, p < 0.05), a relationship which persisted at six months as well (46.2% versus 37.7%, p < 0.01). Lower rates of high-dose opioid utilization (=100 MME per day) were also found in the cannabis user cohort during the initial period of 14-30 days following surgery (6.91% versus 3.79%, p < 0.05). This relationship also approached significance 121-150 days after surgery (3.13% versus 1.32%, p = 0.051).

CONCLUSIONS:
In this study, patients with a history of cannabis use were less likely to use opioids as early as two months postoperatively. They had lower rates of high-dose opioid utilization in the immediate postoperative period. While this study cannot say whether cannabis is a beneficial adjunctive therapy for pain, clearly physicians should be aware of their patients’ cannabis use patterns to provide appropriate dose titration over time.
370 Is There an Optimal Surgical Approach in Degenerative Cervical Myelopathy?: An Individual Participant Data Meta-Analysis
Authors: Bak Alex Beomju , Moghaddamjou Ali , Alvi Mohammed Ali , Harrop James S. , Arnold Paul M. , Fehlings Michael G. 
Published: March 2024

INTRODUCTION:
Contradictions exist about impact of anterior vs. posterior surgical approach on outcomes of degenerative cervical myelopathy (DCM).

METHODS:
Individual patient data of subjects who underwent surgery for DCM was identified from a pooled dataset of the AO Spine CSM-North America, CSM-International, and CSM-Protect clinical studies. Primary outcomes were changes in short form 36 Physical Component Summary score (SF36-PCS) and mJOA score at 12 months. Secondary outcomes were change in total Neck Disability Index (NDI) score and SF36 Mental Component Summary score (SF36-MCS). Two comparison cohorts were created: i) anterior surgery and ii) posterior surgery. One-stage mixed-effects meta-analysis with study and treatment exposure as random effects was performed and reported with mean differences and 95% confidence intervals. A subgroup analysis planned a priori in mild DCM patients (mJOA 15-17) was performed.

RESULTS:
A total of 979 patients met eligibility criteria. Patients who had anterior decompressive surgery experienced greater improvements at 1yr of follow-up than those who underwent posterior decompressive surgery in SF36-PCS score (adjusted MD 1.57 [95% CI 0.11 to 3.03], p = 0.0348) and NDI score (adjusted MD 3.32 [95% CI 0.58 to 6.05], p = 0.0172). A greater proportion of patients that underwent anterior surgery achieved clinically important recovery of their NDI (OR 1.49 [95% CI 1.15 to 1.93], p = 0.002; aOR 1.46 [95% CI 1.08 to 1.96], p = 0.013) and SF36-PCS scores at 1yr (OR 1.45 [95% CI 1.12 to 1.88], p = 0.004, aOR 1.34 [95% CI 1.00 to 1.80], p = 0.052). In patients with mild DCM (n = 186), patients who underwent anterior decompressive surgery experienced greater improvements in SF36-PCS score, mJOA score, and Neck Disability Index score than posterior surgical patients.

CONCLUSIONS:
Anterior surgical decompression for DCM is associated with greater improvements in 1yr patient-reported outcomes than posterior surgical decompression.
371 The Impact of Thoracolumbar Inflection Point on Outcomes and Complications in Adult Spinal Deformity
Authors: Mir Jamshaid M. , Passias Peter G. , Lewis Stephen , Tretiakov Peter S. , Dave Pooja , Lafage Renaud , Smith Justin S. , Line Breton G. , Diebo Bassel G. , Daniels Alan H. , Gum Jeffrey Lynn , Protopsalt Themistocles 
Published: March 2024

INTRODUCTION:
The importance of alignment on postoperative outcomes and mechanical complications has been well established. However, the impact of alignment parameters relative to thoracolumbar inflection point remains unclear.

METHODS:
ASD patients with 2-year data, fused in the lower-thoracic (T7-T12) to sacrum were included. Thoracolumbar inflection-point(IP), IP differences from UIV, LLA, and theoretical-IP based on Roussouly morphology were assessed. Cases were stratified based on IP changes from baseline (BL) into Caudal(L), Same(S), or Cranial(H). Analysis controlled for invasiveness, baseline deformity, frailty, and PJK prophylaxis.

RESULTS:
650 patients met inclusion. PJF or PJK with reoperation was associated with a more caudal BL-IP (L2 inferior end plate (EP) vs L1-body, p < .001). In adjusted analysis, a more caudal BL IP had 25% higher odds of developing PJF by 2Y (OR:1.26, p=0.003). Postoperative normalization to theoretical Roussouly IP was associated with decreased rates of rod breakage (p = .049), but had higher rates of PJF (p = .044). Stratifying groups based on IP change from BL, rates of PJK and PJF by 2Y were higher in H (p < .003), with no difference in meeting Roussouly target IP. There was 4.4x lower odds of developing PJF in L and 2.0x in S compared to H (p < .05). Increased distance of UIV to IP was associated with mechanical-complications (MC) (p < .05). Decreased distance between LLA-IP at BL was associated with MC (p = .04).

CONCLUSIONS:
Despite lower frailty and baseline deformity in the cohort with a more cranially adjusted postoperative inflection point, there were higher rates of PJK and PJF. Increased distance between lumbar lordosis apex and inflection point was associated with higher rates of PJK, PJF, and thoracic decompensation. Correspondingly, a greater distance between the upper instrumented vertebra and inflection point was predictive of development of regional decompensation. The target inflection point can be an important parameter to minimize complications associated with ASD surgery.
375 Cervical Arthroplasty in the Treatment of Myelopathy: Clinical Predictors, Utilization, and Outcomes in a Large Administrative Database
Authors: Norval de Leeuw Charles , Yoo Jung U. , Orina Josiah N. 
Published: March 2024

INTRODUCTION:
Cervical arthroplasty is a treatment for cervical radiculopathy; however, it may also be safe and effective in patients with mild myelopathy.

METHODS:
Retrospective data spanning 2016-2020 from the PearlDiver Patient Claims Database was used to select patients. Age, gender, osteoporosis, obesity, smoking, diabetes, Charlson Comorbidity Index (CCI), and 1- or 2-level surgery, re-operation rates, 90-day readmission, medical complications, and morphine milligram equivalents (MME) before/after surgery were collected. Univariate & multivariate analyses were performed to identify differences. Reoperation rates were compared using propensity-matched analysis.

RESULTS:
We identified n = 2,391 (4.5%) CDA and n = 50,845 ACDF procedures for cervical myelopathy. Predictors favoring CDA included female sex, younger age, lower CCI score, lower incidence of obesity, osteoporosis, diabetes, or smoking (p ≤ 0.001); remaining significant after multivariate analysis except sex (p = 0.06). Single-level surgery was more predictive for undergoing CDA. CDA patients had lower 90-day readmissions, complications, and lower opioid utilization. The overall reoperation rate was 5%. Predictors of reoperation included: male sex, younger age, greater CCI, obesity, osteoporosis, diabetes, smoking, and 2-level surgery, remaining significant after multivariable logistic regression except for diabetes (p = 0.23) and CCI (p = 0.05). The robustness of these factors were evaluated by matching patients (n = 2,391) with no difference in re-operation rates identified (p = 0.47).

CONCLUSIONS:
CDA patients are generally healthier (lower incidence of obesity, smoking, diabetes, CCI) and represents 4.5% of procedures for 1- or 2-level cervical myelopathy. Readmission rates, medical complications, and opiate use was lower with patients undergoing CDA, despite an overall similar reoperation rate. This study is limited by its retrospective nature and the lack of granular outcomes measurements. However, the data suggests that CDA is a viable option for cervical myelopathy.