System-wide integration of patient reported outcome measure collection through an electronic medical record system: A state-wide retrospective study.

Background And Purpose: In spine neurosurgery practice, patient-reported outcome measures (PROMs) are tools used to convey information about a patient's health experience and are an integral component of a clinician's decision-making process as they help guide treatment strategies to improve outcomes and minimize pain. Currently, there is limited research showing effective integration strategies of PROMs into electronic medical records. This study aims to provide a framework for other healthcare systems by outlining the process from start to finish in seven Hartford Healthcare Neurosurgery outpatient spine clinics throughout the state of Connecticut.

Surgical Approaches for the Treatment of Thoracic Disk Herniation: Results of a Decision Analysis.

Study Design: A decision analysis.

Objective: To perform a decision analysis utilizing postoperative complication data, in conjunction with health-related quality of life (HRQoL) utility scores, to rank order the average health utility associated with various surgical approaches used to treat symptomatic thoracic disk herniation (TDH).

Summary Of Background Data: Symptomatic TDH is an uncommon entity accounting for <1% of all symptomatic herniated disks.

ProDisc cervical arthroplasty does not alter facet joint contact pressure during lateral bending or axial torsion.

Study Design: A biomechanical study of facet joint pressure after total disc replacement using cadaveric human cervical spines during lateral bending and axial torsion.

Objective: The goal was to measure the contact pressure in the facet joint in cadaveric human cervical spines subjected to physiologic lateral bending and axial torsion before and after implantation of a ProDisc-C implant.

Summary Of Background Data: Changes in facet biomechanics can damage the articular cartilage in the joint, potentially leading to degeneration and painful arthritis.

Facet joint contact pressure is not significantly affected by ProDisc cervical disc arthroplasty in sagittal bending: a single-level cadaveric study.

Background Context: Total disc arthroplasty is a motion-preserving spinal procedure that has been investigated for its impact on spinal motions and adjacent-level degeneration. However, the effects of disc arthroplasty on facet joint biomechanics remain undefined despite the critical role of these posterior elements on guiding and limiting spinal motion.

Purpose: The goal was to measure the pressure in the facet joint in cadaveric human cervical spines subjected to sagittal bending before and after implantation of the ProDisc-C (Synthes Spine Company, L.

Hyponatremia following endoscopic third ventriculostomy: a report of 5 cases and analysis of risk factors.

Object: Electrolyte and endocrinological complications of endoscopic third ventriculostomy (ETV) are infrequent but serious events, likely due to transient hypothalamic-pituitary dysfunction. While the incidence of diabetes insipidus is relatively well known, hyponatremia is not often reported. The authors report on a series of 5 patients with post-ETV hyponatremia.

Contact pressure in the facet joint during sagittal bending of the cadaveric cervical spine.

The facet joint contributes to the normal biomechanical function of the spine by transmitting loads and limiting motions via articular contact. However, little is known about the contact pressure response for this joint. Such information can provide a quantitative measure of the facet joint's local environment.

Use of occipital bone graft in pediatric posterior cervical fusion: an alternative paramedian technique and review of the literature.

An alternative method of bone grafting for pediatric posterior cervical and occipitocervical fixation is presented in detail. Full-thickness autografts from small craniectomies of the occipital bone are used to augment posterior segmental fusion in pediatric patients. Twelve patients have been treated successfully without bone graft donor site complications.

Pressure measurement in the cervical spinal facet joint: considerations for maintaining joint anatomy and an intact capsule.

Study Design: A novel noninvasive approach to measure facet joint pressure in the cervical spine was investigated using a tip-mounted transducer that can be inserted through a hole in the bony lateral mass. This technique is advantageous because it does not require resection of the joint capsule, but there are potential issues regarding its applicability that are addressed.

Objective: The objective was to evaluate the effect of a tip-mounted pressure probe's position and orientation on contact pressure measurements in biomechanical experiments.

Anomalous fiber realignment during tensile loading of the rat facet capsular ligament identifies mechanically induced damage and physiological dysfunction.

Many pathophysiological phenomena are associated with soft tissue loading that does not produce visible damage or tissue failure. As such, there is an unexplained disconnect between tissue injury and detectable structural damage during loading. This study investigated the collagen fiber kinematics of the rat facet capsular ligament to identify the onset of subfailure damage during tensile loading conditions that are known to induce pain.

Subcutaneous heparin for prophylaxis of venous thromboembolism in deep brain stimulation surgery: evidence from a decision analysis.

Objective: The addition of subcutaneous heparin (SQH) to mechanical prophylaxis for venous thromboembolism (VTE) involves a balance between the benefit of greater protection from VTE and the added risk of intracranial hemorrhage. There is evidence that the hemorrhage risk outweighs the benefits for patients undergoing craniotomy. We investigated the safety of SQH in patients undergoing deep brain stimulation (DBS) surgery.

Multistage epilepsy surgery: safety, efficacy, and utility of a novel approach in pediatric extratemporal epilepsy.

Objective: To evaluate the safety, efficacy, and utility of a novel surgical strategy consisting of multiple (more than two) operative stages performed during the same hospital admission with subdural grid and strip electrodes in selected pediatric extratemporal epilepsy.

Methods: Subdural grid and strip electrodes were used for multistage chronic electroencephalographic monitoring in 15 pediatric patients (age, <19 yr) with refractory localization-related epilepsy and poor surgical prognostic factors. Initial resective surgery and/or multiple subpial transections were performed, followed by further monitoring and additional resection and/or multiple subpial transections.

Merging cultures: palliative care specialists in the medical intensive care unit.

We summarize the key interventions and general findings from a 3-yr project titled, "Merging Palliative and Critical Care Cultures in the Medical Intensive Care Unit." This multifaceted demonstration project was designed so palliative care and intensive care clinicians would share their expertise and develop projects that promote end-of-life care in a medical intensive care unit (ICU) setting. A variety of interventions are described, including collaborating with ICU leaders, training nurses as "palliative care champions," opening visiting hours, educating house officers and other staff about relevant palliative practices, establishing the presence of a palliative care specialist during work rounds, teaching about and promoting family meetings, introducing a "Get to Know Me" poster, staff support efforts, and modeling of interdisciplinary teamwork.

Subpectoral implantation of the vagus nerve stimulator.

Objective: To report the technique of subpectoral (SP) implantation of the vagus nerve stimulator (VNS) generator.

Methods: We retrospectively reviewed and compared demographics and complications from patients receiving either subcutaneous (SQ; n = 107) or SP (n = 138) VNS implants, performed by one surgeon (WKD) between 1999 and 2003. Selection of implant location was made during the preoperative surgeon-patient consultation on the basis of surgeon recommendation and patient preference.

Multistage epilepsy surgery: safety, efficacy, and utility of a novel approach in pediatric extratemporal epilepsy.

Objective: To evaluate the safety, efficacy, and utility of a novel surgical strategy consisting of multiple (more than two) operative stages performed during the same hospital admission with subdural grid and strip electrodes in selected pediatric extratemporal epilepsy.

Methods: Subdural grid and strip electrodes were used for multistage chronic electroencephalographic monitoring in 15 pediatric patients (age, <19 yr) with refractory localization-related epilepsy and poor surgical prognostic factors. Initial resective surgery and/or multiple subpial transections were performed, followed by further monitoring and additional resection and/or multiple subpial transections.

The unique characteristics of "upper" lumbar disc herniations.

Objective: To compare the characteristics, presentation, and surgical outcome of patients with microdiscectomies at L1-L2 and L2-L3 with those we treated at L3-L4. We further sought to compare these results with those reported in the literature for discectomies at the L4-L5 and L5-S1 levels.

Methods: We reviewed the clinical data collected from 69 patients who had 72 L1-L2, L2-L3, and L3-L4 microdiscectomies performed from 1989 to 1999 at the New York University Medical Center.