bluuebunny/crossref_metadata_2025_split huggingface dataset:
420 Coaching for Success: An Athlete-Centered Approach to Optimizing Performance and Protecting Wellbeing in Neurosurgery Residents
Authors: Chennareddy Susmita , Kalagara Roshini , Schupper Alexander J. , Carr Matthew Thomas , Philbrick Brandon , Turner Dan , Kellner Christopher Paul 
Published: March 2023

INTRODUCTION:
Medicine has long attracted high-performing individuals. In particular, neurosurgical residents are faced with challenging conditions, including long workdays, demanding caseloads, and complex relationships, which rival those of the world’s greatest athletes. Unlike athletes, however, who have personalized programs that optimize performance and protect wellbeing, neurosurgical residents typically have a less-developed support network.

METHODS:
In collaboration with a human performance specialist, we conducted interviews, team exercises, and questionnaires with residents at our institution over six weeks. Qualitative data were analyzed using domain-classification, sentiment analysis, word association and proprietary algorithms, to identify themes of wellbeing, performance, and culture.

RESULTS:
Ten residents participated in the sessions; the highest and lowest scoring domains are reported. Five key findings were highlighted on domain analysis: (1) Residents noted meaningful workplace relationships and felt respected by peers; (2) Considerable variation existed in residents’ perceived ability to maintain their work level and in their preferences around sleep, exercise, nutrition, and free time; (3) Major sources of stress included sleep loss, work pace, uncertainty, where to focus wellbeing efforts, and mild performance anxiety; (4) Most residents underutilized relaxation techniques, noting frequent changes in motivation/self-worth; (5) Nearly all residents reported a deep sense of fulfillment/satisfaction.

CONCLUSIONS:
The neurosurgery residency environment requires sustained high performance. Here, we highlight opportunities for neurosurgery resident wellbeing and performance optimization, including strengthening communication under pressure, strategic decision-making promoting work-life balance/self-preservation, and encouraging a culture prioritizing wellbeing and performance. Importantly, inter-resident diversity accentuates the need for individualized resident support. Based on these findings, several programs were deployed, including a 12-month coaching program, an operating room feedback tool, and a digital advisor providing rapid, personalized guidance on performance and wellbeing.
426 Utility of the Fried Phenotype as a Frailty Assessment Tool in Predicting Post-Operative Outcomes in Lumbar Degenerative Spine Surgery Patients
Authors: Yan Sandra C. , Porche Ken Michael , Hoh Daniel J. , Garvan Cynthia , Mohamed Basma 
Published: March 2023

INTRODUCTION:
Frailty is a syndrome of physiological decline that can predispose surgical patients to increased peri-operative morbidity. The Fried phenotype is a clinical measure of frailty and categorizes patients’ frailty based on grip strength, walking speed, unintentional weight loss, low physical activity, and exhaustion. It has been validated in non-spine surgical populations and has been shown to be correlated with poor postoperative outcomes and longer hospital lengths of stay (LOS); it has not yet been validated in patients undergoing spine surgery. Other assessment tools, including the Modified Frailty Index-11 (mFI-11) and Charlson Comorbidity Index (CCI), are calculated based on comorbidities. The mFI-11 has previously been studied in spine patients - a higher mFI-11 score has been associated with a higher risk of post-operative morbidity and mortality.

METHODS:
Patients >65 years of age who underwent elective lumbar spine surgery for degenerative disease since 2015 were included. Data for the Fried phenotype, mFI-11, CCI, and outcomes were gathered for each patient. ROC curves were generated, and multivariate analyses were performed.

RESULTS:
248 patients (128 females; 120 males) with an average age of 71.8 years were included. The median Fried score was 1, median CCI was 1, and median mFI-11 was 0.18. The median LOS was 4 days, with 11 30-day re-admissions. Fried phenotype was found to be the best predictor of an extended LOS and of a non-home discharge.

CONCLUSIONS:
The Fried phenotype is now shown to be a validated measure of frailty in the spine population. Because it relies on categories that are impacted by the patient's functional condition (instead of the comorbidity burden), it has profound implications for optimizing patients through pre-habilitation prior to elective surgery.
428 Accomplishing Realignment Goals Withstands the Test of Time: The Outcomes of a Prospective Consecutively Enrolled Single-Center Adult Cervical Deformity Series With Minimum 5-Year Follow-Up
Authors: Passias Peter G. , Williamson Tyler K. , Joujon-Roche Rachel , Imbo Bailey , Krol Oscar , Tretiakov Peter S. , Bennett-Caso Claudia , Owusu-Sarpong Stephane , Lebovic Jordan 
Published: March 2023

INTRODUCTION:
Adult cervical deformity(CD) realignment has shown promising short-term and two-year clinical results, but longer-term outcomes of CD surgery remain unclear.

METHODS:
Operative CD patients>18 years eligible for 5-year (5Y) follow-up were included. Optimal thresholds for C2 Slope and T1 Slope by Passfall et al were assessed. Student’s t-test, paired t-test, binary and multivariable logistic regression analyses were used to evaluate the clinical, radiographic, and complications outcomes of the five-year eligible cohort.

RESULTS:
58 patients were enrolled from 2012 to 2017(54.5±10.3 years,57% female, BMI: 30.0 ± 7.3 kg/m2, 16% osteoporosis), and underwent surgical correction (levels fused: 5.2 ± 2.6, EBL: 772 ± 672 mL, operative time: 372 ± 139 min, LOS: 5.9 ± 8.1 days). By surgical approach, 13.8% anterior-only, 51.7% posterior-only, 34.5% combined. 53% had previous cervical surgery, 41% a fusion. The most common UIV was C3, LIV was T1. By three months (3M), patients improved in cervical lordosis, C2-C7 SVA (cSVA), and T1 Slope(all p <.02), but not C2 Slope or TS-CL (both p>.5). The cohort significantly improved from baseline (BL) to 2Y in NDI, NRS-Neck, and EQ-5D(all P<.02). From 2Y to last follow-up, patients did not improve in mJOA or NDI, but did in EQ-5D (0.441 to 0.509) and NRS-Neck (5.9 to 5.0, both p<.05). There were 14(24.1%) cases of DJK, 6 were distal junctional failure (10.3%), and 17(29.3%) underwent reoperation. Patients corrected below the T1 Slope threshold of 26.5° and maintained at last follow-up experienced DJK less often(OR: 0.1,[0.02-0.74]). Patients corrected below the C2 Slope threshold of 10° and maintained at last follow-up experienced no DJK, DJF or reoperations.

CONCLUSIONS:
Although complications including distal junctional failure and reoperation remain prevalent, correction of cervical deformity and achievement of realignment targets results in notable clinical and radiographic improvement with most patients achieving favorable outcomes by two years, with further improvement seen until last follow-up.
432 Enhanced Surgical Recovery for Thoracolumbar Spine Surgery is Associated With Decreased Opioid Consumption, Length of Hospital Stay, and Hospital Readmissions: Evaluation of 51,236 Cases
Authors: Good Christopher , Bess Shay , Orosz Lindsay , Scibelli Stephen Scott , Line Breton G. , Remington Gina , Roman Cecile , Luckett Daniel , Jazini Ehsan 
Published: March 2023

INTRODUCTION:
Evidence-based enhanced surgical recovery (ESR) programs integrate a multidimensional approach to optimize patients during the pre-, intra-, and post-operative phases of surgery. Smaller studies suggest benefits of ESR in spine surgery, but large-scale evidence is lacking.

METHODS:
In this retrospective case-control study of a healthcare system ESR program, data from thoracolumbar (TL) fusions were extracted from electronic medical records. Patients were divided into two cohorts, ESR or non-ESR, based upon enrollment into an ESR program defined by (1) preoperative patient education, (2) multimodal analgesia, (3) intraoperative fluid optimization, (4) opioid-sparing anesthesia, and (5) early postoperative nutrition and ambulation. Exclusion criteria were: unknown ESR status, age <18 yrs, and surgery for tumor, infection, or trauma. Impact of ESR upon postoperative daily morphine milligram equivalents (MME), length of hospital stay (LOS), and 30-day hospital readmission rates (READMIT) was evaluated for single-level TL fusions, multi-level TL fusions, and all TL fusions using regression models.

RESULTS:
51,236 TL fusion cases were identified from 2018 to 2021: 24,391 participated in an ESR program and 26,845 did not. ESR and non-ESR groups were demographically similar. For single level TL fusions, ESR was associated with decreased MME (β= -8.76, p < 0.001), LOS (β= -8.85, p < 0.001), and READMIT (OR = 0.77, 95% CI: 0.67-0.88). For multi-level TL fusions, ESR was associated with decreased MME (β = -7.32, p < 0.001) and LOS (β= -12.14, p < 0.001), and for all TL fusions, ESR was associated with decreased MME (β= -7.94, p<0.001), LOS (β = -10.54, p < 0.001), and READMIT (OR = 0.91, 95% CI: 0.84-0.98).

CONCLUSIONS:
This national healthcare system analysis of 51,236 TL fusion cases by 1,352 surgeons at 138 centers confirms that ESR adoption is associated with decreased MME, LOS, and READMIT. Surgeons should consider adoption of ESR programs to improve patient care.
437 Percutaneous Juxtapedicular Cement Salvage of Failed Pedicle Screws: A Cadaveric Biomechanical Study
Authors: Kurland David B. , Lendhey Matin , Delavari Nader , Winfield Jalen , Mahoney Jonathan , Bucklen Brandon , Frempong-Boadu Anthony 
Published: March 2023

INTRODUCTION:
Posterior spinal fixation with pedicle screw-based constructs is the gold standard for stabilizing the thoracolumbar spine; however, these constructs sometimes fail due to fatigue loading, necessitating revision surgery. A common hardware revision strategy involves open surgery for screw upsizing, with or without cement augmentation, and extension of fusion. Others have described good clinical outcomes following percutaneous juxtapedicular cement salvage of failing pedicle screws. The relative biomechanical properties of these various approaches has not been evaluated.

METHODS:
Thirty-two fresh, un-embalmed vertebrae from four cadaveric thoracolumbar spines were used for the study. The study was conducted in two phases. The first phase involved primary pedicle screw insertions and pullout strength testing to model critical pedicle screw failure. The second phase involved revision of failed pedicle screws followed by pullout testing. The four revision cohorts were: 1) Screw Upsizing, 2) Vertebroplasty (cement augmentation with replacement of primary screw), 3) Fenestrated Screws with cement augmentation, and 4) Juxtapedicular Cement Salvage.

RESULTS:
There was no statistically significant difference in primary fixation strength between the cohorts. The Screw Upsizing cohort exhibited inferior pullout strength compared to the other groups which involved cement augmentation. There was no significant difference in pullout strength between Vertebroplasty, Fenestrated Screws, or Juxtapedicular Cement Salvage cohorts.

CONCLUSIONS:
Cement augmentation confers superior pullout strength compared to screw upsizing only. The key finding of this study is that the technique of percutaneous juxtapedicular cement salvage is biomechanically non-inferior to other revision strategies that require an open procedure to perform.
438 Benefits of Short- Versus Long-segment Fixation for the Treatment of Thoracolumbar Chance Fractures: A Comparison of Perioperative and Radiological Outcomes
Authors: Vaca Silvia , Carmichael Marc , Miao Jingya , Singh Harminder 
Published: March 2023

INTRODUCTION:
Discussion continues regarding optimal surgical management of thoracolumbar fractures. Some have indicated long-segment posterior fixation (LSPF) is favorable when evaluating implant stability, kyphotic deformity, and pain. However, most studies either included multiple fracture subtypes or focused on burst fractures. Short-segment fixation (SSPF) may be similarly effective for a subset of patients while minimizing surgical time and length of stay (LOS). This study reviews inpatient and follow-up outcomes of chance fractures managed with SSPF versus LSPF.

METHODS:
Retrospective review of 50 consecutive patients with thoracolumbar distraction injuries (AO B1 and B2) at a single center over a five-year period. Patients underwent pedicle fixation one level (SSPF) or two to three levels (LSPF) above and below the fracture. Patient demographics, preoperative characteristics, and perioperative outcomes were compared between groups. Radiological outcomes were assessed by measuring Cobb angles immediately postoperatively and up to 12 months postoperatively.

RESULTS:
There was a 31% reduction in mean surgical time for SSPF patients vs LSPF (134 vs 195 minutes, independent samples t test, p = 0.037) without a significant difference in ICU LOS (4.6 vs 4.8 days, independent samples t test, p = 0.947), hospital LOS (15 vs 14 days, independent samples t test, p = 0.865) or complication rates (2 of 35 vs 2 of 15 patients, Fisher’s Exact, p = 0.574). Longitudinal assessment of kyphosis by measuring Cobb angles immediately postoperatively and 2 - 4, 6, 8 - 12, and > 12 months postoperatively showed no significant differences in radiological outcomes between groups. There was a trend toward an increased likelihood of discharge to home (Likelihood ratio = 5.299, ꭓ2 test, p = 0.032) with SSPF.

CONCLUSIONS:
SSPF is non-inferior to LSPF for thoracolumbar chance fractures while offering reduced surgery time. Our results additionally suggest SSPF may offer increased likelihood of discharge home.
441 The Role of Preoperative MRI Imaging in Assessing Neurovascular Compression Prior to Microvascular Decompression in Trigeminal Neuralgia
Authors: Xu Risheng , Nair Sumil , Raj Divyaansh , Materi Joshua , Gujar Sachin , Huang Judy , Blitz Ari M. , Lim Michael , Sair Haris , Bettegowda Chetan 
Published: March 2023

INTRODUCTION:
Preoperative MRI is a standard component of the preoperative clinical workup for patients prior to microvascular decompression (MVD). However, its ability to accurately exclude neurovascular compression of the trigeminal nerve is not well understood.

METHODS:
We retrospectively reviewed 1020 patients with available preoperative MRI data prior to microvascular decompression. General patient demographics and clinical characteristics were collected for each case. We recorded both evidence of neurovascular conflict on preoperative MRI radiology notes and intraoperative compression from operative notes. Sensitivity, specificity, positive predictive value, and negative predictive value was determined for general MRI, high-resolution MRI, and non-high resolution.

RESULTS:
Overall, preoperative MRI prior to MVD demonstrated a sensitivity of 75.8%, specificity of 65.8%, positive predictive value of 92.4%, and negative predictive value of 33.3% in predicting neurovascular compression of the trigeminal nerve. In particular, MRI was unable to identify 21.0% cases of sole arterial compression, 42.5% cases of sole venous compression, and combined arterial and venous compression in 18.5% of cases. 958 (93.9%) patients underwent high-resolution preoperative MRI with skull base sequences. This exhibited a sensitivity of 75.6%, specificity of 66.9%, positive predictive value of 92.5% and a negative predictive value of 33.4% in predicting trigeminal nerve neurovascular compression. Finally, non-high resolution MRI showed a sensitivity of 78.8%, specificity of 50.0%, positive predictive value of 89.1%, and negative predictive value of 31.3%. Importantly, the negative predictive values of general, high resolution, and non-high resolution MRIs were all below 50%.

CONCLUSIONS:
Preoperative MRI may offer a high predictive value for neurovascular conflict and should be part of the standard preoperative care workup for trigeminal neuralgia patients. However, lack of neurovascular conflict on preoperative imaging is not sufficient to exclude patients from undergoing MVD.
443 Bilateral Facial Pain With Simultaneous Onset in Trigeminal Neuralgia
Authors: Materi Joshua , Xu Risheng , Nair Sumil , Wang Dorothy , Kalluri Anita , Raj Divyaansh , Xia Yuanxuan , Huang Judy , Lim Michael , Bettegowda Chetan 
Published: March 2023

INTRODUCTION:
Bilateral TN (BTN) represents a non-negligible disease burden. BTN is often sequential in nature, meaning pain develops on one side before developing on the contralateral side. The few cases of simultaneous onset BTN are often indiscriminately considered or not specified from sequential onset BTN cases.

METHODS:
A retrospective analysis was conducted to identify patients with simultaneous onset of bilateral TN. Demographic characteristics and comorbidities were assessed. Treatment plans and modalities were recorded, and procedural outcomes and treatment durability was assessed by determining median time pain recurrence in patients with at least 30 days of follow-up. Pharmacotherapy treatment and Barrow Neurological Institute pain intensity scores were compared at last follow-up with index treatment.

RESULTS:
Between 1996 and 2021, 17 out of 1723 patients with trigeminal neuralgia presented with simultaneous onset of bilateral trigeminal orofacial pain which underwent bilateral surgical intervention. Patients were followed for 3 to 148 months, during which 63 procedures were performed: 20 glycerin rhizotomies, 25 glycerin-radiofrequency rhizotomies, and 18 microvascular decompressions. 16 of 17 patients experienced pain recurrence after undergoing treatment: 12 with bilateral pain and 4 with unilateral recurrence. Glycerin-radiofrequency rhizotomy provided the greatest recurrence free interval (median = 15.4 months) compared to glycerin rhizotomy (median = 0.9 months; p = 0.02) and microvascular decompression (median = 7.8 months; p = 0.25). Over the course of treatment, the number of pharmacotherapy agents increased from 2 to 3 (p = 0.05). Overall facial pain scores improved from a median of 6 to 4 bilaterally.

CONCLUSIONS:
Patients with simultaneous bilateral trigeminal neuralgia represent a rare disease population who tend to have early pain recurrence after surgical treatment. Nevertheless, many experience overall pain improvement with re-treatment.
451 Posterior Cingulate Theta Power as a Novel Biomarker of Mood
Authors: Hacker Carl , Brunner Peter , Willie Jon Timothy , Leuthardt Eric C. 
Published: March 2023

INTRODUCTION:
One third of patients with major depressive disorder (MDD) are refractory to standard therapies. Progress in therapeutic neuromodulation for depression has been challenging because of the widespread, network basis of mood and lack of neurophysiologic biomarkers. Neuroimaging studies of depression demonstrate increased connectivity within the default mode network (DMN), which subserves internal processes such as self-reflection, mind wandering, and memory. Invasive electrophysiology in the resting state has demonstrated that DMN connectivity corresponds to correlations in theta-band power. DMN activity is anti-correlated with the dorsal attention network (DAN) which, in contrast, subserves externally oriented cognition (i.e., top-down attention), and demonstrates alpha-specific resting-state correlations.

METHODS:
We used hourly, self-reported measures of mood and video facial affect recognition to estimate mood valence in six epilepsy patients undergoing invasive stereotactic electroencephalography monitoring. We analyzed power spectra and functional connectivity (band-limited power correlations) in epochs corresponding to mood estimates. Patients without substantial inpatient mood variability (n=3) were excluded.

RESULTS:
Depressed mood was correlated with increased theta power. This was most significant in electrodes within posterior cingulate cortex (DMN region; r = -0.58; p = 0.0007). Conversely, alpha power was increased during elevated mood, most significantly in the intraparietal sulcus (DAN region; r = 0.55, p = 0.0013). Theta connectivity was correlated with depressed mood (r = -0.53, p = 0.003) whereas alpha connectivity was correlated with elevated mood (r = 0.56, p = 0.002).

CONCLUSIONS:
Our results recapitulate the frequency specificity of resting-state physiology and encourage a network-based perspective of depression neurophysiology. Theta and alpha power within DMN and DAN networks, respectively, represent important biomarkers of mood and may guide neuromodulatory therapies. Posterior cingulate/precuneus cortex is a major DMN hub and should be sampled in future studies of neural correlates of mood.
456 CD39 T Cells With Low PD-1 Expression are Markers for Durable Immunotherapy Response to Anti-PD-1 in Murine Glioblastoma
Authors: Choi John , Pant Ayush , Kim Young-Hoon , Routkevitch Denis , Jackson Christopher Mitchell , Jackson Christina , Kim Lily H. , Lim Michael 
Published: March 2023

INTRODUCTION:
Clinical trials investigating anti-PD-1 therapy for glioblastoma (GBM) have failed to demonstrate increased overall survival, unlike in other cancers such as non-small cell lung cancer (NSCLC). Despite the immunosuppressive characteristics of GBM, a small subset of patients in these trials have shown durable anti-PD-1 response. Recently, CD39+ T cells have been implicated as infiltrating lymphocytes that, once activated, demonstrate robust anti-tumor activity. Understanding the unique immunosuppressive milieu of GBM including this cell population may help elucidate why some patients show treatment response.

METHODS:
Mice orthotopically implanted with GL261 had blood collection prior to anti-PD-1 exposure with t-SNE mapping of T cells. The molecular profiles of mice with long-term survival were compared with those that did not. Due to a lack of GBM patient samples that have shown immunotherapy response, we examined whether these molecular patterns recapitulated in the blood of NSCLC patients responded to anti-PD-1.

RESULTS:
The blood of long-term survivor mice implanted with GBM demonstrated a significantly greater proportion of CD39+ CD8 T cells with low PD-1 expression (PD-1lo) with subsequent increased representation of this population in the tumor as well (P < 0.05). This CD39+ CD8+ PD-1lo population was also highly represented in the blood of treatment-naÏve NSCLC patients who responded to anti-PD-1 (P < 0.05). Furthermore, once exposed to anti-PD-1 in vivo, this CD39+ CD8+ PD-1lo population showed high immune activity with robust IFN-y expression (P < 0.05).

CONCLUSIONS:
Mice with CD39+ CD8+ PD-1lo T cells are strongly associated with anti-PD-1 response. This has implications for exploring this cell population as a blood biomarker and an active anti-tumor population that may be mobilized with adoptive cell transfer and CAR-T cell strategies.