What's new in neurological surgery.

Neurological surgery is a discipline of medicine and the specialty of surgery that provides operative and nonoperative management (ie, critical care, prevention, diagnosis, evaluation, treatment, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; evaluation and treatment of pathologic processes that modify the function or activity of the nervous system, including the hypophysis; and operative and nonoperative management of pain. As such, neurological surgery encompasses treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, and skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those that may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. 1 Neurosurgery has surpassed 100 years of development since Harvey Cushing and others began dedicated careers to the study and surgical treatment of disorders of the nervous system. A separate Board was incorporated in 1940, initiating the process of certification of physicians in a recognized medical specialty. The field continues to evolve today in response to progress in imaging, discoveries in neuroscience, advances in technology, and application of novel treatments by practitioners. This article will highlight some of the important contributions that are currently in the conferences and literature within the discipline. Spinal surgery Surgery of the spinal column remains the most common procedure carried out by neurosurgeons in the United States. Early in training, neurosurgeons are exposed to diagnosis and treatment of traumatic and nontraumatic conditions that affect the spinal cord and nerves. Residents are expected to gain expertise in management of patients with these conditions, and the more recent incorporation of techniques involving instrumentation into training programs have resulted in neurosurgeons able to manage the gamut of spinal disorders. Technology in this area has proliferated rapidly in the past 20 years and has been championed by neurosurgeons and orthopaedists alike. These specialists have sometimes worked together, sometimes competed, and, more recently, have begun discussions of a separate specialty of spinal surgery. A number of socioeconomic drivers have provided impetus for this notion. These include physician reimbursement for spinal procedures, development of spine surgery centers outside of the typical hospital setting, and self-designation by neurosurgeons as spine surgeons with concomitant elimination of any responsibility for cranial conditions. This latter process may be the result of reductions in malpractice insurance costs for such self-designations or elimination of responsibility for participation in trauma center call for traumatic brain injured patients. It is likely a combination of the two factors. Three significant developments in spine surgery have moved to the forefront: fusion surgery using instrumentation, disc replacement, and, perhaps most important, outcomes analysis for spine surgery. Technologic advances in fusion surgery include pedicle screws, intervertebral fusion cages, machined allografts, and plates and rods. In the cervical spine, a variety of plates or rods and screws applied to the anterior spinal column or to the posterior lateral masses have been used after decompressive surgery (either discectomy anteriorly or laminectomy posteriorly) to provide immediate No competing interests declared.