Publications by authors named "N R 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
Article Synopsis
- Learning curves (LC) for various spinal procedures show a wide range of case numbers required for proficiency, from 10 to 44 cases, impacting factors like operative times and patient outcomes.
- Many studies suggest that implementing in-person/intraoperative mentoring could mitigate the risks associated with the learning process, especially since significant complications are more common early in a surgeon's experience.
- Overall, there's a strong argument for spine surgeons to engage in mentoring to improve safety for patients during their training period in minimally invasive spinal surgeries.