bluuebunny/crossref_metadata_2025_split huggingface dataset:
624 Economic Development and Trends of Cerebrovascular Disease Mortality in Eastern Europe: 1992-2019
Authors: Stonnington Henry Owen , Singh Rohin , Nguyen Brandon , Rangel India , Brown Nolan James , Shahrestani Shane , Patel Naresh P. 
Published: March 2023

INTRODUCTION:
Several studies have shown that a country's overall mortality rates are inversely related to it's gross domestic product (GDP). Eastern Europe experienced rapid economic growth after the fall of communism, and as such its public health sector swiftly improved. How this economic growth has affected mortality rates due to cerebrovascular disease has never been studied.

METHODS:
Eight countries were included in this study, representing the Warsaw Pact founding members: Albania, Bulgaria, Poland, Romania, Hungary, and Czechia, with Russia and Ukraine representing the former Soviet Union. As East Germany joined West Germany in 1990, it was excluded. Age standardized death rates from cerebrovascular disease per 100,000 people from 1992-2019 were taken from the World Health Organization (WHO) Mortality Database using the ICD-10 (International Classification of Disease) codes 160-169. Each country’s GDP per capita (inflation adjusted to 2015 dollar amount) during those years was taken from the World Bank World Development Indicators Database.

RESULTS:
Cerebrovascular disease mortality decreased from 1992-2019 in every country, despite divergent trends in economic development. Indeed, Ukraine’s cerebrovascular disease mortality rate decreased by 42.9% even though its GDP per capita decreased by 4.8%. The countries with the largest decreases in mortality are Czechia (-78.9%), Hungary (-62.7%), and Russia (-49.3%) while Albania had the smallest decrease (-29.4%).

CONCLUSIONS:
Rates of cerebrovascular disease mortality among the Warsaw Pact’s founding members decreased after the fall of communism, despite differing rates of economic development. Further research is warranted regarding these countries’ healthcare practices during this period. Hopefully, lessons can be gleaned to improve public health and neurosurgical care in other developing nations.
626 From the Stroke Belt to San Francisco: Racial Disparities in Stroke Persist
Authors: Collins Malie Kawila , Billingsley Angel , Amoah Dadey David Yaw , Dodd Robert L. 
Published: March 2023

INTRODUCTION:
Racial disparities in stroke are classically observed in geographical areas carrying the greatest stroke burden and mortality, namely the Stroke Belt region of the Southeastern U.S. In these territories, African Americans experience a substantially greater stroke incidence than Caucasians, however there is a paucity of in-depth analyses for regions of vastly different demographic variation and socioeconomic profile. The authors seek to determine if the same disparity exists in the surrounding counties of the San Francisco Bay Area.

METHODS:
A county-specific search of the CDC Interactive Atlas of Heart Disease and Stroke was conducted for seventeen Bay Area counties (2017-2019) using stroke hospitalization rates by race, population counts, race distribution, and percent aged ≥65. Percent estimates of the racial distribution of IS and HS hospitalizations were calculated. The probability of Black racial identity and IS was estimated to observe the relationship between population distribution across counties and the likelihood of IS hospitalization among Blacks.

RESULTS:
Stroke hospitalization rates among Blacks/African Americans averaged 10.67 per 1000 for IS (95% CI [10.01, 11.32]), 2.19 for HS (95% CI [1.96, 2.42]); average rates among whites/Caucasians were 7.04 (95% CI [6.64, 7.45]) and 1.37 (95% CI [1.30, 1.43]), respectively. While the probability of Black racial identity and IS hospitalization was expectedly higher in counties with a larger Black population, it was disproportionate in counties like Alameda and Sacramento.

CONCLUSIONS:
Examination of CDC data revealed a 1.5-fold greater disparity in stroke hospitalization rates among African Americans in the San Francisco Bay Area, indicating a persistence of established racial disparities in other parts of the country. Further analysis of socioeconomic data by county and regional comparisons are necessary to uncover the mechanisms of racial disparity in stroke.
658 Pseudarthrosis and Reoperation Rates in Minimally Invasive Adult Spinal Deformity Correction
Authors: Kalavacherla Sandhya , Stone Lauren , Pham Martin H. 
Published: March 2023

INTRODUCTION:
Adult spinal deformity (ASD) has historically been corrected via open surgery (OS). Recent developments in minimally invasive surgery (MIS) have made ASD correction possible with less blood loss, shorter hospital stays, and fewer complications. However, it has been proposed that inherent exposure constraints in MIS approaches limit proximal construct fusion, resulting in pseudarthrosis and potentially proximal junctional kyphosis and failure.

METHODS:
We initially screened 66 abstracts in PubMed. Manuscripts were initially included if they described outcomes from an MIS to correct ASD, including those comparing outcomes between MIS and OS or hybrid open-MIS. Exclusion criteria included failure to mention pseudarthrosis and surgeries performed on 2 levels or fewer. After independent review by two authors, 10 papers were selected. Patient demographics, perioperative and postoperative characteristics were calculated.

RESULTS:
Within the 10 articles, 509 MIS patients were reviewed. The average age was 65.5 years; 64.8% were female. An average of 6 levels (4.2 - 11) were fused per patient. Perioperative characteristics include mean follow-up time of 26.9 months, mean estimated blood loss (EBL) of 527 mL, mean operating time (OT) of 297.9 minutes, and mean length of stay (LOS) of 7.7 days. Among manuscripts comparing MIS to OS, all reported a statistically significant lower EBL in MIS patients. Conversely, OT and LOS were less consistently reported as lower in MIS compared to OS. The overall proximal pseudarthrosis rate among MIS patients was 6.2%. Among patients with pseudarthrosis, 88.2% underwent revision.

CONCLUSIONS:
The results of this analysis demonstrate a measurable risk of pseudarthrosis when using MIS to treat ASD, overwhelmingly requiring reoperation. Considering this risk of pseudarthrosis and subsequent revision surgery against the benefits of MIS is crucial to evaluate surgical treatment options for patients with ASD.
661 Six-Month Spinal Surgery Outcomes in Marijuana and Opiate Users as Determined by Preoperative Urine Toxicology
Authors: Singh Manjot , Bajaj Ankush , Shlimak Anna , Kanekar Samika , Leary Owen P. , Gokaslan Ziya L. , Scarfo Keith-Austin , Guglielmo Maria 
Published: March 2023

INTRODUCTION:
Despite their limited utility, diagnostic codes for substance use disorders and self-reported patient histories are often used to assess the impact of marijuana and opiate use on spinal surgery outcomes in the pre-operative setting.

METHODS:
Adult patients undergoing elective spinal surgery between August 2020 and May 2022 with a single neurosurgical provider were offered enrollment into the study. Participants completed urine toxicology screenings at preoperative baseline visits and reported Oswetry Disability Index (ODI), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) at baseline and postoperative follow-up visits over a six-month period. Outcome measures for the marijuana and opiate use groups were analyzed using group-wise linear regression analyses (P<0.05).

RESULTS:
67 participants (mean age 59 years, 66% female, 96% white) were included in this study. Participants commonly underwent lumbar decompression with laminectomy (47%), lumbar fusion (24%), and cervical fusion (12%). Preoperative urine toxicology screenings demonstrated that marijuana (28%) and opiate (19%) use were variably consistent with patient-reported frequencies (18% and 19%, respectively). Regression analyses revealed a statistically significant increase in NDI (P = 0.042) and VAS (P = 0.034) among marijuana users relative to non-users over a six-month period after spinal surgery. However, no significant changes were observed in ODI (P = 0.065) among marijuana users or ODI (P = 0.105), NDI (P = 0.241), and VAS (P = 0.125) among opiate users over the same time period.

CONCLUSIONS:
Preoperative marijuana use, as determined by urine toxicology, was associated with poorer postoperative neck disability and subjective pain outcomes, potentially due to decreased pain tolerance. The same effect was not seen with preoperative opiate use. Future analyses will evaluate marijuana and other substance use within a larger cohort.
662 Navigation in Cervical Spine Surgery: A Review of Past and Current Uses
Authors: Avila Mauricio J. , Farhadi Dara , Cavagnaro María José , Orenday Jose , Fellow Research , Hussein Amna , Reyes Angelica Alvarez , Bauer Isabel , Khan Naushaba , Strouse Isabel Martha , Baaj Ali A. 
Published: March 2023

INTRODUCTION:
The last two decades in spine surgery have resulted in an expansion of innovation and new enabling technologies. Within those new developments, spinal navigation has been adopted widely. Nonetheless, the use in the cervical spine remains a less explored

METHODS:
A scoping review of the literature was performed via PubMed. Limited to English and no date limit. Different search queries with MesH terms such as “Surgical Navigation Systems" "Spatial Navigation”, "Surgery, Computer-Assisted”, "Cervical Vertebrae", “cervical spine” with combination of OR and AND. Inclusion criteria: articles discussing the use of any navigation platform in the cervical spine.

RESULTS:
A total of 365 articles were found. After title and abstract selection, a total of 87 articles were reviewed. All the articles were retrospective. A total of 2101 patients underwent cervical procedures with spinal navigation, 54% were male. Average age of the cohort was 53.6 years. The Stealth navigation system (Medtronic) was the most commonly used followed by BrainLab and the large majority used CT based navigation. Degenerative conditions were the most common followed by trauma. There were 1872 total screws placed under navigation. Most common use for navigation was placement of cervical pedicle screws with a range of pedicle screw accuracy from 76.5-97.1%. The most common level for misplacement was C4. Additional uses include occipital and C1-2 fusion, corpectomies, transoral, transnasal approaches, and tumor localization. Direct complications from screw placement: C5 palsy, vertebral artery injury and dural tears. Mean follow up was 22.6 months.

CONCLUSIONS:
Spinal navigation in the cervical spine remains an understudied field. The current reports show good accuracy for placement of cervical pedicle screws, with minimal complications but other uses within the cervical spine remain somewhat limited. Given our evolving understanding of cervical pathology
667 Trends and Patterns of Robotic Assistance in Lumbar Fusion Surgery
Authors: Pando Alejandro , Hanna Gabriel , Goldstein Ira M. 
Published: March 2023

INTRODUCTION:
Robotic-assisted spine surgery is an emerging field that is growing in utilization. Intraoperative robotic surgical units cost upwards of $600,000 for medical facilities to purchase. Despite significant cost barriers, these devices are highly marketable for hospitals and physicians.

METHODS:
The Nationwide Inpatient Sample database from 2016 to 2019 was investigated. Inclusion criteria were patients ≥ 18-years-old who underwent elective lumbar spinal fusion surgery. Trends of robotic-assisted lumbar fusion were examined over time, as well as stratified based on patient and surgical characteristics.

RESULTS:
A total of 176,377 patients met the inclusion criteria. The overall rate of robotic-assisted lumbar fusion was 1.2% (2,131/174,246). Patients with private insurance were more likely to receive robotic-assisted lumbar fusion (40.3% vs. 37.5%; p < 0.05). Stratifying by race, whites were more likely to receive robotic-assisted lumbar fusion (84.1% vs. 79.5%; p < 0.05). Patients who underwent robotic-assisted lumbar fusion were significantly more likely to have a diagnosis of spondylolisthesis compared to those that underwent traditional lumbar fusion (25.9% vs. 22.0%; p < 0.05). Patients with lumbar fusion done via the anterior approach were more likely to have robotic-assisted surgery compared to other approaches (25.2% vs. 21.3; p < 0.05). Overall, there was a steady increase in its use over time, with patients who underwent lumbar fusion procedures four times more likely to receive robotic-assistance in 2019 compared to 2016 (OR: 4.0; 95% CI: 3.5-4.6; p < 0.0001). Robotic-assisted lumbar fusion was associated with higher inpatient costs ($170,036.40 vs. $139,026.10; p < 0.0001) despite having equivalent length of stay (3.31 ± 2.6 vs. 3.37 ± 2.6; p = 0.06).

CONCLUSIONS:
Robotic-assisted lumbar fusion is on the rise. Patients who had private insurance, were diagnosed with spondylolisthesis, and who had lumbar fusion via the anterior approach were more likely to undergo lumbar fusion using robotic-assistance.
670 Learning Curve Associated With Thoracoscopic Anterior Vertebral Body Tether for Idiopathic Scoliosis: Analysis of Three Independent Surgeons
Authors: Lau Darryl , Kurland David B. , Neifert Sean N. , Wei-Hung Hwang Steven , Pahys Josh , Samdani Amer F. 
Published: March 2023

INTRODUCTION:
Anterior vertebral body tethering (VBT) is a fusionless surgery that harnesses growth to correct idiopathic scoliosis. More surgeons are beginning to implement VBT.

METHODS:
A single-institution retrospective review of three surgeons' experiences of their first 40 single thoracic VBT and 20 double thoracolumbar VBT cases was performed. Patients had skeletally-immature, idiopathic scoliosis and underwent thoracoscopic VBT. Primary outcomes were intraoperative measures and radiographic correction. A pooled and individual surgeon analysis was performed with multivariable modeling.

RESULTS:
A total of 126 single and 60 double VBT patients were included. Mean age was 12.7 years and 13.4% were male. Mean segments tethered was 8.8 in single and 11.0 in double VBT. Mean preoperative thoracic scoliosis was 50.6°: single (49.3°) and double (53.3°). Mean lumbar scoliosis was 35.9°: single (20.9°) and double (49.0°) (p < 0.001). Average OR time was 273.7 minutes with double VBT taking significantly longer (216.4 vs. 394.0 minutes, p<0.001). Mean blood loss was 194.5 ml and fluoroscopy dose 73.6 mGy with no differences between single and double VBT. For single VBT, there was a significant decrease in operative time per 10 cases performed (287.9 to 174.1. minutes). This trend was present for all surgeons. A nonsignificant decrease in fluoroscopy dosing was evident (70.1 to 53.5 mGy, p=0.154). Single and double VBT achieved 41.1% and 47.3% thoracic curve correction, respectively. Double VBT achieved 51.5% lumbar curve correction. Increased experience was not associated with absolute or percentage curve correction for single and double VBT.

CONCLUSIONS:
VBT is an exciting fusionless surgical option for scoliosis. Increased experience resulted in shorter operative time but curve correction was adequate even at the start of the learning curve. Additional studies of long-term results of initial case experiences are needed.
673 Utility of Diffusion Basis Spectrum Imaging in Quantifying Baseline Disease Severity and Prognosis of Cervical Spondylotic Myelopathy
Authors: Zhang Justin , Javeed Saad , Greenberg Jacob K. , Jayasekera Dinal , Sun Peng , Blum Jacob , Dibble Christopher , Song Chunyu , Song Sheng-Kwei , Ray Wilson Zachary 
Published: March 2023

INTRODUCTION:
Despite advancements in diffusion-weighted imaging, few studies have examined associations between diffusion MRI markers and CSM-specific clinical domains at baseline and long-term follow-up.

METHODS:
A single-center prospective cohort study enrolled fifty CSM patients who underwent surgical decompression and twenty controls from 2018-2020. At initial evaluation, all patients underwent diffusion-weighted MRI acquisition, followed by DTI and DBSI analyses. Diffusion-weighted MRI metrics assessed white matter integrity by fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. To improve estimations of intra-axonal anisotropic diffusion, DBSI measures intra-/extra-axonal fraction, and intra-axonal axial diffusivity. DBSI also evaluates extra-axonal isotropic diffusion by restricted and non-restricted fraction. Clinical assessments were performed at baseline and two-year follow-up and included the mJOA, SF-36 PCS, SF-36 MCS, NDI, MDI, and DASH. Pearson’s correlation coefficients were computed to compare associations between DTI/DBSI and clinical measures. A False Discovery Rate correction was applied for multiple comparisons testing.

RESULTS:
At baseline presentation, of 36 correlations analyzed between DTI metrics and CSM clinical measures, only DTI fractional anisotropy showed a positive correlation with SF-36 PCS (r = 0.36, p = 0.02). In comparison, there were 30/81 (37%) significant correlations among DBSI and clinical measures. Increased DBSI axial diffusivity, intra-axonal axial diffusivity, intra-axonal fraction, restricted fraction, and extra-axonal anisotropic fraction were associated with worse clinical presentation (decreased mJOA, SF-36 PCS/MCS, and increased NDI, MDI, DASH). At latest follow-up, increased preoperative DBSI intra-axonal axial diffusivity and extra-axonal anisotropic fraction were significantly correlated with improved mJOA.

CONCLUSIONS:
Our findings demonstrate that DBSI measures may reflect baseline disease burden and long-term prognosis of CSM as compared to DTI. With further validation, DBSI may serve as a non-invasive biomarker following decompressive surgery.
674 Diffusion Basis Spectrum Imaging Predicts Comprehensive Clinical Outcomes Following Surgery for Cervical Spondylotic Myelopathy
Authors: Zhang Justin , Javeed Saad , Jayasekera Dinal , Greenberg Jacob K. , Dibble Christopher , Blum Jacob , Sun Peng , Song Sheng-Kwei , Ray Wilson Zachary 
Published: March 2023

INTRODUCTION:
A major shortcoming in improving care for cervical spondylotic myelopathy (CSM) patients is the lack of robust quantitative imaging tools to guide surgical decision-making.

METHODS:
A prospective cohort study enrolled fifty CSM patients who underwent cervical decompressive surgery. DBSI metrics assessed white matter tract integrity by fractional anisotropy, axial diffusivity, radial diffusivity, and fiber fraction. To evaluate extra-axonal diffusion, DBSI measures restricted and non-restricted fractions. Neurofunctional status was assessed by the mJOA, MDI, and DASH. Quality of life was measured by the SF-36 PCS and MCS. The NDI was used to measure self-reported neck pain. Patient satisfaction was assessed by the NASS satisfaction index. Support vector machine classification algorithms were used to predict surgical outcomes. Specifically, three models were built for each clinical outcome measure (e.g., mJOA), including clinical, DBSI, and combined models.

RESULTS:
Twenty-seven mild (mJOA 15-17), 12 moderate (12-14) and 11 severe (0-11) CSM patients were enrolled. Twenty-four (60%) underwent anterior surgery compared to 16 (40%) posterior surgery. The mean (SD) follow-up was 23.2 (5.6, range 6.1-32.8) months. The best performing model was for the prediction of the NASS satisfaction index, with an accuracy [95% CI] of 94.4 [94.3, 94.8]. Conversely, the worst performing model was for the NDI, with an accuracy of 73.8 [73.6, 74.5]. When predicting improvement in the mJOA, the clinically-driven model had an accuracy of 61.9 [61.6, 62.5], compared to 78.6 [78.4, 79.2] in the DBSI model, and 90.5 [90.2, 90.8] in the combined model.

CONCLUSIONS:
When combined with key clinical covariates, DBSI metrics predicted improvement after surgical decompression with high accuracy. These results suggest that DBSI may serve as a non-invasive imaging biomarker for CSM.
676 Anatomic Assessment of L1-S1 Neural Foraminal Dimensions Using Computed Tomography
Authors: Razzouk Jacob , Harianja Gideon , Urbina Bryan , Cabrera Andrew , Ramos Omar , Wycliffe Nathaniel D. , Cheng Wayne K. , Danisa Olumide A. 
Published: March 2023

INTRODUCTION:
While radiographic parameters for diagnosis of central lumbar canal stenosis are well known, parameters for diagnosis of neural foraminal stenosis are less well defined. Previous research has used magnetic resonance imaging (MRI) to describe neural foraminal dimensions. However, the blooming artifact on MRI may distort these measurements. There is limited research using computed tomography (CT) to investigate normal neuroforamina dimensions.

METHODS:
We evaluated CT imaging of 55 female and 55 male subjects between 18 and 35 years of age. Those with history of degenerative disc disease, spondylolisthesis, fracture, neoplasm, trauma, existing spinal hardware, CT imaging performed due to back pain, or previous spinal surgery were excluded from review. Three independent reviewers were trained by a board-certified neuroradiologist to measure L1-S1 neural foraminal dimensions bilaterally. Intraclass correlation coefficient (ICC) two-way mixed model on absolute agreement was used to analyze interrater reliability. Pearson’s correlation was used to evaluate associations among variables. Differences between sexes were analyzed using independent sample t-tests. Measurement differences between disc levels and left- and right-sided measurements were analyzed using paired sample t-tests and one-way analysis of variance.

RESULTS:
Mean subject age, height, weight, and BMI were 27.16 years, 1.71 m, 88.1 kg, and 29.63 kg/m2, respectively. No moderate or strong correlations were found between measurements and age, height, weight, or BMI for all levels L1-S1. No sex differences were found for measurements at all levels L1-S1.

CONCLUSIONS:
This study describes CT-based L1-S1 neural foraminal dimensions in patients without pathology affecting the neuroforamina. Dimensions were not strongly influenced by demographic or anthropometric factors.
679 Epidural Hypertension Theory in Patients With Lumbar Spinal Stenosis
Authors: Vargas Jimenez Andres Camilo , Granada Angela Carrascosa , Barcia Albacar Juan Antonio 
Published: March 2023

INTRODUCTION:
Laminectomy is the standard of treatment in Lumbar Spinal Stenosis(LSS). Multiple studies (Mariconda;Boden;Schonstrom;Matsumoto;Herno;Webber.) have not found relationship between spinal canal widening and symptoms improvement in LSS. Neurogenic compression and rootlets hypoxia theories try to explain pathophysiology of LSS. We propose Epidural Hypertension (EH) as a new paradigm that explains dynamic stress of neural structures involved in LSS.

METHODS:
Group A: single-segment LSS diagnosed by magnetic resonance (n = 4). Group B: Patients without LSS requiring surgery for another diagnosis (spinal cord stimulation, foraminotomy) (n = 3). Laminectomy was performed, previously, flavum ligament was meticulously dissected and a pressure microsensor was inserted in epidural space in stenotic segment. EP was measured in 0 and 50° extension in order to extrapolate EP in standing position.

RESULTS:
EP in LSS patients was 18,5 mmHg at 0° (IQR 16.5-37.5 mmHg) and 26 mmHg at 50° (IQR 20-34.5 mmHg). In patients without LSS, EP was 8mmHg at 0° (IQR 1-8 mmHg) and 3 mmHg at 50° (IQR 1-12 mmHg). We found differences using Wilcoxon's test. EP was greater in patients with LSS at 0° (p = 0.031) y 50° (p = 0.034).

CONCLUSIONS:
EH may play a foundamental role in pathophysiology of LSS. In Patients without LSS we found a drop in EP at 50° possibly secondary to caudal CSF displacement. In LSS patients we found a raise in EP at 50° possibly secondary to spinal canal narrowing impeding normal CSF flow increasing hydrostatic pressure in the stenotic segment. This results might be the first step to consider EH as a treatment target in LSS and determine its relationship with LSS symptoms.