bluuebunny/crossref_metadata_2025_split huggingface dataset:
111 Improved Functional Outcomes of Stroke Patients Undergoing Mechanical Thrombectomy After Arriving via Mobile Stroke Unit
Authors: Al Saiegh Fadi , Velagapudi Lohit , Khanna Omaditya , Tjoumakaris Stavropoula I. , Gooch M. Reid , Rosenwasser Robert H. , Jabbour Pascal 
Published: March 2023

INTRODUCTION:
Mobile stroke units (MSUs) have been implemented worldwide for stroke care, but outcome data is lacking to show their efficacy specifically in patients undergoing mechanical thrombectomy (MT).

METHODS:
A retrospective review of a stroke database was performed to identify patients who underwent MT after arrival via MSU from August 2019 to December 2020. Demographic factors, past medical history, stroke characteristics, treatment variables, complications, and functional outcomes were recorded. These were compared to date-matched patients who underwent MT after arrival via conventional means.

RESULTS:
Seven patients were treated with MT after arriving by MSU. These were compared to 50 date- matched patients who underwent thrombectomy after arrival through conventional means. No statistically significant difference between cohorts was observed in terms of demographic variables, co-morbidities, stroke characteristics, or tPA administration. Patients from the MSU cohort had significantly shorter time from symptom onset to groin puncture time (191.33 mins ± 77.53 vs 483.51 mins ± 322.66, p = 0.034). Importantly, MSU-transferred patients had significantly better discharge functional status measured by modified Rankin Scale (mRS) (1.86 ± 1.35 vs 3.57 ± 1.88, p = 0.024). No significant difference in final TICI score, complications, length of stay, or mortality was observed.

CONCLUSIONS:
Our pilot study demonstrates the efficacy of the MSU in decreasing door-to-puncture time and a concordant improvement in discharge mRS. Further prospective studies are needed to assess cost-efficacy and optimal protocol for MSUs in stroke care.
117 Social Determinants of Health and Spine Tumor Surgery Outcomes: A Nationwide Analysis of Disparities from 2002-2019
Authors: Tang Oliver Young , Ayala Cameron , Feler Joshua , Rivera Perla Krissia M. , Bajaj Ankush , Ganga Arjun , Fridley Jared , Toms Steven A. , Gokaslan Ziya L. , Sullivan Patricia Zadnik 
Published: March 2023

INTRODUCTION:
Earlier research has demonstrated that social determinants of health (SDoH) impact neurosurgical access and outcomes, influencing patient disparities.

METHODS:
We identified all admissions with a spine tumor diagnosis in the National Inpatient Sample from 2002-2019. Four SDoH were analyzed: race and ethnicity, insurance, household income, and safety-net hospital (SNH) treatment. Hospitals in the top quartile of safety-net burden (percentage of patients receiving Medicaid or uninsured) were categorized as SNHs. Multivariable regression queried the association between 22 variables and six perioperative outcomes: mortality, discharge disposition, complications, length of stay (LOS), and hospitalization costs. Relative importance of predictors for disposition were assessed using random forest models.

RESULTS:
Of 6,593,391 total admissions with spine tumors, 219,380 (3.3%) underwent surgery. Non-white race (odds ratio [OR] = 0.80–0.91, P = 0.001) and non-private insurance (OR = 0.76–0.83, p = 0.001) were associated with lower odds of surgery. Among surgical admissions, presenting severity, including myelopathy and plegia, was elevated among nonwhite, non-private insurance, and low-income admissions (all P = 0.001). Black race (OR = 0.70, P = 0.001), Medicare (OR = 0.70, P = 0.001), Medicaid (OR = 0.90, P = 0.001), and lower income (OR = 0.88–0.93, all P = 0.001) were associated with decreased odds of favorable discharge disposition. Elevated LOS and costs were observed among non-white (LOS: +6-10%, costs: +5-9%, both P = 0.001) and Medicaid (LOS: +16%, costs: +6%, both P = 0.001) admissions. SNH treatment was also associated with higher mortality (OR = 1.49, P = 0.001) and complications (OR = 1.20, P = 0.001). From 2002-2019, disposition improved annually for Medicaid patients (OR = 1.03 per year, P = 0.022) but worsened for Black patients (OR = 0.98 per year, P = 0.046). Random forest models identified household income as the most important disposition predictor.

CONCLUSIONS:
For spine tumor admissions, SDoH predicted surgical intervention, presenting severity, and perioperative outcomes. Over two decades, disparities improved for Medicaid patients but worsened for Black patients.
119 An Institutional Analysis of Venous Sinus Stenting and Cerebrospinal Fluid Shunting for Idiopathic Intracranial Hypertension
Authors: Yamamoto Erin A. , Mazur-Hart David , Lee Daniel , Schoettler Woll S. Cody , Ramos Christian Lopez , Munger Daniel , Richie Emma , Bozorgchami Hormodz , Dogan Aclan , Nesbit Gary , Priest Ryan , Falardeau Julie , Jia-Xin Liu Jesse 
Published: March 2023

INTRODUCTION:
Idiopathic intracranial hypertension (IIH) is a debilitating disease that can present with severe vision loss. Although medical management is the first-line treatment, these cases commonly require intervention by either ventriculoperitoneal/pleural shunting (VPS) or, more recently, by venous sinus stenting (VSS). Unfortunately, this chronic disease can lead to multiple clinical encounters which increases financial burden. Therefore, identifying ways to effectively treat IIH definitively while limiting healthcare costs are of great interest.

METHODS:
This is a retrospective study of IIH patients diagnosed via modified Dandy criteria who received VPS (n=27) or VSS (n=27) from May 2008–May 2019. Visual outcomes were reported by a neuro-ophthalmologist at approximately 1-month post-procedure. Costs of emergency department as well as and outpatient/inpatient encounters for neurosurgery and ophthalmology were obtained from the index procedure to 3 years post-procedure.

RESULTS:
VSS patients had higher pre-intervention ophthalmology evaluation rates (stents: n = 22, 88.9%; shunts: n = 7, 23.1%; p < 0.0001). Papilledema was present in most patients (VSS 82.6% vs VPS 66.7%, p = 0.60) and all patients had stable/improved papilledema at follow-up. Two VSS patients (4.9%) required a second stent. Four VSS patients (9.8%) had a VPS placed. No VPS patients received a VSS. Encounter cost for VSS placement were more expensive than primary VPS placement ($10,749 vs $13,648; p = 0.002). However, at 1.5 years after index procedure, cumulative VPS cost surpassed VSS and persisted at 3 years ($22,674 vs $17,441, p = 0.039).

CONCLUSIONS:
VPS and VSS have similar visual outcomes with all cases having stable or improved papilledema. The upfront cost of VSS is greater than VPS; however, VPS quickly surpasses VSS in cost by 1.5 years after index procedure and continues to study endpoint at 3 years. These results may help guide multi-disciplinary care for patients with IIH.
122 Prospective, Randomized, Blinded Clinical Trial Comparing PEEK and Allograft Spacers in Patients Undergoing ACDF Surgeries
Authors: Villavicencio Alan T. , Nelson Ewell Lee , Rajpal Sharad , Beasley Kara D. , Burneikiene Sigita 
Published: March 2023

INTRODUCTION:
The biomechanical qualities as well as osteoconductive, osteogenic, and osteoinductive properties of various graft materials have been previously evaluated. There remain questions, however as to whether there are any clinical and/or radiographic outcome differences in the selection of interbody graft types for ACDF.

METHODS:
Patients undergoing one- to three-level ACDF with single anterior plate fixation were randomized (1:1 ratio) to receive either cortical allograft or PEEK interbody spacers. Radiographic and clinical outcomes were assessed at 3, 6, 12 and 24 months with an additional postoperative radiographic assessment.

RESULTS:
A total of 120 patients were enrolled and randomized. Comparing clinical outcomes, no differences in arm or neck pain scores were noted, however, there was a statistically significant (<0.041) improvement in SF-36 PCS scores for the allograft group at all follow-up time points and a tendency towards lower disability scores. Overall, evidence of radiographic fusion was achieved in 87 (91.6%) patients: five (10.2%) and three (6.5%) patients had pseudoarthrosis (p=0.72) in the PEEK and allograft groups, respectively. At the 24-month follow-up, any cervical or segmental alignment restoration achieved with surgery was lost and no statistically significant changes were detected when all levels of surgery were included. Likewise, there were no statistically significant differences between the groups for anterior or posterior body height measurements at the 24-month follow-up. Approximately 20% of patients had anterior and posterior subsidence, all grade 0 regardless of the group assignment.

CONCLUSIONS:
Comparable radiographic outcomes were observed for patients undergoing one- to three-level PEEK vs. allograft-assisted ACDF surgeries.
123 Early Postural Stability Changes in Patients Undergoing Correction of Spinal Deformity
Authors: Keister Alex , Grossbach Andrew James , Toop Nathaniel , Mallory Noah , Gibbs David Charles , Xu David S. , Viljoen Stephanus 
Published: March 2023

INTRODUCTION:
Adult spinal deformity (ASD) is an increasingly prevalent cause of pain and disability. It is known that ASD correction results in improved alignment, but not whether this alignment results in objective improvements in postural stability.

METHODS:
A retrospective review of a prospectively maintained database identified 16 patients undergoing ASD correction surgery with five or more segments. Balance was assessed via a force plate pre- and three months postoperatively. Participants were instructed to stand still, with their hands at their sides and eyes open. Center of pressure (COP) and center of gravity (COG) parameters were analyzed and used to derive head sway in the Dubousset cone of economy (COE). Spinopelvic parameters (PI, PT, SVA, and LL) on standing scoliosis radiographic films were also measured pre- and three months postoperatively.

RESULTS:
In our 16-patient series, there was a mean age of 61.3 years-old, and a median of 10 segments fused. Postoperative force plate assessment showed a decrease in total COP sway and sway velocity (p < 0.05). Coronal COP sway and sway velocity also decreased (p < 0.05). There was a decrease in total, coronal and sagittal COG sway and sway velocity postoperatively (p < 0.05). In the COE, total head sway decreased (p < 0.05). PT remained unchanged following surgical correction, while LL and SVA improved from 44.9° to 56.7° (p < 0.01) and 82.2 to 22.5 mm (p < 0.01), respectively. PI-LL mismatch also improved from 16.2° to 4.8° (p < 0.01).

CONCLUSIONS:
Following long segment fusion for ASD, postural stability may improve as early as three months, concomitant with improved spinopelvic alignment. We believe force plate assessment warrants further study for postoperative evaluation of postural alignment and clinical outcomes in ASD patients.
124 Multidimensional Approach to Frailty Improves Prediction of Adverse Outcomes in Metastatic Spine Tumor Surgery
Authors: Rigney Grant Harding , Razak Shahaan , Duvall Julia , Kiapour Ali , Williamson Theresa , Massaad Elie , Shin John H. 
Published: March 2023

INTRODUCTION:
Surgery for individuals with spinal metastases can have a substantial impact on a patient’s quality of life. Recent research has highlighted the importance of preoperative nutritional status and frailty on outcomes, but little is known about which aspects of malnutrition carry clinical significance.

METHODS:
Cancer patients who underwent surgery for spinal metastases between August 1, 2014, to March 20, 2019, were stratified by New England Spinal Metastasis Score (NESMS). Frailty was assessed using the Metastatic Spinal Tumor Frailty Index. Nutrition was assessed via the prognostic nutritional index. The primary outcome was overall postoperative survival. Secondary outcomes included 6- and 12-month survival rates, postoperative complication rates, and readmission after surgery.

RESULTS:
Our study included 154 patients with a mean (SD) age of 63.23 (13.14) years, of whom 94 (61%) were female. 56 patients (36.3%) were classified as NESMS grade 3, while 46 (29.9%) were NESMS 2, 36 (23.4%) were NESMS 1, and (16) 10% were NESMS 0. NESMS 0 group had the highest proportion of severely frail patients (56.2%). Poor nutritional status (PNI < 40.4; Odds ratio; OR 1.87; 95% CI; 0.398-8.82) and increased inflammation (PLR; OR 1.80; 95% CI, 0.766-4.21) were associated with a meaningful increased rate of complications after surgery. Patients with normal nutritional status (AGR, PNI) had a better prognosis than those with poor nutritional status in the same NESMS group.

CONCLUSIONS:
Malnutrition and severe frailty are associated with high rates of adverse events in high-risk cancer patients with spinal metastases within NESMS prognostic groups. Further work should assess the effectiveness of pre-habilitation programs to improve physiological reserves for patients with spinal metastasis.
130 Prediction of In-Hospital Mortality After Acute Traumatic Brain Injury managed by Tranexamic Acid: Secondary Exploration of CRASH-3 Trial via Automated Machine Learning
Authors: Haider Ali , Ullah Tauseef , Khan Inayat Ullah , Zehra Saiqa , Khawaja Hashir Fahim , Mehmood Abbas Syed Mohammad , Mohsin Rabia , Khan Ayesha Khalid , Shah Ali Haider 
Published: March 2023

INTRODUCTION:
Acute traumatic brain injury (acTBI) has significant morbidity and mortality (M&M) associated with it— increased intracranial pressure (ICP) among the attributed causative mechanisms. Tranexamic acid, therefore, is adopted to decrease ICP and subsequently the acTBI-associated M&M.

METHODS:
The study population comprised 12,743 patients from 175 hospitals in 29 countries experiencing acTBI randomly assigned to receive tranexamic acid or placebo. The current state of the art (SOTA) for automated Machine Learning (aML) was adopted to develop predictive models with the incorporation of the ensemble approach. Logloss and Macro weighted average Area Under the Receiver Operating Curve (mWA-AUROC) assessed the predictive discriminative ability of the developed models.

RESULTS:
An ensemble of Extreme Gradiant Boosting Machine, Light Gradiant Boosting Machine, CatBoost, Random Forest and Neural Network predicted IHM along with the cause of death in acTBI patients randomly assigned to Tranexamic acid management with an mWA-AUROC of 0.94, an accuracy of 85.8% and a logloss of 0.37. Motor and verbal responses along with pupillary reactions were recognized as the most influential predictors for IHM in such patients with maintenance dose of Tranexamic acid imparting moderate to minuscule influence. Boxplot indicates a relative decrease in logloss by adopting the ensemble approach.

CONCLUSIONS:
Our novel approach to developing predictive prognosticative models for acTBI patients managed by Tranexamic acid by exploring automated machine learning is the very first attempt of its nature. Adoption of the current SOTA for aML provides optimal predictions which, when incorporated into the respective management and prognosticative protocols, shall translate into a decrease in the M&M associated with TBI by assisting in risk stratification and complication triaging.
133 Evaluating the Neuroprotectivity of Hypercapnia on Spreading Depolarizations
Authors: Shukla Geet , Parks Ken , Hartings Jed 
Published: March 2023

INTRODUCTION:
Spreading depolarizations (SDs) are a class of pathologic electrical activity in the brain characterized by ionic equilibrium disruption and depression of brain activity. SDs are recorded in stroke and traumatic brain injury and are a predictor of secondary damage. We recently found that low end-tidal CO2 (ETCO2) may be associated with a detrimental course of SDs in patients, but it is unknown whether this association is causal.

METHODS:
In mechanically ventilated rats under normoxia (30% O2) assigned to either hypocapnia (ETCO2 25-30 mmHg) or hypercapnia (45-50 mmHg), we triggered SDs via microinjection of 1M KCl for 90 minutes in the cerebral cortex. Additionally, in rats brought to hypoxia (10% O2), we triggered singular SDs under hypocapnia, normocapnia (30-35 mmHg), and hypercapnia. We measured regional cerebral blood flow (rCBF), tissue oxygenation, pH, and SD electrophysiology.

RESULTS:
ETCO2 had no significant effect on SD duration, frequency, delay after stimulus induction, or terminal SD at the time of death. ETCO2 showed a weak negative effect on maximum rCBF, but no effect on duration or integral of rCBF response. In contrast, mean arterial pressure (MAP) showed a strong negative effect on SD duration and delay after stimulus induction but had no effect on frequency. MAP also showed a mild effect on maximum rCBF, as well as the duration and integral of rCBF response.

CONCLUSIONS:
This research showed that ETCO2 does not play a role in determining duration and frequency of spreading depolarizations as well as associated hyperemic response. However, we confirmed prior results that MAP may play a role since relative hypertension was shown to reduce duration of SDs and level of rCBF response.
137 Successful Management of Refractory Craniofacial Pain With Peripheral Nerve Field Stimulation: An International Case Series
Authors: Chavarro Velina S. , Nair Ishiwara , Lieber Bryan , Eshraghi Yashar , Denis Daniel , Olson Sarah 
Published: March 2023

INTRODUCTION:
Craniofacial pain syndromes (CPS) encompass various debilitating pain etiologies including trigeminal neuralgia, migraine, cluster headaches, atypical facial pain and post-herpetic neuralgia. Although medical management is initially indicated, most patients with CPS eventually require surgical intervention.

METHODS:
This is a retrospective chart review of adults with refractory CPS who underwent PNFS. Implantation areas included the greater occipital nerve and CNV branches. Outcomes include pain severity measured with Barrow Pain Scale (BPS), functional status pre- and post-operatively, complications secondary to PNFS, and time to re-intervention.

RESULTS:
Seventeen patients underwent PNFS implantation for: atypical TN (48%), migraine (18%), post-herpetic neuralgia (12%), other CPS (17%). Baseline BPS pain score was 5/5 for all patients. At 2 weeks post-PNFS 88% of patients (N = 16) reported BPS score of 1/5. At 1-month post-PNFS 77% of patients (N = 17) had BPS score 2/5 or less; at 6 months follow-up, 77% of patients (N = 14) had BPS score 2/5 or less; and at 12-month follow-up, 63% of patients (N = 11) reported BPS score 2/5 or less. Patients with good outcomes had no further pain-related hospital admissions. The most sustained results were achieved amongst patients with post-herpetic neuralgia. Complications included infection in 2 patients, and refractory pain in 3 patients requiring re-intervention at 10 months post-PNFS on average.

CONCLUSIONS:
This case series demonstrates the utility of PNFS for CPS refractory to traditional medical and surgical management. All patients reported significant pain relief with improvement of function early in the post-operative period. Different etiologies of CPS and PNFS technology may partially explain the variability in long-term outcomes. PNFS technology is continuously optimizing pulse settings and technical characteristics and may be an adequate intervention for refractory CPS.
138 Open Dorsal Root Ganglion Lead Placement After Percutaneous Trialing: A Case Series
Authors: Elhamdani Shahed , Esplin Nathan , Tomycz Nestor Denys 
Published: March 2023

INTRODUCTION:
Dorsal root ganglion (DRG) stimulation is a newer mode of neurostimulation for neuropathic pain in which individual electrodes are placed over the dorsal root ganglion (DRG). Although designed for percutaneous placement, open placement of DRG has been described in small case series and case reports when percutaneous placement failed or was anatomically not considered feasible. This is the largest series of open DRG stimulator placement and the first performed after successful percutaneous trialing.

METHODS:
We present a case series of N = 6 patients who underwent successful DRG stimulator placement via open laminotomy/laminectomy technique after a successful percutaneous DRG stimulator trial performed by a pain management physician.

RESULTS:
At a median 7.3 months status post implant, all patients continue to report significant relief of pain with their stimulator. There were no serious adverse events. Mean fluoroscopy time/case was 49.7 seconds. Technical nuances of open DRG stimulator placement will be discussed.

CONCLUSIONS:
This is the largest series of open DRG stimulator placement that has been reported. We have observed good patient pain relief and no serious adverse events. Although more invasive, potential advantages of open DRG stimulator placement include direct anchoring technique and lower radiation exposure times for patients and staff. Open DRG stimulator technique via laminectomy/laminotomy may also improve adoption of DRG stimulation by spinal surgeons who are familiar with exposing the DRG with open technique.
139 Durable Pain Relief With 10 kHz Spinal Cord Stimulation for Patients With Refractory Back Pain Who are not Surgical Candidates
Authors: Patel Naresh P. , Kapural Leonardo , Jameson Jessica , Johnson Curtis , 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 , Goree Johnathan , Lyons Mark K. , Sack Andrew , Bruce Diana , Rubenstein Frances , Province-Azalde Rose , Caraway David 
Published: March 2023

INTRODUCTION:
A large multicenter RCT was undertaken to provide high level evidence of the clinical effectiveness of 10kHz SCS over conventional medical management (CMM) for the treatment of nonsurgical refractory back pain (NSRBP), and the 12-month results were recently published (Kapural et al, 2022).

METHODS:
Patients were enrolled if ineligible for surgery based on surgical consultation. Subjects were randomized 1:1 to either 10kHz SCS in addition to CMM or CMM alone. Both groups had the option of crossing over at 6 months if satisfactory pain relief was not achieved. In addition, all subjects had the option of consenting to a study extension to 24-months. We present pain relief reported on the visual analog scale (VAS), Oswestry Disability Index (ODI), and quality-of-life (EQ-5D-5L) at 18 months.

RESULTS:
There were 159 patients randomized to either CMM alone (n = 75) or to 10kHz SCS in addition to CMM (n=83), with similar baseline characteristics. None of the 69 implanted patients in the 10 kHz SCS arm chose to crossover to CMM arm, while 74.7% (56/75) in the CMM arm crossed over, resulting in 125 total implanted patients. A total of 5/125 (4%) explants occurred during 18-month follow-up, two due to dissatisfaction with therapy and three to infection (two replaced). At 18 months the following outcomes were achieved: durable pain relief (mean 71%, 95%CI 66-76%), 74% of patients with clinically significant disability improvement with 40% moving from severe/moderate disability to minimal disability, and significant improvement in all dimensions of the EQ-5D-5L.

CONCLUSIONS:
This large, multicenter study demonstrates that the addition of 10kHz SCS to CMM results in profound and durable improvements in pain relief, function, and quality-of-life in these NSRBP patients who have been deemed not surgical candidates and exhausted all available appropriate nonoperative medical management.