Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy for Painful Spinal Metastases: A Comparative Analysis of Randomized Trials and Practical Considerations.

Purpose: Recent randomized trials have compared the efficacy and safety of stereotactic body radiation therapy (SBRT) with those of standard conventional external beam radiation therapy (cEBRT) for the treatment of painful spinal metastases. We conducted a composite analysis of these trials in order to inform current practice using pooled outcomes.

Methods And Materials: Data from each randomized trial were abstracted from the final publications with biologically effective doses (BEDs) recalculated for SBRT and cEBRT.

Prophylactic Radiotherapy Of MInimally Symptomatic Spinal Disease (PROMISSeD): study protocol for a randomized controlled trial.

Background: Early palliative/pre-emptive intervention improves clinical outcomes and quality of life for patients with metastatic cancer. A previous signal-seeking randomized controlled trial (RCT) demonstrated that early upfront radiotherapy to asymptomatic or minimally symptomatic high-risk osseous metastases led to reduction in skeletal-related events (SREs), a benefit driven primarily by subgroup of high-risk spine metastasis. The current RCT aims to determine whether early palliative/pre-emptive radiotherapy in patients with high-risk, asymptomatic or minimally symptomatic spine metastases will lead to fewer SREs within 1 year.

Initial experience with minimally invasive endoscopic evacuation of intracerebral hemorrhage in the setting of radiographic herniation.

Background: Spontaneous intracerebral hemorrhage (ICH) can rapidly result in cerebral herniation, leading to poor neurologic outcomes or mortality. To date, neither decompressive hemicraniectomy (DH) nor hematoma evacuation have been conclusively shown to improve outcomes for comatose ICH patients presenting with cerebral herniation, with these patients largely excluded from clinical trials. Here we present the outcomes of a series of patients presenting with ICH and radiographic herniation who underwent emergent minimally invasive (MIS) ICH evacuation.

Responder Analysis of Pain Relief After Surgery for the Treatment of Spinal Metastatic Tumors.

Background: Central tendency analysis studies demonstrate that surgery provides pain relief in spinal metastatic tumors. However, they preclude patient-specific probability of treatment outcome.

Objective: To use responder analysis to study the variability of pain improvement.

Neurosurgical Mimics.

The goal of the following article is to help the practicing physician learn to recognize conditions that mimic conditions requiring neurosurgical intervention. Each case vignette is presented with relevant clinical history and examination, imaging studies and findings, as well as other testing results. The management for the corresponding diagnosis is presented.

Challenges in Diagnosis and Management of Previously Embolized Spinal Dural Arteriovenous Fistulae.

Background: Given the growing prevalence of initial endovascular treatment for type 1 spinal dural arteriovenous fistulae (dAVF), there are an increasing number of patients presenting with progressive symptoms related to recurrent previously embolized spinal dAVF. This study's goal was to identify demographic, clinical, and radiographic variables among patients who have failed embolization of type I spinal dAVF.

Methods: A retrospective review of 24 consecutive surgeries for type I spinal dAVF performed by the senior author (A.

Syrinx shunts for syringomyelia: a systematic review and meta-analysis of syringosubarachnoid, syringoperitoneal, and syringopleural shunting.

Objective: Syringomyelia is a debilitating, progressive disease process that can lead to loss of neurological function in patients already experiencing significant compromise. Syringosubarachnoid, syringoperitoneal, and syringopleural shunts are accepted treatment options for patients with persistent syringomyelia, but direct comparisons have been lacking to date. The authors conducted a systematic review of the literature and meta-analysis to compare clinical outcomes between these three syrinx shunt modalities.

The Impact of Non-Elective Admission on Cost of Care and Length of Stay in Anterior Cervical Discectomy and Fusion: A Propensity-Matched Analysis.

Study Design: Retrospective cohort study.

Objective: To evaluate the impact of admission status on patient outcomes and healthcare costs in anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: Undergoing ACDF non-electively has been associated with higher patient comorbidity burdens.

Application of Cooperative Game Theory Principles to Interpret Machine Learning Models of Nonhome Discharge Following Spine Surgery.

Study Design: Retrospective analysis of prospectively acquired data.

Objective: The aim of this study was to identify interaction effects that modulate nonhome discharge (NHD) risk by applying coalitional game theory principles to interpret machine learning models and understand variable interaction effects underlying NHD risk.

Summary Of Background Data: NHD may predispose patients to adverse outcomes during their care.

Lower Mortality and Morbidity with Low-Molecular-Weight Heparin for Venous Thromboembolism Prophylaxis in Spine Trauma.

Study Design: Retrospective review of prospectively collected data.

Objective: The objective of this study was to evaluate outcomes between patients receiving LMWH versus UH in a retrospective cohort of patients with spine trauma.

Summary Of Background Data: Although multiple clinical trials have been conducted, current guidelines do not have enough evidence to suggest low-molecular-weight heparin (LMWH) or unfractionated heparin (UH) for venous thromboembolism (VTE) prophylaxis in spine trauma.

The Impact of Diabetes on Outcomes and Health Care Costs Following Anterior Cervical Discectomy and Fusion.

Study Design: Retrospective cohort study.

Objectives: Anterior cervical discectomy and fusion (ACDF) is commonly used to treat an array of cervical spine pathology and is associated with good outcomes and low complication rates. Diabetes mellitus (DM) is a common comorbidity for patients undergoing ACDF, but the literature is equivocal about the impact it has on outcomes.

Survival Trends After Surgery for Spinal Metastatic Tumors: 20-Year Cancer Center Experience.

Background: Over the last 2 decades, advances in systemic therapy have increased the expected overall survival for patients with cancer. It is unclear whether the same survival benefit has been conferred to patients requiring surgery for metastatic spinal disease.

Objective: To examine trends in postoperative survival over a 20-yr period for patients surgically treated for spinal metastatic disease.

Hypofractionated spinal stereotactic body radiation therapy for high-grade epidural disease.

Objective: To characterize the clinical outcomes when stereotactic body radiation therapy (SBRT) alone is used to treat high-grade epidural disease without prior surgical decompression, the authors conducted a retrospective cohort study of patients treated at the Memorial Sloan Kettering Cancer Center between 2014 and 2018. The authors report locoregional failure (LRF) for a cohort of 31 cases treated with hypofractionated SBRT alone for grade 2 epidural spinal cord compression (ESCC) with radioresistant primary cancer histology.

Methods: High-grade epidural disease was defined as grade 2 ESCC, which is notable for radiographic deformation of the spinal cord by metastatic disease.

Afternoon Surgical Start Time Is Associated with Higher Cost and Longer Length of Stay in Posterior Lumbar Fusion.

Background: Existing research about surgical start time is equivocal about associations between outcomes and late start times, and there is only one published report investigating start time in spine surgery. Therefore, the objective of this study was to assess associations between surgical start time, length of stay (LOS), and cost in lumbar spine surgery.

Methods: Patients at a single institution undergoing posterior lumbar fusion (PLF) were grouped based on whether they received their surgery before or after 2 pm, with those receiving their surgery between 12 am and 6 am and receiving surgery for tumors, trauma, or infections being excluded.

By the Numbers Analysis of Effect of COVID-19 on a Neurosurgical Residency at the Epicenter.

Background: The severe acute respiratory syndrome coronavirus 2 pandemic has created challenges to neurosurgical patient care. Despite editorials evaluating neurosurgery responses to 2019 novel coronavirus disease (COVID-19), data reporting effects of COVID-19 on neurosurgical case volume, census, and resident illness are lacking. The aim of this study was to present a real-world analysis of neurosurgical volumes, resident deployment, and unique challenges encountered during the severe acute respiratory syndrome coronavirus 2 outbreak peak in New York City.

Large Rises in Thoracolumbar Fusions by 2040: A Cause for Concern with an Increasingly Elderly Surgical Population.

Background: With a growing aging population in the United States, the number of operative lumbar spine pathologies continues to grow. Therefore, our objective was to estimate the future demand for lumbar spine surgery volumes for the United States to the year 2040.

Methods: The National/Nationwide Inpatient Sample was queried for years 2003-2015 for anterior interbody and posterior lumbar fusions (ALIF, PLF) to create national estimates of procedural volumes for those years.

Changing Causes of US Neurological Disease Mortality From 1999 to 2017.

This study estimates neurological disease mortality rate trends in the US population from 1999 to 2017 as well as regionalized differences within the US.

Utility of the Hospital Frailty Risk Score for Predicting Adverse Outcomes in Degenerative Spine Surgery Cohorts.

Background: As spine surgery becomes increasingly common in the elderly, frailty has been used to risk stratify these patients. The Hospital Frailty Risk Score (HFRS) is a novel method of assessing frailty using International Classification of Diseases, Tenth Revision (ICD-10) codes. However, HFRS utility has not been evaluated in spinal surgery.

Neurosurgical management of brain and spine tumors in the COVID-19 era: an institutional experience from the epicenter of the pandemic.

The challenges of neurosurgical patient management and surgical decision-making during the 2019-2020 COVID-19 worldwide pandemic are immense and never-before-seen in our generation of neurosurgeons. In this case-based formatted report, we present the Mount Sinai Hospital (New York, NY) Department of Neurosurgery institutional experience in the epicenter of the pandemic and the guiding principles for our current management of intracranial, skull base, and spine tumors. The detailed explanations of our surgical reasoning for each tumor case is tailored to assist neurosurgeons across the United States as they face these complex operative decisions put forth by the realities of the pandemic.

Later Surgical Start Time Is Associated With Longer Length of Stay and Higher Cost in Cervical Spine Surgery.

Study Design: Retrospective study of a surgical cohort from a single, large academic institution.

Objective: The aim of this study was to investigate associations between surgical start time, length of stay, cost, perioperative outcomes, and readmission.

Summary Of Background Data: One retrospective study with a smaller cohort investigated associations between surgical start time and outcomes in spine surgery and found that early start times were correlated with shorter length of stay.

Advanced Techniques for Endoscopic Intracerebral Hemorrhage Evacuation: A Technical Report With Case Examples.

Background: Multiple surgical techniques to perform minimally invasive intracerebral hemorrhage (ICH) evacuation are currently under investigation. The use of an adjunctive aspiration device permits controlled suction through an endoscope, minimizing collateral damage from the access tract. As with increased experience with any new procedure, performance of endoscopic minimally invasive ICH evacuation requires development of a unique set of operative tenets and techniques.

Adjacent Segment Reoperation and Other Perioperative Outcomes in Patients Who Underwent Anterior Lumbar Interbody Fusions at One and Two Levels.

Objective: This is the first large retrospective analysis of patients undergoing anterior lumbar interbody fusion (ALIF) with concern for clinical determinants leading to reoperation for adjacent segment disease (ASD). The objective of this study is to examine the specific perioperative and clinical determinants that affect need for adjacent segment reoperation in patients who underwent 1-level and 2-level ALIF procedures for degenerative disc disorders.

Methods: All cases at our institution between 2008 and 2016 involving an ALIF performed for degenerative disc disorders at 1 or 2 levels were examined.