Complementary effects of postoperative delirium and frailty on 30-day outcomes in spine surgery.

Background Context: With an increasingly older population, the number of frail patients requiring surgical management for degenerative spine diseases is rapidly increasing. Older patients are at increased risk of developing postoperative delirium (POD), which increases the odds of postoperative morbidity and mortality in spine surgery patients. Therefore, frail spine surgery patients may be at greater risk of developing POD and subsequent adverse outcomes.

Venous Thromboembolic Events in Adult Trauma Patients Receiving Balanced Hemostatic Resuscitation (BHR): An Analysis of Their Incidence, Predictors, and Associated Mortality Rates at a Level 1 Trauma Center.

Background and objective Studies assessing the incidence of venous thromboembolic (VTE) events in the setting of massive balanced transfusions and/or tranexamic acid (TXA) infusion have yielded varied outcomes. In light of this, we conducted this study to examine the incidence of VTEs in trauma patients requiring blood products, and to identify the risk factors for VTE and mortality in this population. Methods We performed a retrospective analysis of trauma patients admitted to our level 1 trauma center from January 2013 to September 2023.

The Role of Neuropsychology in Traumatic Brain Injury: Comprehensive Literature Review.

Traumatic brain injury (TBI) is a major public health concern, often leading to significant behavioral and cognitive changes with subsequent impairment in daily functioning and personal interactions. The management of TBI involves a multidisciplinary approach. Neuropsychology has emerged as a critical discipline in assessing, diagnosing, treating, and rehabilitating individuals with TBI.

Advanced Neck Dermatillomania Leading to Cervical Osteomyelitis and Epidural Abscess.

Dermatillomania, a condition characterized by compulsive skin picking, can lead to tissue damage and severe infections of adjacent structures. This case report presents the first documented instance of dermatillomania-induced cervical osteomyelitis and epidural abscess. Herein, we describe the case of a 45-year-old male patient with a history of a non-healing posterior neck wound, which progressively worsened and extended to the posterior cervical spine.

Predictors of Surgical Outcomes in Patients with Abducens Nerve Schwannoma: A Comprehensive Systematic Review and a Case Report.

Background: Abducens nerve (AN) schwannomas are extremely rare tumors. Clinical characteristics and factors that influence postoperative outcomes are not well defined.

Objective: To characterize clinical features of AN schwannomas and predictors of surgical outcomes.

The Surgical Management of Holospinal Epidural Abscess: A Case Report and Review on Catheter-Based Irrigation Techniques.

Holospinal epidural abscess (HEA) is an extremely rare spinal infection involving the entire spine and is infrequently reported in the literature. Cases with evidence of spinal cord compression and consequent neurological deficit are typically managed with prompt surgical drainage and broad-spectrum antibiotics. Surgical intervention is often challenging because this condition is inherently associated with poor prognosis and serious complications, including death.

Brain Meningiomas Manifesting as Intracranial Hemorrhage: Comprehensive Systematic Review and Report of the First Case of Hemorrhagic Meningiomatosis.

Objective: To characterize the salient features of hemorrhagic manifestation of meningiomas and to report on the first case of hemorrhagic meningiomatosis.

Methods: A comprehensive systematic review of the English-language literature was performed using MEDLINE, PubMed, and Google Scholar databases to identify case reports and series of brain meningiomas manifesting as intracranial hemorrhage.

Results: A total of 65 patients were evaluated.

Intracranial Subdural Hematoma Versus Postdural Puncture Headache Following Epidural Anesthesia: A Case Report.

Headache is a relatively common complaint following dural puncture whether it is diagnostic (lumbar puncture) or unintentional (e.g., after epidural anesthesia).

Use of Dental Bisphenol A-Glycidyl Methacrylate Composite to Repair Refractory Cerebrospinal Fluid Leaks Associated With Large-Scale Anterior Skull Base Defects.

Treatment of refractory cerebrospinal fluid (CSF) leaks, particularly those associated with large skull base defects, is challenging. A variety of synthetic biomaterial-based systems have been investigated in experimental models and/or humans for reconstructing cranial base defects. A widely used dental composite (bisphenol A-glycidyl methacrylate [bis-GMA]) has been shown to be effective for reconstruction of anterior skull base defects in animal models.

Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part III Lumbosacral Spine.

Spine surgery at the wrong level is an undesirable event and unique pitfall in spine surgery. It is detrimental to the relationship between the patient and the surgeon and typically results in profound medical and legal consequences. It falls under the wrong-site surgery sentinel events reporting system.

Anatomical Variations That Can Lead to Spine Surgery at The Wrong Level: Part II Thoracic Spine.

Spine surgery at the wrong level is a detrimental ordeal for both surgeon and patient, and it falls under the wrong-site surgery sentinel events reporting system. While there are several methods designed to limit the incidence of these events, they continue to occur and can result in significant morbidity for the patient and malpractice lawsuits for the surgeon. In thoracic spine, numerous risk factors influence the development of this misadventure.

Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part I, Cervical Spine.

Spine surgery at the wrong level is an adversity that many spine surgeons will encounter in their career, and it falls under the wrong-site surgery sentinel events reporting system. The cervical spine is the second most common location in the spine at which surgery is performed at the wrong level. Anatomical variations of the cervical spine are one of the most important incriminating risk factors.

The Neural Sulcus of the Cervical Vertebrae: A Review of Its Anatomy and Surgical Perspectives.

The neural sulcus is a bony channel that spans the transverse process in the subaxial cervical spine. It is located between the anterior and posterior tubercles on either side of the transverse foramen, housing the spinal nerve as it passes through the intervertebral foramina. Although numerous studies have evaluated the anatomy of the cervical spine, very little data on detailed anatomy of the neural sulcus and its implication in cervical spine surgery exist.

Delayed Cerebral Ischemia of the Corpus Callosum: A Case Report.

Ischemic infarction of the corpus callosum is a rare condition due to its rich vascular supply and therefore has been infrequently reported. Here, we present a case of a patient who developed a delayed infarct of the corpus callosum in the body. The condition was characterized by bilateral lower extremity weakness and visual disturbances following intraventricular hemorrhage managed with ventriculostomy.

Reattachment of the Multifidus Tendon in Lumbar Surgery to Decrease Postoperative Back Pain: A Technical Note.

The posterior midline approach to the lumbar spine requires significant manipulation of the paraspinal muscles. Muscle detachment and retraction results in iatrogenic damage such as crush injury, devascularization, and denervation, all of which have been associated with postoperative pain. The muscle most directly affected by the posterior approach is the lumbar multifidus (LM), the largest and most medial of the deep lumbar paraspinal muscles.

Quality and Clinical Care Development in Spine Surgery-Connecting the Dots: An Expanded Clinical Narrative.

Our health care system is an evidenced-based quality-centric environment. Pursuit of quality is a process that encompasses knowledge development and care advancements through collaboration and expertise. Depicted here is the foundational knowledge, process, and contributions that hallmark successful clinical quality programs.

Cervical spondylodiscitis caused by in a non-immunocompromised patient: A case report and review of literature.

Background: Fungal cervical spondylodiscitis is rare and accounts for less than 1% of all cervical, thoracic, and lumbar vertebral osteomyelitis and discitis.

Case Description: A 32-year-old non-immunocompromised male presented with persistent neck pain and paresthesias. The magnetic resonance imaging of the cervical spine demonstrated a contrast-enhancing erosive lesion involving the cervical C6 and C7 vertebral bodies accompanied by epidural phlegmon.

Candida parapsilosis Infection of Ventriculoperitoneal Shunt in Adult: Case Report and Literature Review.

Background: Candida parapsilosis is an incredibly rare cause of ventriculoperitoneal (VP) shunt infections, with only 1 adult case reported in the literature to date.

Case Description: We describe the case of a 45-year-old man admitted for a traumatic fall and subsequently treated with VP shunt placement for obstructive hydrocephalus secondary to a cerebellar contusion and intraventricular hemorrhage. Eight months following VP shunt placement, the patient presented with a 2-month history of clear fluid leakage through a dehiscent surgical abdominal wound overlying the distal VP shunt.

Extraforaminal compression of the L5 nerve: An anatomical study with application to failed posterior decompressive procedures.

This anatomical study was performed to elucidate the pertinent foraminal and lateral L5 nerve anatomy to enhance our understanding of possible neurologic causes of failed decompression surgery. Persistent extraforaminal L5 nerve compression is a possible cause of persistent symptoms following lumbosacral surgery. The amount of extraforaminal space for the L5 ventral ramus was examined in fifty adult human skeletons (100 sides).

Advancement of Surgical Visualization Methods: Comparison Study Between Traditional Microscopic Surgery and a Novel Robotic Optoelectronic Visualization Tool for Spinal Surgery.

Introduction: The operating microscope (OM) has become instrumental in aiding surgeons during key microdissection with greater safety and detail. An exoscope offers similar detail with improved functionality and greater implications for live teaching and improved operating room flow.

Methods: Eleven senior neurosurgery residents and fellows performed unilateral, single-level laminotomies on fresh cadavers using an OM and exoscope.

Cervical fracture from chronic steroid usage presenting as a stroke: A case report.

Introduction: Misdiagnosis of Brown-Séquard-like presentations can delay treatment; potentially endangering the positive outcomes a patient might otherwise have had. Stroke mimics can be perceived as signaling the end of urgent investigation and care once stroke is ruled out; however, stroke mimics themselves can require prompt care. Herein, we discuss an extremely rare case where stroke was ruled out, resulting in a lapse in care that lead to an exacerbated hemiparesis over the following week.

New Landmark for Localizing the Site of the Subdental Synchondrosis Remnant: Application to Discerning Pathology from Normal on Imaging.

Objective: We hypothesized that the entry site of the basivertebral vein into the basivertebral foramen of C2 might localize the subdental synchondrosis between the odontoid process and body of C2, which may be helpful for odontoid fracture classification.

Methods: Twenty-five dry adult C2 specimens underwent thin-cut computed tomography and were sectioned sagittally. The basivertebral foramen was then correlated to internal bony anatomy.

Dynamic susceptibility contrast and dynamic contrast-enhanced MRI characteristics to distinguish microcystic meningiomas from traditional Grade I meningiomas and high-grade gliomas.

OBJECTIVE Microcystic meningioma (MM) is a meningioma variant with a multicystic appearance that may mimic intrinsic primary brain tumors and other nonmeningiomatous tumor types. Dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) MRI techniques provide imaging parameters that can differentiate these tumors according to hemodynamic and permeability characteristics with the potential to aid in preoperative identification of tumor type. METHODS The medical data of 18 patients with a histopathological diagnosis of MM were identified through a retrospective review of procedures performed between 2008 and 2012; DSC imaging data were available for 12 patients and DCE imaging data for 6.