bluuebunny/crossref_metadata_2025_split huggingface dataset:
434 Reduced Postoperative Narcotics Consumption With Intraoperative Thoracolumbar Interfascial Plane (TLIP) Block Compared to Traditional Field Block
Authors: Brusko Gregory D. , Lu Victor M. , Borowsky Peter , Levi David , Wang Michael Y. 
Published: March 2022

INTRODUCTION:
Given the increasing burden of narcotics usage, spine surgeons have adopted several innovative methods to reduce postoperative pain and narcotics consumption. Local infiltrative anesthetics are commonly administered intraoperatively to provide a local field block for several days after surgery. However, these blocks are limited to the areas in which the anesthetic is injected and is technique-dependent.

METHODS:
A retrospective review of a single surgeon, single institution series of adult patients was conducted between July 2019 and November 2020. Patients were divided into the TLIP or Traditional group depending on which infiltration technique was used. All patients underwent thoracolumbar fusion. Baseline and demographic characteristics and daily narcotics consumption were collected for each patient. All opioid amounts were converted into morphine milligram equivalents (MMEs) for standardization. Analyses were conducted using chi-square exact test and Wilcoxon rank-sum test for categorical and continuous data, respectively.

RESULTS:
A total of 136 patients were included. Sixty-four (47%) and 72 (53%) managed by TLIP and traditional approaches respectively. Overall mean age was 66.1 years (range, 26-85) with 63 (46%) males and 73 (54%) females, with no significant difference between groups. TLIP patients on average required less hydromorphone than Traditional patients on POD1 (25.1 vs 58.1 mg, P = 0.03) and overall (99.2 vs 184 mg, P = 0.04), less diazepam overall (4.1 vs 10.4 mg, P = 0.01) and less overall opioid medication on POD1 (65.9 vs 95.6 MME, P = 0.04) and overall (221 vs 325 MME, P = 0.03). There was no statistical difference in Percocet use, or any opioid. medications on POD0. TLIP patients experienced shorter length of stay compared to the Traditional group although this difference did not achieve significance (3.0 vs 3.6, P = 0.28). Complication rates were comparable between groups.

CONCLUSION:
TLIP patients required less hydromorphone and diazepam, as well as total narcotics during their hospital stay, indicating that on average they experienced less severe pain and muscle spasms postoperatively.
435 Internal Neurolysis for Trigeminal Neuralgia: Systematic Review
Authors: Sabourin Victor , Karsy Michael , Lavergne Pascal , Stefanelli Anthony , Al Saiegh Fadi , Evans James J. 
Published: March 2022

INTRODUCTION:
Trigeminal neuralgia (TN) remains a challenging disease with debilitating symptoms and variable efficacy of treatment options. Internal neurolysis (IN) is a technique to dissect out the cisternal portion of the trigeminal nerve into multiple “fascicles”, and has shown potential as a treatment option.

METHODS:
Studies from 2000-2021 that assessed IN for TN were aggregated and independently reviewed. Outcomes evaluated included post-operative pain scores as defined by the BNI-PS or UCSF-PS, recurrence rates, hypesthesia scores as defined by the BNI-HS, and complications. Outcome were stratified as either excellent (BNI-PS: I or UCSF: excellent), good (BNI-PS: I/II or UCSF: excellent) or fair (BNI-PS: I-III and UCSF: excellent/good). Recurrence rates were considered for any pain recurrence and for significant recurrence defined as BNI-PS I/II transitioning to III-V. Weighted averages for demographics, outcomes and complications were generated.

RESULTS:
A total of 520 patients in 12 studies were identified with 384 patients undergoing IN. The mean follow-up was 36.5 months (range 12-90 months). Overall, an excellent to good outcome was seen in 83.7% of patients. Pain outcomes at 1 year were excellent: 58-78.4%, good: 77-93.75%, and fair: 80-93.75%. Overall pain outcomes were excellent: 47-82.1%, good: 62.5-87.1% and fair: 80-100%. Hypesthesia following IN was seen in as many as 96% post-operatively, however at follow-up remained in only 1.75-10%. The 1-year and overall recurrence rates of any pain were: 3.92-42% and 3.6-50%. The 1-year and overall rates for significant recurrence of pain were: 3.92-17% and 3.6-25%.

CONCLUSION:
IN represents a potentially promising approach for the surgical treatment of TN in the absence of vascular compression and cases of recurrence. It may also be an adjunct option to MVD in cases of low grade vascular compression. Further study is required to evaluate the impact of IN.
442 Cage Type in Short Segment Transforaminal Lumbar Interbody Fusions is Associated With Alterations in Foraminal Height, but Not Clinical Outcomes
Authors: Gibbs David C. , Viljoen Stephanus , Toop Nathaniel , Maggio Dominic , Oosten James , Deistler Kyle , Gilkey Ty , Farhadi Francis , Grossbach Andrew J. 
Published: March 2022

INTRODUCTION:
Steerable “banana” cages have been shown to increase index level segmental lordosis in short-segment transforaminal lumbar interbody fusion (TLIF) procedures. The same is not true for straight “bullet” cages. While this increase in lordosis is generally thought to be advantageous, a theoretical complication is decreased foraminal height leading to worsened clinical outcomes.

METHODS:
We retrospectively reviewed one- and two- level TLIFs at a single tertiary care center between 2012 and 2020 with minimum one-year follow-up. Patient report outcome measures (PROMs), revision rates, and radiographic measurements were compared between two cohorts based on cage morphology.

RESULTS:
48 patients with 56 straight and 93 patients with 129 steerable cages were identified. Steerable cages were associated with an increase in index level segmental lordosis (7.7 vs 11.8°, p < 0.001) and a decrease in foraminal height (20.3 vs 18.4 mm, p < 0.001). Straight cages were associated with a decrease in index level lordosis (8.2 vs 6.3, p = 0.004) and no significant change in foraminal height (19.5 vs 20.2 mm, p = 0.08). Despite these differences, both cohorts reported improved NRS leg, NRS back, RAND SF-36 pain, RAND SF-36 physical functioning, and ODI scores at last follow-up (p = 0.005). One-year revision rates were similar (straight - 4.2%, steerable - 2.2%, p = 0.88) between cohorts.

CONCLUSION:
Steerable cages are associated with increased index level segmental lordosis and decreased foraminal height after TLIF. Straight cages are associated with decreased segmental lordosis, but do not correlate with a significant change in foraminal height. Both cage types are associated with significantly improved clinical outcomes.
448 Revision Rate and Long-Term Outcome After Minimally Invasive Surgical Treatment of Lumbar Adjacent Segment Disease: A Retrospective Review of 176 Adjacent Level Reoperations
Authors: Zhao David , Fayed Islam , Coleman Garrett , Onyiah Amara , Bharil Sarika , Liu Jiaqi , Anaizi Amjad N. , Voyadzis Jean-Marc , Sandhu Faheem A. 
Published: March 2022

INTRODUCTION:
The concept of accelerated degeneration at the level adjacent to a fused spinal segment is a well-known and studied phenomenon. Most current surgical paradigms address this with extension of fusion. However, decompression with laminectomy and/or discectomy, particularly with MIS approaches, are viable options.

METHODS:
A single-center retrospective review of consecutive cases from 2013-2020 was performed. All patients who underwent lumbar surgery for ASD were included. The primary outcome was need for revision surgery following either a decompression, microdiscectomy, or instrumented fusion for lumbar ASD. Multivariable regression analysis (chi-square and ANOVA) was performed on demographic, operative, and follow-up data.

RESULTS:
We identified 176 patients who underwent surgery for lumbar ASD with mean follow-up of 9.3 years. 129 patients were treated with fusion, 37 with laminectomy, and 10 with microdiscectomy. In total, 41 patients required revision surgery following their ASD operation: 28 (21.7%) after fusion, 10 (27%) after laminectomy, and 3 (30%) after microdiscectomy (p = 0.697). Symptomatic disc herniation manifested sooner requiring reoperation -- on average 43.8 months (p = 0.006) after index procedure.

CONCLUSION:
There was no significant difference in revision rate among patients undergoing extension of fusion, laminectomy, or discectomy in the treatment of lumbar ASD. Focal adjacent stenosis or disc herniation can be durably treated with MIS laminectomy or discectomy, respectively. Accelerated disc degeneration after discectomy for lumbar ASD may require a subsequent fusion. Lumbar ASD associated with mobile spondylolisthesis should be treated by extension of fusion.
452 Lateral Interbody Fusion Using a 3D Navigation-guided, Prone, Single Position Approach: A Case Series
Authors: Hoffman Samantha , Gupta Saksham , Huang Kevin T. , Klinger Neil , Lu Yi 
Published: March 2022

INTRODUCTION:
Interbody fusion via the lateral approach provides certain biomechanical advantages over the posterior approach, including the larger allowable implant size and more anterior implant position. However, current methods for lateral interbody placement require either a two-staged procedure or a lateral single position with limited access to the posterior spine. We present our case series of the first 10 patients who underwent novel single position prone lateral approach, which provides simultaneous full access to the anterior and posterior lumbar spine.

METHODS:
We combined prospective collection of operative and surgical outcome data with retrospective analysis for patients with prone lateral lumbar interbody fusion (Pro-LLIF). Propensity score matching was used to identify 10 control patients who had undergone comparable levels of oblique lateral interbody fusion (OLIF) for comparison.

RESULTS:
Single position prone lateral approach allows both lateral lumbar interbody placement and direct posterior decompression and pedicle screws placement in one position. 3D navigation is utilized to plan lateral spine trajectory and interbody cage placement. Tubular retractors are used for quick and safe access to the retroperitoneal space. Under direct vision, direct psoas muscle dissection is performed and additional retractor pins are placed to minimize risks to the lumbar plexus. Our cohort comprised eight female and two male patients with average BMI of 28.5 and average age of 66.5 years. Average total operative time for Pro-LLIF was 4.5 hours compared to 4.33 hours for OLIF (p > 0.5). Mean estimated blood loss was 240 mL and 262.5 mL for Pro-LLIF and OLIF, respectively (p > 0.5). Pro-LLIF patients did not experience significantly different lengths of stay or discharge rates to rehabilitative facilities.

CONCLUSION:
Single position prone lateral approach provides safe and simultaneous access to lateral interbody cage placement and direct posterior neural decompression and segmental fixation. Efficiency will improve with increased experience with this promising technique.
456 Assessing the Efficacy of the mJOA in Myelopathic Patients: A Cervical QOD Study
Authors: Yee Timothy J. , Upadhyaya Cheerag D. , Coric Domagoj , Potts Eric A. , Bisson Erica F. , Turner Jay D. , Knightly John J. , Fu Kai-Ming G. , Foley Kevin T. , Tumialan Luis M. , Shaffrey Mark E. , Bydon Mohamad , Mummaneni Praveen V. , Chan Andrew K. , Meyer Scott A. , Asher Anthony L. , Shaffrey Christopher I. , Gottfried Oren N. , Than Khoi D. , Wang Michael Y. , Buchholz Avery L. , Park Paul 
Published: March 2022

INTRODUCTION:
The modified Japanese Orthopedic Association (mJOA) score is a validated metric for assessing severity of myelopathy. However, its relationship to functional and quality-of-life outcomes after surgery is incompletely known.

METHODS:
The cervical module of the prospectively enrolled Quality Outcomes Database (QOD) was queried. Patients over age 18 who underwent single-stage surgery for CSM were included. Revision and operations for infection, trauma, and tumor were excluded. Postoperative outcomes included the modified Japanese Orthopedic Association (mJOA) score, the Neck Disability Index (NDI), and Quality-Adjusted Life Year (QALY) by EQ-5D. Improvement in mJOA was used as the independent variable in univariate and multivariate linear regression.

RESULTS:
Across 14 surgical centers, 1,121 patients were identified. Mean age±SD was 60.6±11.8 years, and 52.5% were male. Anterior-only operations were performed in 772 patients (68.9%), and posterior-only operations in 349 patients (31.1%). Mean mJOA±SD scores at baseline, 3 months postoperatively, and 12 months postoperatively were 12.0 ± 2.8 (n = 1121), 13.9 ± 2.6 (n = 914), and 13.8 ± 2.8 (n = 801). Mean NDI ± SD scores at baseline, 3 months postoperatively, and 12 months postoperatively were 38.3 ± 20.8 (n = 1117), 23.1 ± 17.9 (n = 942), and 20.4 ± 19.4 (n = 807). Mean QALY ± SD scores at baseline, 3 months postoperatively, and 12 months postoperatively were 0.6 ± 0.2 (n = 1029), 0.7 ± 0.2 (n = 899), and 0.7 ± 0.2 (n = 761). By univariate analysis, improvements in mJOA were associated with improvements in NDI and QALY at 3 and 12 months postoperatively (all p < 0.0001). These findings were similar in multivariate analysis.

CONCLUSION:
In this large cohort of patients who underwent surgery for CSM, improvements in mJOA were associated with improvements in NDI and QALY. These findings suggest that changes in mJOA can serve as a proxy for functional and quality-of-life outcomes.
460 Access to Thrombectomy Capable Stroke Centers in the US: Current Geographic Patterns and Economic Disparities
Authors: Waqas Muhammad , Levy Bennett , Baig Ammad , Cappuzzo Justin M. , Monteiro Andre , Mullin Wallace , Davies Jason , Snyder Kenneth V. , Levy Elad I. , Siddiqui Adnan H. 
Published: March 2022

INTRODUCTION:
In the last five years, mechanical thrombectomy has revolutionized the standard of care for patients suffering from acute stroke. The mechanical thrombectomy procedures for removal of clot from large vessel of the brain has been shown to be cost effective compared to the traditional medical therapy. Given the fact that clinical outcomes are strongly dependent on time to recanalization, it is important to examine the socioeconomic disparity of geographic living distance from thrombectomy capable stroke centers (TCC) as related to patient outcomes.

METHODS:
The data on the US population and geographic location of thrombectomy capable stroke centers was obtained from the US Census Bureau and the websites of accrediting agencies and state governments. Using previously validated methods we estimated the population with 1 hour access to TCC. We additionally acquired median household income data for each state in the US. The proportion of population with 1 hour access to TCC was compared between low, middle and high median household states.

RESULTS:
There was a total of 316 TCCs in the analysis, and approximately 65% of all US residents have within one-hour access to a specialized stroke center by way of air or ground. The states with >50% of the population having less than 1-hour access to thrombectomy centers, had the average median income was nearly $10,000 more when compared to states with <50% of the population with 1-hour access to TCC. In high-income states, 69.0% of the population had one-hour access to TCCs. In the middle-income states, 49.5 % of the population had one-hour access to TCCs, while only 21.4 % states one-hour access to TCCs, p-value = 0.01. A positive and significant relationship between economic status and percentage population with one-hour access was observed (r = 0. 44, p-value = 0.01).

CONCLUSION:
One-hour access to thrombectomy capable stroke centers is available to 65% of the US residents. A positive and significant relationship between economic status and percentage population with one-hour access was observed.
461 The Utility of Remote Video Technology in Continuing Neurosurgical Care in the COVID-19 Era: Reflections From the Past Year
Authors: Sharma Akshay , Winkelman Robert , Schlenk Richard P. , Rasmussen Peter A. , Angelov Lilyana , Benzil Deborah L. 
Published: March 2022

INTRODUCTION:
The 2020 COVID-19 pandemic exposed existing stressors in the neurosurgical care infrastructure in the United States.

METHODS:
Several distance-health and audio-visual innovations were implemented that expanded neurosurgical care and education at our institution, including use of remote video technology to facilitate inpatient consultations and outpatient ambulatory virtual visits, optimize our regional hospital neurosurgical coverage, expand our interdisciplinary patient management conferences (i.e. Tumor Board), and further enhance our neurosurgical resident education program. Enterprise patient-experience data was queried for outpatient visits in the department of neurosurgery to evaluate patient satisfaction following the switch to virtual visits.

RESULTS:
Between January of 2020 and April of 2021 our department of Neurosurgery more than doubled the utilization of virtual visit following pandemic restrictions.Our survey of 10,772 patient following outpatient visits between April 2020 and March 2021 showed that virtual visitation was equal if not better in providing satisfactory and compassionate patient care. Further, after switching our interdisciplinary spine tumor board to virtual, we increased surgeon participation and attendance by 49.29%. We also found that the integration of remote audio-visual technology in resident didactics and clinical training expanded our ability to provide a comprehensive and personalized educational experience for our trainees.

CONCLUSION:
Distance-health technology has improved our ability to provide care and comprehensive training at our institution. Our investment in the infrastructure required for these remote audio-visual services during the pandemic can facilitate the expansion of neurosurgical care provision for patients across the United States in the future. As we progress, governing bodies within organized neurosurgery should advocate for the continued financial and licensing support of theses service on a national fiscal and policy level.
468 Team Sport Participation Protects Against Burnout During Neurosurgery Training
Authors: Yengo-Kahn Aaron M. , Grimaudo Heather C. , Tonetti Daniel , Burns Carter , Bonfield Christopher M. , Dewan Michael C. , Wellons John C. , Chitale Rohan V. , Chambless Lola B. , Zuckerman Scott L. 
Published: March 2022

INTRODUCTION:
Burnout is experienced by up to two-thirds of neurosurgery residents. Team sport participation as an adolescent or young adult has been shown to protect against adverse mental health outcomes (e.g. depression or anxiety) in adulthood.

METHODS:
A cross-sectional survey study of neurosurgery residents enrolled in U.S. programs was conducted between 6/2020-2/2021. Variables collected through surveys included demographics, weekly exercise, and prior team sport participation, defined as an organized team sport at the high school or collegiate level, even if performed individually (i.e. track/golf). Outcomes included ratings of feelings of sadness, anxiety, stress, burnout, optimism and fulfillment on 100-point scales, with 100 being “I constantly feel this during the day.” Individual measures were significantly correlated (r > 0.35, p < 0.0005) and averaged into a composite outcome - "Burnout Composite Score" (BCS). A three-way ANOVA tested the effects of resident level, exercise days and team sport participation on BCS.

RESULTS:
Of 229 submitted responses, 228 (99.5%) provided complete data. Overall, 185 (81.1%) residents had participated in team sports. Weekly exercise days was similar across groups (2.5±1.8 vs 2.1 ± 1.8, p = 0.20). The team sports group reported lower mean BCS (37.14 vs 43.57, p = 0.030, Cohen’s d = 0.369). There was a significant interaction between team sports and exercise regimen on BCS (F(3,211) = 3.39, p = 0.019, n2 = 0.046). Post-hoc analyses demonstrated more exercise days per week was associated with decreased BCS for prior team sport athletes (F(3,211) = 11.10, p < 0.0005), but not for non-participants (F(3,211) = 0.476, p = 0.699). Team sport participation was associated with a larger reduction in BCS among senior residents (11.46 pts, p = 0.016), than junior residents (4.33 pts, p = 0.29).

CONCLUSION:
Prior team sport participation was associated with lower BCS, an effect more pronounced during senior residency, where residents assume formalized leadership responsibilities. Lessons imparted during early team sport experience may have profound impacts on reducing burnout throughout a seven-year neurosurgery residency.
469 The Role of Social Determinants of Health in Child Mortality and Survival Following Abusive Head Trauma
Authors: Singer Timothy , Warner Claire , Mehl Steven , Cain Cary , Kralik Stephen F. , Orman Gunes , Desai Nilesh , Sarpong Kwabena , Donaruma Marcella , Huisman Thierry , Naik-Mathuria Bindi , Weiner Howard L. , Risen Sarah , Donoho Daniel 
Published: March 2022

INTRODUCTION:
Abusive Head Trauma (AHT) is a leading cause of preventable pediatric death in the United States, with mortality rates as high as 30. Although population-based studies implicate the Social Determinants of Health (SDOH), “the conditions in the environments where people are born, live, learn, work, play, worship, and age,” as risk factors for AHT mortality, patient-level series have not been widely reported. Examining patient-level SDOH data could provide valuable information for targeted interventions to prevent AHT mortality.

METHODS:
We included children <5 years with expert-confirmed AHT at our freestanding children's hospital from 3/2018-2/2021. Demographic, social, and clinical data were excerpted. Pediatric neuroradiologists reviewed imaging. Descriptive and inferential analyses were conducted with RStudio.

RESULTS:
Of 103 patients with AHT, 19 (18.4%) died and 84 (82.6%) survived. The cohorts were demographically similar. Housing status was not significantly different. Prior interactions with a social worker (11% vs 19%), Child Protective Services (42% vs. 32%), and law enforcement (44% vs. 32%) were frequently observed but not significantly different. Health access measures including insurance status and established care with a pediatrician were similar. Deceased children were more likely to have mothers who were jobless 64% vs. 40%, p = 0.042). Mothers of deceased children were younger (22 vs. 25 years, p = 0.038). Clinically, a strong association was observed between in-hospital mortality and injury severity on presentation (Glasgow Coma Scale, Injury Severity Score, Abbreviated Injury Scale), intubation, presence of hypoxic-ischemic injury, and percent of hospitalization in the intensive care unit. Frequency of neurosurgical intervention was equal between cohorts (32% vs. 23%, p = 0.39).

CONCLUSION:
Adverse SDOH were observed frequently in both cohorts, often at levels far exceeding state and national averages. Children who died from AHT were more likely to have younger, unemployed mothers.