bluuebunny/crossref_metadata_2025_split huggingface dataset:
461 Outcomes and Healthcare Utilization of Adult Spinal Cord Injury Associated With Time to Surgery: An Analysis of the National Trauma Data Bank (NTDB): 2019-2021
Authors: Pico Annemarie Campbell , Nosova Kristin , Deaver Courtney , Bauer Isabel L. , Dholaria Nikhil , Quiceno Esteban , Hussein Amna , Abdulla Ebtesam , Moniakis Alexandros , Khan Monis , Prim Michael Dyton , Bates Bryan , Keric Natasha , He Jack , Baaj Ali A. 
Published: March 2024

INTRODUCTION:
Prior studies have established evidence that early surgical decompression following traumatic spinal cord injury (SCI) is associated with better outcomes. However, it is not clear whether increased time to surgery is correlated with worse complications and increased healthcare utilization.

METHODS:
Patients with traumatic SCIs were identified in NTDB. For surgical patients, time to surgery was extracted and patients classified by time to surgery of >=12 hours. Chi-sq and non-parametric tests were used.

RESULTS:
9,987 patients with SCI were identified; 40.49% were complete. 66.24% of incomplete and 56.66% of complete had a time to surgery greater than 12 hours. Those with incomplete SCI and surgery after 12 hours had increased Injury Severity Score (ISS) (μ = 0.36), ICU length of stay (LOS) (μ = 0.91 days), days on ventilation (μ = 2.01 days), and days to discharge (μ = 1.39 days) (p < 0.005). Those with complete SCI and surgery after 12 hours had increased ICU LOS (μ = 2.7 days, p < 0.0001). Mortality rate was not positively associated with time to surgery greater than 12 hours for complete and incomplete SCI group.

CONCLUSIONS:
Although prior studies support earlier surgical intervention for those experiencing SCI, the majority of patients are undergoing surgery more than 12 hours after their injury. Additionally, patients with incomplete SCI waiting >=12 hours have longer ICU stay, more ventilated days, longer hospitalization, and increased ISS. Additional studies are needed to identify barriers to earlier surgery and to establish cutoff times for maximum benefit.
464 Remote Cognitive Behavioral Therapy Utilizing an In-home Virtual Reality Toolkit (Vx Therapy TM) Reduces Pain, Anxiety, and Depression in Patients With Chronic Cervical and Lumbar Pain: A Potential Opiate Alternative in Multimodal Pain Management
Authors: McGirt Matthew J. , Holland Christopher Michael , Zuckerman Scott L. , Theodore Nicholas , Pfortmiller Deborah , Stanley Gerry 
Published: March 2024

INTRODUCTION:
Virtual reality has reduced acute pain through visual and auditory distraction, as well as altered brain neurobiology. VR attenuates pain-induced brain activity without narcotic-related side effects or dependency. Cognitive behavioral therapy (CBT) has demonstrated improved pain-related anxiety, depression, physical disability, resiliency, and quality of life. CBT access remains a challenge in most care communities.

METHODS:
145 patients with chronic neck and back pain (63 cervical, 46 non-radicular lumbar, 36 radicular lumbar) enrolled into a 14 week Vx therapy CBT program with therapist guided utilization of an in-home VR system with 50 modules (education, meditation, distraction, entertainment). Pain and anxiety severity scores were recorded before and immediately after VR use as well as time to pain recurrence. PROMIS measures of daily pain intensity, pain behavior, pain interference, anxiety, and depression were recorded at baseline and after 14 weeks of Vx therapy.

RESULTS:
PROMIS domains were significantly improved after Vx treatment vs baseline for the entire cohort and each subgroup. VR acutely reduced pain during use on average by 33% (p < 0.05) across all 14 weeks lasting a mean 2.5 hours. VR acutely reduced anxiety during use on average by 46% (p < 0.05) across all 14 weeks lasting a mean 2.7 hours. The effect was similar for all three diagnosis groups.

CONCLUSIONS:
Remote CBT guided in-home VR toolkit (Vx therapyTM) provided effective multi-hour sustained pain relief in patients with chronic neck and back pain with and without radiculopathy. Significant improvement in overall pain, anxiety, and depression and reduced pain interference was observed. This non-invasive, non-pharmaceutical Vx therapy is an ideal option to improve outcomes in post-opioid pain management.
466 Primary Anterior Lumbar Interbody Fusion, With and Without Posterior Instrumentation: A 1377 Patient Cohort From a Multicenter Spine Registry
Authors: Laiwalla Azim , Chang Richard , Harary Maya , Alsalek Samir , Richards Hunter , Brara Harsimran Singh , Hirt Daniel , Harris Jessica , Terterov Sergei , Tabaraee Ehsan , Rahman Shayan 
Published: March 2024

INTRODUCTION:
Anterior lumbar interbody fusion (ALIF) is a versatile and powerful technique for a variety of lumbar degenerative pathologies. Adding posterior supplementary fixation to ALIF (ALIF+PSF) is common and may confer benefits in terms of higher fusion rate but could contribute to adjacent segment disease (ASD) due to additional rigidity.

METHODS:
Adult patients who underwent primary ALIF for lumbar degenerative pathology between levels L4-S1 over a 12-year period were included. Cases of trauma, cancer, infection, supplemental decompression, noncontiguous fusions, prior lumbar fusions, and other interbody devices were excluded. Primary outcomes included reoperation for nonunion and ASD. Multivariable Cox proportional hazard regression was used to evaluate risks adjusting for patient characteristics.

RESULTS:
The study consisted of 1377 cases; 307 ALIF alone and 1070 ALIF+PSF. Mean follow-up time was 5.6-years. 5-year crude nonunion incidence was 2.4% for ALIF only and 0.5% for ALIF+PSF; after adjustment for covariates, a lower operative nonunion risk was observed for ALIF+PSF (HR = 0.22, 95% CI = 0.07-0.70). Of patients deemed potentially suitable for ALIF alone, one would need to add PSF in 53-patients to prevent one case of operative nonunion at a 5-year follow-up (number needed to treat). Five-year operative ASD incidence was 4.3% for ALIF only and 6.2% for ALIF+PSF; with adjustments, no difference was observed between the cohorts (HR = 0.96, 95% CI = 0.53-1.74).

CONCLUSIONS:
While addition of posterior instrumentation in ALIFs is associated with lower risk of operative nonunion compared to ALIF alone, it is rare in both techniques (<5%). Accordingly, surgeons should evaluate added risks associated with addition of PSF, and rather reserve PSF for patients at higher risk for operative nonunion. Rates of operative ASD were not statistically higher with addition of PSF suggesting concern regarding future ASD may be less supported.
470 Changes in CT Hounsfield Unit and T Score Before and After Osteoporosis Treatment With Teriparatide or Denosumab
Authors: Yaffe Noah , Herring Eric , Mauria Rohit , Labak Collin M. , Sharpe Megan , Wong Mandy , Okonmah Amanda , Patel Mohit , Smith Gabriel Alexander 
Published: March 2024

INTRODUCTION:
In 2004, 10 million individuals over the age of 50 were estimated to suffer from osteoporosis in the US and this prevalence was expected to rise dramatically. Currently the standard for diagnosis is by defining the bone mineral density using a dual energy xray absorptiometry (DEXA) machine. Literature has demonstrated that the hounsfield (HU) on a CT of the lumbar spine vertebrae can be an extremely sensitive and specific metric towards identifying those with osteoporosis or osteopenia, however further evaluation of this measure and how it changes with osteoporosis treatment, specifically with newer treatment options (ie denosumab and teriparatide) is needed.

METHODS:
Chart review was completed for patients started on denosumab or teriparatide between 2014 and 2022. Patients were included if they were started on denosumab or teriparatide for osteoporosis or osteopenia treatment and had a DEXA and CT available at some point pre or post treatment. Demographic, medication information, pre and post treatment both DEXA based T scores and CT Hounsfield units (HU) at T12-L3 were collected. ANOVA and T tests were used for statistical analysis.

RESULTS:
A total of 38 patients were included in our study. Average premedication HU at T12, L1, L2, L3 were 106, 94, 92, and 83 respectively. Those treated with teriparatide showed a significant (p = 0.03) decrease in HU at L1 over the study period compared to those treated with Denosumab.

CONCLUSIONS:
HUs can serve as a widely available surrogate to both diagnose and monitor the treatment of osteoporosis.
472 Complications of 3D-Navigated Spinal Procedures: A Systematic Review
Authors: Suri Ikaasa , Suthakaran Sayahi , Ezzat Bahie , Arroyave Villada Juan Sebastian , Kwon Daniel , Martin Lily , Hu James , Yaeger Kurt , Carr Matthew Thomas 
Published: March 2024

INTRODUCTION:
3D surgical navigation has revolutionized spinal surgery. However, information on the overall usability of these tools is limited and inconsistent, especially with regard to operative time and radiation exposure. Complication rates across institutions and platforms have not been systematically examined, leading to a lack of quantitative understanding on surgical success rates.

METHODS:
This study used PRISMA guidelines and a PROSPERO-registered protocol to identify studies on FDA-approved 3D navigation systems in spinal procedures from Ovid MEDLINE(R), Embase, and Cochrane CENTRAL. Results were assessed by two independent reviewers using inclusion/exclusion criteria and risk of bias tools.

RESULTS:
70 studies, totaling 3500 patients, were included. Complication and surgical success rates have remained constant since 2004, with overall rates of 5.18% and 93.74%, respectively. When segmented by spinal region, complication rates may be moderately positively correlated with frequency of cervical and thoracic procedures (r = 0.49, p = 0.40). 23 studies, totaling 1723 patients, compared the performance of 3D navigation to 2D fluoroscopy or freehand navigation. There was a significant difference of 6.47% between surgical success rates of the interventional and control groups (p = 0.01). However, there was no significant difference in radiation exposure or operative time between 3D navigated procedures and their controls.

CONCLUSIONS:
This study concludes that 3D navigation may have higher surgical success rates than 2D fluoroscopy and freehand navigation; increased surgeon comfort with riskier procedures on more complex segments of the spine may explain the slight increase in complication rates observed since 2004; and there is a need for improvement in 3D navigation tools to decrease operative time and radiation exposure.
474 Comparing the Reciprocal Changes of Single Level Transforaminal Interbody Fusions Versus Lateral Interbody Fusions: A Radiographic Analysis for Sagittal Alignment and Spinopelvic Parameters
Authors: Giraldo Juan Pedro , Zhou James , Farber Samuel Harrison , Moraes Vitor , Alan Nima , O'Neill Luke , Tumialan Luis Manuel , Uribe Juan S. 
Published: March 2024

INTRODUCTION:
Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are two techniques that are widely used to treat single-level pathology at L4-5. To date, no studies have compared the two techniques in terms of their ability to address disc space pathology, such as loss of height and spondylolisthesis, and achieve spinopelvic alignment goals.

METHODS:
After IRB approval, this study retrospectively reviewed the records of 203 patients who underwent single-level L4-L5 TLIFs and single-level L4-L5 LLIFs between 2017 to 2022. Preoperative and postoperative scoliosis films were collected and analyzed using an automated calibrated radiographic tool to measure pre-postoperative SA and SPs. Two blinded readers measured the pre-postoperative variables. Independent Sample T-tests were used to analyze the radiographic outcomes between the two groups.

RESULTS:
This study evaluated the results of 203 single-level TLIFs and LLIFs (109 L4-L5 TLIFs, and 94 L4-L5 LLIFs). Among the surgeries analyzed, 90 were MIS TLIFs, 19 open TLIFs, 16 standalone LLIs, and 78 LLIFs with posterior instrumentation. Postoperative scoliosis films were taken at a median of 0.28 (± 0.4) months. The analysis focused on comparing the reciprocal changes between both procedures. Significant statistical differences was found for ΔGTilt (p = 0.036), ΔLPA (p = 0.12), ΔADH (p = 0.03), ΔPDH (p = 0.04), ΔFH (p = 0.001), and ΔS% (p = 0.01) in the LLIF group, among all the variables included in the analysis.

CONCLUSIONS:
L4-5 LLIF and TLIF resulted in statistically similar amounts of lordosis restoration and reciprocal change at proximal and distal lumbar levels. LLIF was found to be superior in restoration of anterior disc height, posterior disc height, and foraminal height compared to TLIF. LLIF was also superior in percentage reduction of spondylolisthesis.
475 Molybdenum-Rhenium Rods in Complex Adult Spine Surgery Without Rod Fractures: A Multicenter Retrospective Case Series
Authors: Enguidanos Stephen , Ammar Kevin N. , Poelstra Kornelis , Cormier Jason , Malcolm James , Scibelli Stephen , McGirt Matthew J. , Chang Michael S. , Seecharan Dave , Chen Yi-Ren , Sinha Maya , Mehta Ankit Indravadan , Cowart Pam 
Published: March 2024

INTRODUCTION:
In complex spine surgery, current pedicle screw systems with 5.5 mm titanium, cobalt chromium or stainless steel rods have rod failure rates of approximately 9% with a minimum of 1-year follow-up. The fracture rate with these alloys increases to approximately 22% in PSO cases.1 Molybdenum-rhenium has demonstrated superior yield strength and fatigue endurance limit compared to Ti-6Al-4V and CoCr.

METHODS:
Retrospective, multicenter, case series. Inclusion criteria were = 4 levels posterior instrumented fusion with 4.5 mm molybdenum-rhenium rods, age = 18 yrs and 6 months or longer radiographic and followup.

RESULTS:
One hundred and fifty-nine (159) consecutive patients from ten different medical centers that had spinal surgery from August 2019 until April 2022 met inclusion criteria. Mean age was 63 ± 11.8 years; 50% women; 31% smokers; 19% diabetic and the mean BMI was 30 ± 7.3. The mean number of levels fused was 5.9 ± 2.7; 22.6% 4 levels, 64.2% 5-9 levels and 13.2% 10 levels or greater. Approximately half were thoracolumbar (27.7%) or thoracolumbar to pelvis (24.5%) and approximately half were lumbar-sacral (47.2%). Thirty-eight patients (24%) had a PSO and 59 patients (39%) had a SPO. All cases were done with molybdenum-rhenium 4.5 mm diameter rods. There were no RFs reported in the 159 cases (0/159; 0.0%) at 22.36 months mean follow-up.

CONCLUSIONS:
There was no incidence of RF in the 159 consecutive patients who underwent complex spine surgery involving multiple levels and osteotomies. A pedicle screw system based upon molybdenum-rhenium 4.5 mm rods provides superior fracture resistance particularly in complex spine procedures.
1 Smith JS, et al., Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine. 2014 Dec; 21(6): 994-1003.
479 BrainPacer: Wireless Battery-Free Neuromodulator Embedded in a Dural Graft
Authors: Garcia Diogo P. , Benbuk Ahmed , Gullick Daniel , Christen Jennifer , Quinones-Hinojosa Alfredo 
Published: March 2024

INTRODUCTION:
Neuromodulation represents an emerging realm of disruptive technologies for brain/spine disorders with potential applications across disease states, including neurodegenerative, neoplastic, epilepsy, trauma and vascular disorders. However, current implants have limitations inherent to the use of wires, batteries that need replacement, infection, and implant failure that have hindered wider adoption.

METHODS:
A 100 µm-thick, biocompatible, flexible, and transparent Parylene/PDMS substrate was used. In vivo validation (120 stimulation bursts, 10 pulses, 4 rats and 4 implants) was pursued using motor cortex stimulation after identification of the hindlimb representation via direct cortical stimulation. Hindlimb motion and reliability of stimulation and movement were detected via a video analysis software. A comparison of efficiency was conducted between the proposed dura substitute method and conventional direct stimulation method.

RESULTS:
Benchtop testing demonstrates reliable monophasic voltage pulses with an amplitude of 20V that can be subsequently regulated. Stimulation through the dura substitute results in reduced efficiency by 60% due to current loss but it offers the same reliability, triggering a motor response at each stimulation onset with an average limb deflection of 5.2 ± 2.986 mm with 99% confidence level. At least 30 seconds of recordings were obtained in each animal at a stimulation frequency of 1 Hz.

CONCLUSIONS:
We designed, validated and tested both a novel wireless and battery-free implant and a novel embodiment for placement with revolutionary potential. The implant triggers motor response through an FDA-approved dura substitute, without contacting the cortical surface. Studies in free-moving animals for chronic response studies are ongoing.
480 Effect of Chronic DBS on Ventral Capsule Ventral Striatum-Specific Circadian Rhythm in Refractory Obsessive-Compulsive Disorder
Authors: Reddy Sandesh , Provenza Nicole , Rajesh Sameer Vikram , Diab Nabeel , Allam Anthony , Reyes Gabriel , Dang Huy , Najera Ricardo Andres , Katlowitz Kalman , Giridharan Nisha , Banks Garrett , Storch Eric , Herron Jeffrey , Goodman Wayne , Sheth Sameer A. 
Published: March 2024

INTRODUCTION:
Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) improves symptoms in ∼66% of patients with treatment-resistant obsessive-compulsive disorder (OCD). However, a common adverse effect of VC/VS DBS is hypomania, marked by decreased need for sleep and increased risk-taking behaviors. Modern DBS devices have enabled 24-hour collection of neural data, allowing for tracking of circadian rhythms reflected by VC/VS local field potentials (LFPs).

METHODS:
We implanted six patients with treatment-resistant OCD with a DBS device configured for constant VC/VS stimulation and recording. Spectral power in the 9 ± 2.5 Hz band was estimated onboard the device every 10 minutes for a median of 249 days (range 77-608). We assessed the rhythmicity of power in this spectral band by fitting 7-day retrospective rolling windows of per-day normalized LFP power to cosine functions using least-squared regression. Output metrics included acrophase (time of peak activity), amplitude, and fit significance. We quantified trends in acrophase over time using Pearson correlation.

RESULTS:
All six patients demonstrated consistent 24-hour cyclic LFP activity bilaterally. Two of the six had diurnal peaks which shifted significantly earlier across the study period. The remaining four patients had nocturnal peaks, all shifting significantly later over time. Notably, a patient in the latter group experienced three days of hypomania after DBS initiation associated with circadian disruptions even after clinical symptom resolution. Only after clinical DBS adjustment 2 weeks later did circadian rhythm rapidly return to pre-hypomanic levels.

CONCLUSIONS:
Study patients demonstrated evolving circadian VC/VS LFP activity across the course of DBS therapy, usually independent of cyclic whole-brain activity (i.e. sleep). Conversely, disruptions to these circadian patterns, as observed here during hypomania, may serve as biomarkers of region-specific stimulation side effects.
481 Spinal Cord Stimulator Promotes Neuroplasticity in Patients With Severe Spinal Cord Injury
Authors: Porceban Matheus Moreli , Angelin Leonidas Gomes , Alonso Angelica Castilho , Prota Cristina , Cavalcante de Abreu Christiane Pereira , Storer Ribeiro Lucia Helena , Barros Santos Jenniffer Grace , Cristina de Souza Juliana , Mayr de Biase Maria Eugenia , Sitthinamsuwan Bunpot , Majeed Nasir , Gabana Edelvan , Rodriguez Ferreira Ricardo José , Marcon Raphael Martus , D'Andrea Greve Julia Maria , Cristante Alexandre Fogaça , Lepski Guilherme Alves 
Published: March 2024

INTRODUCTION:
Traumatic spinal cord injury (SCI) is one of the leading causes of morbidity and mortality worldwide. Recently, epidural electrical stimulation (EES) has been shown to restore voluntary motor control in patients with severe SCI.

METHODS:
To this date, three patients with SCI have been implanted with 5-6-5-Specify-Medtronic electrodes and Medtronic-Intellis pulse generator. All procedures were approved by the local Ethics Committee. The age of the patients ranged from 38-69 y, and the levels of the SCI were C6-D5. Clinically, they were classified ASIA A (2) or B (1). The time frame after injury was 2-7 y. Intraoperative electrophysiological mapping was performed to ensure correct location of the lead at the levels involved in the control of L3-S2 nerve roots. Clinical assessments were performed every 3 m. Additionally, we measured superficial EMG each month, through sensors equipped with accelerometers and gyroscopes.

RESULTS:
One patient completed 12 m of intense rehabilitation program. The other two patients are currently on training and to this date they completed respectively 6 and 3 months of the program. All 3 patients were able to perform walking activities on a treadmill and stationary bicycle with stimulation turned on. There was an important improvement in the scales related to motor skills and balance, at expense of worsening in pain scores. After 8 months the first patient started to present voluntary movements even with stimulation turned off.

CONCLUSIONS:
EES allows restoration of voluntary motor control of the legs after severe traumatic SCI. Moreover, after 8 months, a plastic effect could be observed, and a patient was able to control movements even with off stimulation. The observed improvement in overall patient’s performance occurred at expense of more pain, which need to be addressed carefully.
493 Predictors of Recurrence After Surgical Resection of Parafalcine and Parasagittal Meningiomas
Authors: Khanna Omaditya , Momin Arbaz , Barsouk Adam , Mahtabfar Aria , Andrews Carrie Elizabeth , Hafazalla Karim , Lan Matthews , Patel Pious D. , Baldassari Michael P. , Andrews David W. , Evans James J. , Farrell Christopher James , Judy Kevin D. 
Published: March 2024

INTRODUCTION:
Parasagittal and parafalcine meningiomas are challenging tumors to resect, owing to their proximity to the sagittal sinus and associated collateralized venous channels. More research is needed to elucidate relevant factors that affect risk of recurrence.

METHODS:
This is a retrospective study of all patients who underwent resection of parasagittal and parafalcine meningiomas between 2012-2018. Multivariable Cox regression and Kaplan Meier analysis was performed to assess for factors that influence progression free survival (primary endpoint).

RESULTS:
A total of 110 consecutive subjects (mean age: 59.4+/-15.2 years, 67.3% female) with 74 parasagittal and 36 parafalcine meningiomas (92 WHO grade 1, 18 WHO grade 2/3) are included in the study. A total of 37 patients (33.6%) exhibited recurrence with median follow-up of 42 months (IQR: 10-71). In the overall cohort, parasagittal meningiomas exhibited shorter progression free survival compared to parafalcine meningiomas (p = 0.045). On univariate analysis, predictors of recurrence include WHO grade 2/3 vs. grade 1 tumors (HR 4.27, 95%CI: 2.01-9.09; p < 0.001), higher Ki-67 indices (HR, 1.11, 95% CI: 1.07-1.14; p < 0.001), partial (Sindou class 2-4) (HR 2.32, 95% CI: 1.03-5.19; p = 0.04) or complete (Sindou class 5-6) sinus invasion (HR 4.65, 95% CI: 2.07-10.42; p < 0.001), and subtotal resection (HR 4.13, 95% CI: 2.05-8.32; p < 0.001). Location along the anterior, middle or posterior third of the sagittal sinus did not influence risk of recurrence (HR 0.82, 95%CI: 0.30-2.28; p=0.71). Multivariable Cox regression analysis revealed high grade meningiomas (HR: 3.62, 95% CI: 1.60-8.22; p = 0.002), complete sinus invasion (HR: 3.00, 95% CI: 1.16-7.79; p = 0.024), and subtotal resection (HR: 3.10, 95% CI: 1.38-6.96; p = 0.006) portend increased risk of recurrence.

CONCLUSIONS:
This is the largest study to date that identifies predictors that confer increased risk of recurrence after resection of parasagittal and parafalcine meningiomas, which can be used to