Evidence Mounts That About 7% of US Adults Have Had Long COVID.

This Medical News article discusses new US household survey data that found differences in long COVID rates based on preexisting chronic conditions and other factors.

Combined Laminoplasty and Posterior Fusion for Cervical Spondylotic Myelopathy Treatment: A Literature Review.

STUDY DESIGN: A literature review. PURPOSE: To explore the utility of laminoplasty in combination with instrumented fusion, with a focus on neurological outcomes and changes in kyphotic deformity. OVERVIEW OF LITERATURE: Management of cervical spondylotic myelopathy (CSM) to reduce morbidity within the neurosurgical population. METHODS: A US National Library of Medicine PubMed search was conducted for manuscripts pertaining to cervical laminoplasty and fusion for the management of CSM. Several relevant studies were shortlisted for review, and the bibliographies of the articles were searched for additional references. The search was limited to human studies, English-language literature, and reports on more than one patient. RESULTS: Combined laminoplasty and fusion was found to provide at least comparable, if not superior, neurological outcomes in specific patient populations with CSM. The Japanese Orthopedic Association scores, local kyphosis, and C2-C7 angle have been reviewed in several manuscripts, and improvement in each of these categories was found with laminoplasty and fusion. CONCLUSIONS: The treatment of CSM necessitates an individualized approach based on the pathoanatomical variation. Laminoplasty and fusion can be appropriately used for patients with CSM in a setting of local kyphotic deformity, ossification of the posterior longitudinal ligament, associated segmental instability, and the need for strong stabilization.

Quantitative Anterior and Posterior Clinoidectomy Analysis and Mobilization of the Oculomotor Nerve during Surgical Exposure of the Basilar Apex Using Frameless Stereotaxis.

Background Anterior and posterior clinoidectomies have been proposed to augment exposure of the basilar apex. A sequential quantitative benefit analysis offered by these maneuvers has not been reported. Methods Fourteen datasets from eight cadaveric specimens were analyzed. A modified orbitozygomatic frontotemporal craniotomy was performed. The extent of proximal control of the basilar artery was determined through the exposed opticocarotid and carotidoculomotor triangles before and after clinoidectomies and mobilization of the third nerve at the porous oculomotarius. Results Removal of the anterior and posterior clinoids significantly improved proximal basilar artery access ( p < 0.012) and increased the opticocarotid triangle and carotidoculomotor triangle areas ( p < 0.017). Surgical freedom increased inferosuperiorally in the opticocarotid triangle following anterior clinoidectomy ( p < 0.047) and in carotidoculomotor triangle following posterior clinoidectomy ( p < 0.047). Mobilization of the third nerve increased surgical freedom in the mediolateral projection of the carotidoculomotor triangle ( p < 0.047). Conclusion Anterior and posterior clinoidectomies significantly improved the area of exposure of the opticocarotid triangle, carotidoculomotor triangle, and the exposed length of the basilar artery available for proximal control. This improvement is extremely important for large or giant aneurysms of the upper basilar artery or aneurysms hidden by the posterior clinoid.

Commissural myelotomy in the treatment of intractable visceral pain: technique and outcomes.

BACKGROUND: Commissural myelotomy can be valuable for patients with intractable pain associated with malignancy in the abdominal or pelvic region. METHODS: Between December 1992 and June 2009, 11 patients underwent commissural myelotomy at the University of Texas MD Anderson Cancer Center for the treatment of intractable lower extremity, thoracic, pelvic or sacral pain associated with unresectable tumors. The various surgical approaches to myelotomy are discussed. RESULTS: Eight patients had excellent or good outcomes with regard to pain relief, defined as no further pain (excellent) or a significant reduction in pain and not requiring opioids stronger than codeine (good). Complications included new leg weakness (n = 3) and bladder dysfunction (n = 1). CONCLUSION: We found that for the properly selected patient, open midline commissural myelotomy can provide effective pain relief with acceptable postoperative morbidity.

Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients.

OBJECT: Intrathecal baclofen therapy is an effective means of treating intractable spasticity and dystonia in the pediatric and adult population. The authors present a review of complications encountered in a series of 314 pump and catheter-related procedures. The identification and management of these complications will be reviewed. The authors will also identify populations that may be at increased risk for complications. METHODS: A retrospective review was performed of all procedures undertaken during the last 5 years by two surgeons at the authors' institution. Postoperative complications were reviewed. A total of 314 surgical procedures (226 pediatric and 88 adult) were performed in 195 pediatric and adult patients. This included 171 new pump and catheter implants (116 pediatric and 55 adult), 26 elective pump replacements due to end of battery life (15 pediatric and 11 adult), five elective pump repositionings per physiatrist request (three pediatric and two adult), 14 elective catheter repositionings (10 pediatric and four adult), and two normal pediatric catheter explorations. Surgical procedures for complication management included seven pump revisions (five pediatric and two adult), 48 catheter revisions (38 pediatric and 10 adult), and 41 wound revisions (37 pediatric and four adult). The majority of adult pumps were implanted subdermally, whereas in pediatric patients they were placed subfascially. In general, intrathecal catheters were placed under fluoroscopic guidance with the catheter tip placed at T-1 to T-2 for spastic quadriplegia, T-6 to T-10 for spastic diplegia, and midcervical for dystonia. No significant intraoperative complications were encountered. Overall, there was a statistically significantly higher percentage of procedures for overall complication management and wound complication management in pediatric patients compared with adult patients. CONCLUSIONS: Intrathecal baclofen therapy is a highly effective treatment option for patients with medically refractory spasticity. The catheter, pump, and wound are subject to numerous complications both at the time of implantation and throughout the life of the implanted system. Careful technique, close observation, and aggressive evaluation and correction of problems can reduce the incidence and severity of the complications when they occur.

The use of closed-suction irrigation systems to manage spinal infections.

OBJECT: Management of infection in the hardware system-fixated spine has proven to be problematic. In many cases, instrumentation is required to provide stability or to maintain correction of deformity, and removal could be hazardous. The authors describe the use of closed continuous irrigation to treat spinal wound infections in patients with fixation systems; irrigation can be used in all parts of the spine with excellent results. METHODS: The authors conducted a retrospective chart-based review of cases in which spinal instrumentation procedures were performed consecutively during a 10-year period. Infection developed in 36 patients. The infections involved the cervical, thoracic or thoracolumbar, and lumbar regions. Anterior and posterior drains were placed in one patient. In one patient refractory infections responded to replacement of the dual-inflow port drainage system. In all cases the wound infection completely resolved. There were no cases that required the removal of the fusion mass or instrumentation. In all cases progression to solid fusion was achieved. CONCLUSIONS: Closed irrigation systems can be used effectively to manage anterior or posterior cervical, thoracic, and lumbar wound infections. These systems preclude the explantation of the instrumentation and allow spinal stability to be preserved. The authors noted no evidence of recurrent infection or failed fusion.

Effect of hemostasis and electrosurgery on the development and evolution of brain tumor surgery in the late 19th and early 20th centuries.

Hemostatic options available to the surgeon in the late 19th and early 20th centuries were limited. The surgical ligature was limited in value to the neurological surgeon because of the unique structural composition of brain tissue as well as the approaches and operating angles used in this type of surgery. In this manuscript the authors review the options available and the evolution of surgical hemostatic techniques and electrosurgery in the late 19th and early 20th centuries and the impact of these methods on the surgical management of tumors of the brain and its coverings.

The evolution of posterior cervical and occipitocervical fusion and instrumentation.

The past several decades have been the setting for a remarkable evolution of spinal instrumentation technology. The advancements that have been made have allowed previously complex disorders of the cervical spine, the atlantoaxial articulation, and the occipitocervical junction to be managed more effectively with direct methods of internal fixation and arthrodesis. This has resulted in improvements in patient outcomes and fusion success rates. The improved strength of instrumentation constructs allows minimal, if any, external bracing, obviating the need for a halo orthosis in many cases. In this paper the authors review key events that have occurred in neuroimaging, biomechanical testing, and the development of fusion and instrumentation constructs.