Subsidence Rates Associated With Porous 3D-Printed Versus Solid Titanium Cages in Transforaminal Lumbar Interbody Fusion.

STUDY DESIGN: Retrospective Cohort Study. OBJECTIVE: To determine whether 3D-printed porous titanium (3DPT) interbody cages offer any clinical or radiographic advantage over standard solid titanium (ST) interbody cages in transforaminal lumbar interbody fusions (TLIF). METHODS: A consecutive series of adult patients undergoing one- or two-level TLIF with either 3DPT or ST "banana" cages were analyzed for patient reported outcome measures (PROMs), radiographic complications, and clinical complications. Exclusion criteria included clinical or radiographic follow-up less than 1 year. RESULTS: The final cohort included 90 ST interbody levels from 74 patients, and 73 3DPT interbody levels from 50 patients for a total of 124 patients. Baseline demographic variables and comorbidity rates were similar between groups (P > .05). Subsidence of any grade occurred more frequently in the ST group compared with the 3DPT group (24.4% vs 5.5%, respectively, P = .001). Further, the ST group was more likely to have higher grades of subsidence than the 3DPT group (P = .009). All PROMs improved similarly after surgery and revision rates did not differ between groups (both P > .05). On multivariate analysis, significant positive correlators with increasing subsidence grade included greater age (P = .015), greater body mass index (P = .043), osteoporosis/osteopenia (P < .027), and ST cage type (P = .019). CONCLUSIONS: When considering interbody material for TLIF, both ST and 3DPT cages performed well; however, 3DPT cages were associated with lower rates of subsidence. The clinical relevance of these findings deserves further randomized, prospective investigation.

Open Versus Endoscopic Carpal Tunnel Release: A Comparison of Opioid Prescription Patterns and Occupational Therapy Referrals.

BACKGROUND: Endoscopic and open carpal tunnel releases (ECTR and OCTR) are safe and effective operations. We compared the approaches in terms of postoperative opioid refills and occupational therapy (OT) referrals. METHODS: We conducted a retrospective study of patients with carpal tunnel syndrome (CTS) treated with ECTR or OCTR. Patients with isolated idiopathic CTS were included; patients undergoing simultaneous bilateral carpal tunnel release (CTR), revision CTR, and additional procedures at time of CTR were excluded. Outcomes included number of patients requiring an opioid refill and/or an OT referral within 6 months of surgery. RESULTS: A total of 1125 patients met inclusion criteria. Endoscopic release was performed in 634 (56%) cases and open release in 491 (44%). Unadjusted analysis revealed no difference in number of patients requiring refills (6.0% vs 7.1%, P = .44), mean number of refills among those requiring one (1.29 vs 1.23, P = .69), total oral morphine equivalents (45.1 vs 44.7, P = .84), number of patients calling regarding pain (12.8% vs 14.7%, P = .36), OT referrals (12.1% vs 11.4%, P = .71), or average number of OT visits (4.5 vs 4.2, P = .74) for endoscopic and open techniques, respectively. Adjusted analysis revealed lower age, lower body mass index, and history of muscle relaxant as predictors of opioid refills, and in contrast to the unadjusted analysis, operating surgeon and surgical technique were predictors of referral to OT. CONCLUSION: Endoscopic CTR and OCTR did not differ in terms of unadjusted postoperative patient calls for pain, number of opioid refills, or OT referrals. After correcting for individual surgeon practice, endoscopic was associated with decreased odds of requiring postoperative OT.

Office-based Plastic Surgery-Evidence-based Clinical and Administrative Guidelines.

Outpatient procedures are extremely prevalent in plastic surgery, with an estimated 82% of cosmetic plastic surgery occurring in this setting. Given that patient safety is paramount, this practical review summarizes major contemporary, evidence-based recommendations regarding office-based plastic surgery. These recommendations not only outline clinical aspects of patient safety guidelines, but administrative, as well, which in combination will provide the reader/practice with a structure and culture that is conducive to the commitment to patient safety. Proper protocols to address potential issues and emergencies that can arise in office-based surgery, and staff familiarity with thereof, are also necessary to be best prepared for such situations.

Selective Ulnar Nerve Decompression, Capsular Branch Denervation, and Arthroscopic Debridement as a Unique Technique to Improve Quality of Life for Avascular Necrosis of the Distal Humerus and Radius in a Young Patient With ALL.

Avascular necrosis (AVN), one of the most common therapy-related and debilitating side effects of antileukemic treatment, can adversely affect a patient's long-term quality of life. Our case study presents a young woman with bilateral elbow AVN and hip AVN after acute lymphoblastic leukemia treatment, with a unique treatment strategy for her elbow pain. The treatment strategy included elbow joint denervation with arthroscopic debridement and distal humerus core decompression. The goal of this procedure was to improve symptomatic pain while retaining bone stock in the distal humerus hopefully allowing better function of the patient's elbow. This treatment may not only improve the quality of life in a young patient but also delay the need for future surgery. Our patient had improved pain relief in her elbow postsurgery. This procedure may be used for pain control and may have beneficial future implications in this limited population.

Neuroradiological Mimics of Periventricular Leukomalacia.

AIM: Periventricular leukomalacia (PVL) is a term reserved to describe white matter injury in the premature brain. In this review article, the authors highlight the common and rare pathologies mimicking the chronic stage of PVL and propose practical clinico-radiological criteria that would aid in diagnosis and management. METHODS AND RESULTS: The authors first describe the typical brain MRI (magnetic resonance imaging) features of PVL. Based on their clinical presentation, pathologic entities and their neuroimaging findings were clustered into distinct categories. Three clinical subgroups were identified: healthy children, children with stable/nonprogressive neurological disorder, and those with progressive neurological disorder. The neuroradiological discriminators are described in each subgroup with relevant differential diagnoses. The mimics were broadly classified into normal variants, acquired, and inherited disorders. CONCLUSIONS: The term "PVL" should be used appropriately as it reflects its pathomechanism. The phrase "white matter injury of prematurity" or "brain injury of prematurity" is more specific. Discrepancies in imaging and clinical presentation must be tread with caution and warrant further investigations to exclude other possibilities.

The complex relationship between estrogen and migraines: a scoping review.

BACKGROUND: Migraines are a chronic disease for millions worldwide and have been hypothesized to be hormonally mediated due to their higher prevalence in females and menstrual associations. Estrogen has been commonly implicated in migraine pathogenesis, yet its exact role in the pathophysiology of migraines has yet to be fully understood. METHOD: We conducted a scoping review of the literature regarding estrogen's role in migraine pathogenesis and included 19 studies out of an initial 202 in the final review. Two independent reviewers screened and extracted data from included studies based on predetermined inclusions and exclusion criteria. RESULTS: The estrogen withdrawal hypothesis, discussed by 12 of the reviewed studies, is the most discussed theory about estrogen's role in migraine physiology and describes the association of migraine onset with natural declines in estrogen levels, particularly when estrogen levels fall below 45-50 pg/mL after an extended period of priming. Additional findings suggest that women with a history of migraine have an increased sensitivity to physiologic fluctuations in estradiol levels. Several studies suggest that migraines are associated with menstruation. CONCLUSION: It appears that estrogen is very likely to play a key role in migraine pathogenesis, but seems to affect patients in different ways depending on their past medical history, age, and use of hormonal therapy. Further research is warranted to isolate the effects of estrogen in each unique patient population, and we believe that studies comparing menstruating women to postmenopausal women could help shed light in this area.

Social Media Use Among Academic Hand Surgeons.

Purpose: Social media has become increasingly prevalent among the general population in the past decade. We examined the current prevalence of social media use among academic orthopedic-trained and plastic surgery-trained hand surgeons in the United States. Methods: All publicly available hand surgery faculty across the nation were analyzed for their public social media usage, including Instagram, Facebook, Twitter, LinkedIn, and personal websites. Comparisons of social media usage between orthopedic-trained and plastic surgery-trained hand surgeons, male and female academic hand surgeons, hand surgeons from different regions of the United States (East, West, Midwest, and South), and years of experience were analyzed. Results: A total of 469 academic hand surgeons were included. Among academic hand surgeons in the United States, LinkedIn was the most common platform used (40.3%), followed by Facebook (15.78%), a personal website (13.86%), Twitter (12.37%), and Instagram (4.05%). Plastic surgery hand surgeons had more of a presence than orthopedic hand surgeons on Instagram (8.26% vs 2.59%, P < .01)) and Twitter (19.01% vs 10.06%, P < .01). Male hand surgeons were more likely than female hand surgeons to use LinkedIn (41.19% vs 34.85%, P = .04). Southern (18.89%) and Eastern (14.36%) surgeons used personal websites more than Western (6.52%) and Midwestern (4.60%) surgeons (P = .03). Conclusions: Despite the widely known use of social media among plastic and aesthetic surgeons, this study shows the use of web-based marketing strategies to be quite rare in the academic hand surgery setting. Clinical Relevance: Our study shows that throughout the United States, academic hand surgeons use social media at low rates. We suggest that academic plastic surgery and orthopedic hand surgeons throughout the United States consider having a larger social media presence to expand advertising, improve patient education, and enhance networking among their practices. Social media can be a valuable tool and will likely only increase in popularity in the coming years.

Pediatric Posterior Fossa Medulloblastoma: The Role of Diffusion Imaging in Identifying Molecular Groups.

BACKGROUND AND PURPOSE: The molecular groups WNT activated (WNT), Sonic hedgehog activated (SHH), group 3, and group 4 are biologically and clinically distinct forms of medulloblastoma. We evaluated apparent diffusion coefficient (ADC) values' utility in differentiating/predicting medulloblastoma groups at the initial diagnostic imaging evaluation and prior to surgery. METHODS: We retrospectively measured the ADC values of the enhancing, solid portion of the tumor (EST) and of the whole tumor (WT) and performed Kruskal-Wallis testing to compare the absolute tumor ADC values and cerebellar and thalamic ratios of three medulloblastoma groups (WNT, SHH, and group 3/group 4 combined). RESULTS: Ninety-three children (65 males) were included. Fifty-seven children had group 3/group 4, 27 had SHH, and 9 had WNT medulloblastomas. The median absolute ADC values in the EST and WT were .719 × 10-3 and .864 × 10-3 mm2 /s for group 3/group 4; .660 × 10-3 and .965 × 10-3 mm2 /s for SHH; and .594 × 10-3 and .728 × 10-3 mm2 /s for WNT medulloblastomas (P = .02 and .13). The median ratio of ADC values in the EST or the WT to normal cerebellar tissue was highest for group 3/group 4 and lowest for WNT medulloblastomas (P = .03 and .09), with similar results in pairwise comparisons of the corresponding thalamic ADC values (P = .02 and .06). CONCLUSION: ADC analysis of a tumor's contrast-enhancing solid portion may aid preoperative molecular classification/prediction of pediatric medulloblastomas and may facilitate optimal surgical treatment planning, reducing surgery-induced morbidity.