Smart Spine Implants.

Smart spine implants promise to stimulate healing and provide objective information about healing progression. The ability of implants to accelerate healing and provide objective data could help guide postoperative care, foster better outcomes, and reduce complications. Real-time monitoring, remote control and programming, and data analytics are actively being developed and translated into clinical practice.

Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey.

Study Design: Cross-sectional survey.

Objective: Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice.

Improving Awareness Could Transform Outcomes in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 1].

Study Design: Literature Review (Narrative).

Objective: To introduce the number one research priority for Degenerative Cervical Myelopathy (DCM): Raising Awareness.

Methods: Raising awareness has been recognized by AO Spine RECODE-DCM as the number one research priority.

Historical perspectives, challenges, and future directions of implantable brain-computer interfaces for sensorimotor applications.

Almost 100 years ago experiments involving electrically stimulating and recording from the brain and the body launched new discoveries and debates on how electricity, movement, and thoughts are related. Decades later the development of brain-computer interface technology began, which now targets a wide range of applications. Potential uses include augmentative communication for locked-in patients and restoring sensorimotor function in those who are battling disease or have suffered traumatic injury.

Spinal Cord Injury Disrupts Resting-State Networks in the Human Brain.

Despite 253,000 spinal cord injury (SCI) patients in the United States, little is known about how SCI affects brain networks. Spinal MRI provides only structural information with no insight into functional connectivity. Resting-state functional MRI (RS-fMRI) quantifies network connectivity through the identification of resting-state networks (RSNs) and allows detection of functionally relevant changes during disease.

Diffusion Assessment of Cortical Changes, Induced by Traumatic Spinal Cord Injury.

Promising treatments are being developed to promote functional recovery after spinal cord injury (SCI). Magnetic resonance imaging, specifically Diffusion Tensor Imaging (DTI) has been shown to non-invasively measure both axonal and myelin integrity following traumatic brain and SCI. A novel data-driven model-selection algorithm known as Diffusion Basis Spectrum Imaging (DBSI) has been proposed to more accurately delineate white matter injury.

Bioresorbable silicon electronic sensors for the brain.

Many procedures in modern clinical medicine rely on the use of electronic implants in treating conditions that range from acute coronary events to traumatic injury. However, standard permanent electronic hardware acts as a nidus for infection: bacteria form biofilms along percutaneous wires, or seed haematogenously, with the potential to migrate within the body and to provoke immune-mediated pathological tissue reactions. The associated surgical retrieval procedures, meanwhile, subject patients to the distress associated with re-operation and expose them to additional complications.

Magnetic Resonance Imaging Biomarker of Axon Loss Reflects Cervical Spondylotic Myelopathy Severity.

Study Design: A prospective cohort study.

Objective: In this study, we employed diffusion basis spectrum imaging (DBSI) to quantitatively assess axon/myelin injury, cellular inflammation, and axonal loss of cervical spondylotic myelopathy (CSM) spinal cords.

Summary Of Background Data: A major shortcoming in the management of CSM is the lack of an effective diagnostic approach to stratify treatments and to predict outcomes.

Radiation Therapy for Residual or Recurrent Atypical Meningioma: The Effects of Modality, Timing, and Tumor Pathology on Long-Term Outcomes.

Background: Optimal use of stereotactic radiosurgery (SRS) vs external beam radiation therapy (EBRT) for treatment of residual/recurrent atypical meningioma is unclear.

Objective: To analyze features associated with progression after radiation therapy.

Methods: Fifty radiation-naive patients who received SRS or EBRT for residual and/or recurrent atypical meningioma were examined for predictors of progression using Cox regression and Kaplan-Meier analyses.

Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases.

Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami.

No additional protection against ventriculitis with prolonged systemic antibiotic prophylaxis for patients treated with antibiotic-coated external ventricular drains.

OBJECT External ventricular drains (EVDs) are commonly used for CSF diversion but pose a risk of ventriculitis, with rates varying in frequency from 2% to 45%. Results of studies examining the utility of prolonged systemic antibiotic therapy for the prevention of EVD-related infection have been contradictory, and no study to date has examined whether this approach confers additional benefit in preventing ventriculitis when used in conjunction with antibiotic-coated EVDs (ac-EVDs). METHODS A prospective performance analysis was conducted over 4 years to examine the impact of discontinuing systemic antibiotic prophylaxis after insertion of an ac-EVD on rates of catheter-related ventriculitis.

Management of atypical cranial meningiomas, part 2: predictors of progression and the role of adjuvant radiation after subtotal resection.

Background: The efficacies of adjuvant stereotactic radiosurgery (SRS) and external beam radiation therapy (EBRT) for atypical meningiomas (AMs) after subtotal resection (STR) remain unclear.

Objective: To analyze the clinical, histopathological, and radiographic features associated with progression in AM patients after STR.

Methods: Fifty-nine primary AMs after STR were examined for predictors of progression, including the impact of SRS and EBRT, in a retrospective cohort study.

Management of atypical cranial meningiomas, part 1: predictors of recurrence and the role of adjuvant radiation after gross total resection.

Background: Indications for external beam radiation therapy (EBRT) for atypical meningiomas (AMs) remain unclear.

Objective: To analyze features associated with recurrence in AM patients after gross total resection (GTR) and to assess the relative benefit of EBRT in a retrospective cohort study.

Methods: One hundred fifty-one primary AMs after GTR (88 female patients; median follow-up, 45.

Pseudopapilledema and association with idiopathic intracranial hypertension.

Purpose: Diagnosing idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, can be challenging in children. Diagnosis is based on lumbar puncture, opening pressures, and appearance of the optic disk. Misdiagnosis of papilledema, a typical finding, may lead to unnecessary treatments and procedures.

Medial pectoral nerve to axillary nerve neurotization following traumatic brachial plexus injuries: indications and clinical outcomes.

Introduction: The medial pectoral nerve (MPN) represents a viable donor nerve for neurotization procedures for restoration of shoulder function following upper trunk brachial plexus injuries.

Materials And Methods: We report an eight-case series, single-surgeon experience of patients with upper trunk brachial plexus injuries who underwent MPN to axillary nerve (AXN) transfer from 2001-2007 for shoulder stability and abduction.

Results: The mean patient age was 31.

Interactions between programmable shunt valves and the iPad 3 with Smart Cover.

Introduction: In patients with programmable CSF shunt valves, the risk of unintentional valve adjustment associated with the environmental magnetic influence is ever present. We tested whether the iPad 3 with Smart Cover is capable of changing the setting of individual programmable valves ex vivo using direct fluoroscopic visualization.

Methods: The following valves were tested: Strata NSC Adjustable Pressure Valve, Strata NSC Burr Hole Valve, Strata II small valve, Sophysa Polaris model SPV, Aesculap valve proGAV, and Codman Certas Programmable Valve.

Acute Hemorrhage Following Gamma Knife Radiosurgery to a Clival Meningioma.

Background: Gamma Knife radiosurgery (GKS) is a primary treatment modality for small, surgically-challenging meningiomas of the skull base in carefully selected patients. Despite the overall low incidence of complications from this procedure, rare instances of hemorrhagic events following GKS have been reported. In fact, only a single, probable case of acute hemorrhage after GKS for a meningioma exists in the literature.

Gamma knife surgery for a hemangioma of the cavernous sinus in a child.

Cavernous sinus (CS) hemangiomas are rare vascular abnormalities that constitute 0.4%-2% of all lesions within the CS. Cavernous sinus hemangiomas are high-flow vascular tumors that tend to hemorrhage profusely during resection, leading to incomplete resection and high morbidity and mortality.

Repair of a median nerve transection injury using multiple nerve transfers, with long-term functional recovery.

Complete loss of median nerve motor function is a rare but devastating injury. Loss of median motor hand function and upper-extremity pronation can significantly impact a patient's ability to perform many activities of daily living independently. The authors report the long-term follow-up in a case of median nerve motor fiber transection that occurred during an arthroscopic elbow procedure, which was then treated with multiple nerve transfers.

Impact of lateral mass anatomic variation on ideal polyaxial screw head mobility: technical considerations.

Objective: To assess optimal angulation characteristics of lateral mass screws for subaxial (C3 to C6) fixation of the cervical spine in the neutral position.

Background: In the typical Magerl or Anderson placement technique, the screw trajectory is ideally parallel to the facet joint. For the rod and screw to align properly, the screw head must rotate enough to become perpendicular to the rod.

The natural history and clinical presentation of cervical spondylotic myelopathy.

Cervical spondylotic myelopathy (CSM) refers to impaired function of the spinal cord caused by degenerative changes of the cervical spine resulting in spinal cord compression. It is the most common disorder in the United States causing dysfunction of the spinal cord. A literature review of the natural history of mild cervical myelopathy is undertaken.

Magnetic resonance imaging-guided focused laser interstitial thermal therapy for subinsular metastatic adenocarcinoma: technical case report.

Background And Importance: To describe the novel use of the AutoLITT System (Monteris Medical, Winnipeg, Manitoba, Canada) for focused laser interstitial thermal therapy (LITT) with intraoperative magnetic resonance imaging (MRI) and stereotactic image guidance for the treatment of metastatic adenocarcinoma in the left insula.

Clinical Presentation: The patient was a 61-year-old right-handed man with a history of metastatic adenocarcinoma of the colon. He had previously undergone resection of multiple lesions, Gamma Knife radiosurgery, and whole-brain radiation.

Improving surgical outpatient efficiency through mobile phone text messaging.

Introduction: Currently, 175,000 people are on outpatient waiting lists in Irish hospitals. Many clinic slots are taken by patients returning for routine review postoperatively.

Methods: A Nokia mobile phone was used to send an outpatient text (OPT) to patients 2 weeks postdischarge.