• Vognsen Roche posted an update 6 months ago

    Patients underwent a significant change in lumbar alignment (Δpelvic incidence-lumbar lordosis mismatch 21° ± 16°, P < 0.001); 35.0% had UIV in the upper thoracic region, and 65.0% had UIV in the lower thoracic region. At 1 year, revision rate was 11.9%, and rate of radiographic proximal junctional kyphosis was 29.4%. Neural network comprised 8 inputs, 10 hidden neurons, and 1 output (upper thoracic or lower thoracic). After training, results demonstrated an accuracy of 81.0%, precision of 87.5%, and recall of 87.5% on testing.

    An artificial neural network successfully mimicked 2 lead surgeons’ decision making in the selection of UIV for adult spinal deformity correction. Future models integrating surgical outcomes should be developed.

    An artificial neural network successfully mimicked 2 lead surgeons’ decision making in the selection of UIV for adult spinal deformity correction. Future models integrating surgical outcomes should be developed.

    Relative value units (RVUs) form the backbone of health care service reimbursement calculation in the United States. However, it remains unclear how well RVUs align withobjective measures of procedural complexity within neurosurgery.

    The 2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for neurosurgical procedures with >50 patients, using Current Procedural Terminology (CPT) codes. Length of stay (LOS), operative time, mortality, and readmission and reoperation rates were collected for each code and a univariate correlation analysis was performed, with significant predictors entered into a multivariate logistic regression model, which generated predicted work RVUs, which were compared with actual RVUs to identify undervalued and overvalued procedures.

    Among 64 CPT codes, LOS, operative time, mortality, readmission, and reoperation were significant independent predictors of work RVUs and together explained 76% of RVU variance in a multivariate model (R

    = 0.76). Using a difference of >1.5 standard deviations from the mean, procedures associated with greater than predicted RVU included surgery for intracranial carotid circulation aneurysms (CPTs 61697 and 61700; residual RVU= 12.94 and 15.07, respectively), and infratemporal preauricular approaches to middle cranial fossa (CPT 61590; residual RVU= 15.39). Conversely, laminectomy/foraminotomy for decompression of additional spinal cord, cauda equina, and/or nerve root segments (CPT 63048; residual RVU= -21.30), transtemporal craniotomy for cerebellopontine angle tumor resection (CPT 61526; residual RVU= -9.95), and brachial plexus neuroplasty (CPT 64713; residual RVU= -11.29) were associated with lower than predicted RVU.

    Work RVUs for neurosurgical procedures are largely predictive of objective measures of surgical complexity, with few notable exceptions.

    Work RVUs for neurosurgical procedures are largely predictive of objective measures of surgical complexity, with few notable exceptions.

    Lumbar epidural lipomatosis is a rare condition defined as the excessive accumulation of epidural fat (EF). We herein investigated the indicators of the posterior compression factors, EF and yellow ligament, to identify the clinical features of lumbar epidural lipomatosis.

    Five hundred consecutive patients who underwent posterior lumbar decompression surgery for lumbar spinal stenosis (LSS) were retrospectively reviewed. The EF/SC-L index (the ratio of the anteroposterior length of the EF to that of the spinal canal ) was evaluated at the spinal level that exhibited maximum dural tube compression. Selleck ODM208 The participants were divided into 3 groups grade I, EF/SC-L index ≤50%; grade II, EF/SC-L index 51%-74%; grade III, EF/SC-L index ≥75%. EF/SC-A (the ratio of the cross-sectional area of EF to that of SC) and YL/SC-A (the ratio of the cross-sectional area of yellow ligament to that of SC) were calculated. The clinical outcomes were assessed according to the Japan Orthopaedic Association scale for lumbar disease.

    EF/SC-L exhibited a significantly positive correlation with EF/SC-A (r= 0.82, P < 0.001), and a negative correlation with YL/SC-A (r=-0.71, P < 0.001). The Japan Orthopaedic Association score recovery rate was 56.7 ± 22.6 in the case-matched control group, 34.5 ± 31.2 in the grade II group (P < 0.001), and 39.6 ± 24.9 in the grade III group (P=0.032).

    The EF/SC-L index is a simple and reliable indicator to quantitatively evaluate posterior compression in patients with LSS. As the accumulation ofEF is associated with worse operative outcomes, the EF/SC-L index should be considered when planning lumbar decompression surgery for patients with LSS.

    The EF/SC-L index is a simple and reliable indicator to quantitatively evaluate posterior compression in patients with LSS. As the accumulation of EF is associated with worse operative outcomes, the EF/SC-L index should be considered when planning lumbar decompression surgery for patients with LSS.

    Stroke is a potentially life-threatening condition that can lead to disability and prolonged hospital stay. Perioperative stroke is a rare complication of spine surgery, especially in elective procedures. The prevalence of this complication varies in the literature, and the physiopathology is uncertain in many cases. Our objective was to describe 5 cases of patients who underwent spine surgery complicated by perioperative stroke and to analyze their characteristics and clinical outcomes.

    We retrospectively analyzed data from spine surgeries performed at a single institution from January 2016 to December 2019. Patients who presented with perioperative stroke were included. Data related to patient demographics, postoperative status, hospital stay, type of surgery, American Society of Anesthesiologists (ASA) score, neurologic status at discharge, and mortality were registered.

    Five of 1002 consecutive patients (0.49%) had complication of stroke during surgery. The surgeries included occipitocervical fusion, anterior cervical fusion, lumbar fusion, lumbosacral fusion, and thoracolumbar fusion. The mean age of patients was 52.2 ± 15.73 years (range, 39-78 years), and the mean time of hospitalization was 20 ± 26.93 days (range, 6-68 days). The majority of patients were women (80%). Three patients (60%) presented with ischemic stroke, and 2 patients (40%) had hemorrhagic stroke. Two patients were severely disabled, and 3 showed good neurologic outcomes; no in-hospital deaths were observed. The etiology of stroke remained uncertain in the majority of cases.

    Despite the rarity of this complication, perioperative stroke in spine surgery can lead to considerable morbidity. Precocious diagnosis and treatment may improve patient outcomes.

    Despite the rarity of this complication, perioperative stroke in spine surgery can lead to considerable morbidity. Precocious diagnosis and treatment may improve patient outcomes.

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