Publications by authors named "N B Epstein"
Background: The incidence of cerebrospinal fluid (CSF) leaks/dural tears (DT) occurring during anterior cervical diskectomy and fusion (ACDF) are typically relatively low. However, this frequency markedly increases when anterior corpectomy and fusion (ACF) are performed to address ossification of the posterior longitudinal ligament (OPLL).
Methods: The reported frequencies of CSF leaks/DT occurring during elective ACDF (i.
Article Synopsis
- Cervical and lumbar epidural spinal injections are commonly used in the US for back pain despite not having FDA approval, yet studies show they offer little to no short-term or long-term benefits compared to placebos.* -
- Adverse events (AE) are more frequent and severe with cervical injections, particularly transforaminal (C-TFESI), leading to issues like respiratory distress, paralysis, and infections, while lumbar injections have their own set of risks.* -
- Overall, the effectiveness of these injections is questioned, as most research indicates they do not significantly improve patient outcomes compared to other treatments like saline or local anesthetics.*
Article Synopsis
- * Effective methods to reduce these complications include thorough operative decompressions, use of operating microscopes, and avoiding aggressive techniques when significant dural adhesions are present.
- * Recommended repair techniques involve using non-resorbable sutures, muscle patch grafts, and additional methods like fibrin sealants and lumbar drains to mitigate CSF leaks.
Perspective: How can risks to patients be limited during spine surgeons' learning curves?
Surg Neurol Int
March 2024
Background: Learning curves (LC) are typically defined by the number of different spinal procedures surgeons must perform before becoming "proficient," as demonstrated by reductions in operative times, estimated blood loss (EBL), length of hospital stay (LOS), adverse events (AE), fewer conversions to open procedures, along with improved outcomes. Reviewing 12 studies revealed LC varied widely from 10-44 cases for open vs. minimally invasive (MI) lumbar diskectomy, laminectomy, transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and oblique/extreme lateral interbody fusions (OLIF/XLIF).
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