A school-based health centre partnership: Faculty practice, nursing student learning and wellness in youth, families and community.

AIMS AND OBJECTIVES: This paper describes the development of a SBHC with an innovative model of care that grew out of a partnership between a public-school district and a university nursing programme in the midwestern region of the United States. BACKGROUND AND PURPOSE: Persistent barriers to health and health care experienced by youth are well documented. School-based health centres (SBHCs) can improve educational and health outcomes, positively impacting health equity. Academic systems are positioned to address health care needs of the school-aged population, yet educators face challenges of accessing quality learning placements for students and faculty practice sites. METHODS: A community-based collaborative methodology guided the planning phases that were driven by priority needs identified by families and stakeholders. With the mission of "partnering with students, families, and communities in the promotion of health and wellness through engagement in practice, education, and research," an ongoing dialogue over a two-year period led to articulating a vision, designing a plan and implementing a nurse-managed SBHC. The Standards for Reporting Qualitative Research (SRQR) checklist was considered in the preparation of this paper. RESULTS: In three years, this SBHC has addressed and identified priority needs and served individual youth and families. The SBHC provides opportunities for the faculty to fulfil a practice requirement for certification and accreditation. Nursing students engage with youth and families in health education and health promotion while strengthening their technical and relational skills. Family nurse practitioner students gain valuable clinical experience. Faculty with expertise in family nursing guide family assessments, support family resiliency and direct therapeutic conversations with family units. CONCLUSION: SBHCs serve youth, families, and community. This academic-practice partnership has the added benefit of providing faculty practice opportunities and nursing student experiential learning. RELEVANCE TO CLINICAL PRACTICE: SHBCs provide practice opportunities that address needs in individuals, families, and communities. Partnerships should be considered at academic nursing programmes to support their needs and fulfil commitments to address health equity gaps.

Underutilization of advanced presurgical studies and high rates of vagus nerve stimulation for drug-resistant epilepsy: a single-center experience and recommendations.

INTRODUCTION: Epilepsy surgery continues to be profoundly underutilized despite its safety and effectiveness. We sought to investigate factors that may contribute to this phenomenon, with a particular focus on the antecedent underutilization of appropriate preoperative studies. METHODS: We reviewed patient data from a pediatric epilepsy clinic over an 18-month period. Patients with drug-resistant epilepsy (DRE) were categorized according to brain magnetic resonance imaging (MRI) findings (lesional, MRI-negative, or multifocal abnormalities) and type of epilepsy diagnosis based on semiology and electroencephalography (EEG) (focal or generalized). We then analyzed the rates of diagnostic test utilization, surgical referral, and subsequent epilepsy surgery as well as vagus nerve stimulation (VNS). RESULTS: Of the 249 patients with a diagnosis of epilepsy, 138 (55.4%) were found to have DRE. Excluding the 10 patients with DRE who did not undergo MRI, 76 patients (59.4%) were found to be MRI-negative (non-lesional epilepsy), 37 patients (28.9%) were found to have multifocal abnormalities, and 15 patients (11.7%) were found to have a single epileptogenic lesion on MRI (lesional epilepsy). Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) were each completed in nine patients (7.0%) and magnetoencephalography (MEG) in four patients (3.1%). Despite the low utilization rate of adjunctive studies, over half (56.3%) ultimately underwent VNS alone, and 8.6% ultimately underwent definitive intracranial resection or disconnection surgery. CONCLUSIONS: The underutilization of appropriate non-invasive, presurgical testing in patients with focal DRE may in part explain the continued underutilization of definitive, resective/disconnective surgery. For patients without access to a high-volume, multidisciplinary surgical epilepsy center, adjunctive presurgical studies [e.g., PET, SPECT, MEG, electrical source imaging (ESI), EEG-functional magnetic resonance imaging (fMRI)], even when available, are rarely ordered, and this may contribute to excessive rates of VNS in lieu of definitive intracranial surgery.

Deciphering the surgical treatment gap for drug-resistant epilepsy (DRE): A literature review.

Patients with drug-resistant epilepsy (DRE) rarely achieve seizure freedom with medical therapy alone. Despite being safe and effective for select patients with DRE, epilepsy surgery remains heavily underutilized. Multiple studies have indicated that the overall rates of surgery in patients with DRE have stagnated in recent years and may be decreasing, even when hospitalizations for epilepsy-related problems are on the rise. Ultimately, many patients with DRE who might otherwise benefit from surgery continue to have intractable seizures, lacking access to the full spectrum of available treatment options. In this article, we review the various factors accounting for the persistent underutilization of epilepsy surgery and uncover several key themes, including the persistent knowledge gap among physicians in identifying potential surgical candidates, lack of coordinated patient care, patient misconceptions of surgery, and socioeconomic disparities impeding access to care. Moreover, factors such as the cost and complexity of the preoperative evaluation, a lack of federal resource allocation for the research of surgical therapies for epilepsy, and difficulties recruiting patients to clinical trials all contribute to this multifaceted dilemma.

Subaxial Cervical Laminectomy Using a Misonix BoneScalpel®: A Guide to Operative Technique.

INTRODUCTION: Cervical laminectomy is a surgical technique that is used to decompress the spinal cord. The standard equipment for making bony cuts includes a high-speed drill (HSD) or osteotome; the ultrasonic BoneScalpel® (UBS) by Misonix (Farmingdale, NY) may be used for this purpose either alone or in combination with other instruments. OBJECTIVE: We describe the operative technique and principles behind the use of the Misonix BoneScalpel (MBS) for subaxial cervical laminectomy. METHODS: The features, functions and mechanism of the MBS are described. Use of a UBS for en bloc subaxial cervical laminectomy is outlined, including a description of the technique, the avoidance of complications, and perioperative considerations. RESULTS: Use of the MBS in cervical decompression is a safe and effective alternative to HSD when considering tissue selectivity, thermal control, and coagulative effects. CONCLUSION: While the initial upfront cost of the MBS is greater than that of similar equipment, the potential long-term savings in time and resources can yield a cost-effective return. The MBS should be progressively incorporated into the surgical protocol as dictated by the surgeon's comfort level.

Development and Psychometric Evaluation of a Brief Approach and Avoidance of Alcohol Questionnaire.

BACKGROUND: The Approach and Avoidance of Alcohol Questionnaire (AAAQ) was developed as a measure of craving to assess both desires to consume and desires to avoid consuming alcohol. Although the measure has been used in a variety of populations to predict future alcohol use behavior, the factor structures observed vary based on sample type (e.g., clinical vs. college samples) and may be overly long for use in repeated measures designs. The current article describes the development of a brief version of the AAAQ for use in clinical populations. METHODS: Using existing data sets of individuals in treatment for alcohol use disorder, exploratory analyses (e.g., exploratory factor analysis and item response theory) were conducted using an inpatient sample (N = 298) at a substance abuse treatment facility. Confirmatory analyses (e.g., confirmatory factor analysis and multiple regression) were conducted using an inpatient detoxification sample (N = 175) and a longitudinal outpatient treatment sample (N = 53). RESULTS: The brief AAAQ had comparable internal consistency, explained a similar amount of variance in alcohol consumption and related problems, and exhibited superior model fit as compared to the original measure. CONCLUSIONS: These findings indicate that the brief AAAQ is an effective tool to assess alcohol craving in clinical populations in treatment settings.

A standardised database of Chinese emotional film clips.

Film clips are widely used in emotion research due to their relatively high ecological validity. Although researchers have established various film clip sets for different cultures, the few that exist related to Chinese culture do not adequately address positive emotions. The main purposes of the present study were to establish a standardised database of Chinese emotional film clips that could elicit more categories of reported positive emotions compared to the existing databases and to expand the available film clips that can be used as neutral materials. Two experiments were conducted to construct the database. In experiment 1, 111 film clips were selected from more than one thousand Chinese movies for preliminary screening. After 315 participants viewed and evaluated these film clips, 39 excerpts were selected for further validation. In experiment 2, 147 participants watched and rated these 39 film clips, as well as another 8 excerpts chosen from the existing databases, to compare their validity. Eventually, 22 film excerpts that successfully evoked three positive emotions (joy, amusement, and tenderness), four negative emotions (moral disgust, anger, fear, and sadness), and neutrality formed the standardised database of Chinese emotional film clips.

Two Studies of Connectedness to Parents and Suicidal Thoughts and Behavior in Children and Adolescents.

We tested hypotheses that greater connectedness to parent(s) is associated with lower risk for nonlethal suicidal thoughts and behavior (STB), termed direct protective effects, and that parent connectedness serves to moderate (lower) the risk for STB associated with psychopathology including major depressive episode (MDE), termed moderating protective effects. Independent samples of children and adolescents recruited for a multicenter study of familial alcoholism were studied. Generalized estimating equation models were used that adjusted for age, sex, and youth psychopathology variables. The sample for Study 1 was assessed at baseline and about 2- and 4-year follow-ups, with baseline characteristics of n = 921, M age = 14.3 ± 1.8 years, and 51.8% female. The sample for Study 2 was assessed at baseline and about 5-year follow-up, with baseline characteristics of n = 867, M age = 12.0 ± 3.2 years, and 51.0% female. In both studies, increased perceived connectedness to father but not mother was associated with lower risk for measures of STB, consistent with direct protective effects. In Study 1, measures of parent connectedness were associated with lower risk for STB but only for youth that did not experience MDE (or alcohol use disorder), inconsistent with moderating protective effects. Study 2 showed that connectedness to fathers was associated with lower risk for suicide plans or attempts (severe STB) but not frequent thoughts of death or dying (nonsevere STB). Improved connectedness to fathers may lower risk for STB in children and adolescents, consistent with direct protective effects. Hypotheses about moderating protective effects were not supported.

Psychometric examination and validation of the aggressive driving scale (ADS).

Aggressive driving behavior is an important cause of traffic accidents. Based on the recent view that aggressive driving is one way that trait aggression manifests itself, a growing research area has focused on the development of scales to assess aggressive driving. The aggressive driving scale (ADS) analyzed in the present study consists of 24 items. A sample of 276 participants was analyzed to obtain the factor structure and reliability of the ADS and 67 of them participated in the behavioral experiment in order to examine the construct and predictive validity of the scale. Results indicated a 3-factor structure (interference with other drivers, violations/risk taking, and anger/aggression expression behavior) with high item loadings. The ADS had high internal consistency and test-retest reliability. Construct validity of the ADS was established as the ADS subscale scores correlated significantly with trait measures of anger and aggression. Predictive validity of the ADS was verified as most items were significantly correlated with behavioral measures derived from a driving simulator. The ADS was a significant predictor of behavioral measures both in the simulated environment (i.e., frequency of driving off the road, red light running behavior, frequency of colliding with a vehicle, frequency and distance of over speeding, frequency and distance of central crossing) and reported real world situations (i.e., annual moving violations and accidents). These results suggest that the ADS is a reliable and valid tool in evaluating aggressive driving behavior as the current study provides behavioral support for the effectiveness of the ADS in measuring aggressive driving behavior. Aggr. Behav. 42:313-323, 2016. © 2016 Wiley Periodicals, Inc.

The Indirect Effect of Peritraumatic Dissociation on the Relationship Between Childhood Maltreatment and Schizotypy.

Schizotypy is a multidimensional personality construct that is understood as a vulnerability for schizophrenia, often manifesting as more subtle and attenuated symptoms, referred to as schizotypic psychopathology. It has many well-established environmental risk factors, including experiencing childhood maltreatment (CM), but the intermediary mechanisms that relate CM to schizotypic psychopathology are unclear. Prior studies have demonstrated that trait dissociation may indirectly affect the relationship between CM and schizotypic psychopathology. However, less is known about the importance of peritraumatic dissociative experiences during CM and how it relates to schizotypic symptom manifestations in young adulthood. Therefore, the present study explored the independent contributions of peritraumatic and trait dissociation in the relationship between CM and schizotypy. Participants (N = 346) were undergraduate students who completed online self-report measures on CM, trait dissociation, peritraumatic dissociation experienced during CM, and schizotypic symptoms. The indirect effect of peritraumatic dissociation and trait dissociation on the relationship between CM and schizotypy was examined using mediational analyses. Correlational analyses revealed significant associations between self-reported CM, schizotypy, trait dissociation, and peritraumatic dissociation. In addition, mediational analyses indicated a significant indirect effect of peritraumatic dissociation (ß = .06, 95% confidence interval (CI) [0.01, 0.12]), but not trait dissociation (ß = .05, 95% CI [-0.02, 0.12]), on CM and schizotypy. These results highlight peritraumatic dissociation as an important mechanism driving the expression of schizotypic symptoms among individuals with a history of CM. Understanding how trauma sequelae lead to schizotypic psychopathology may be crucial in assessing and treating individuals with maltreatment histories or those on the psychosis spectrum.

The Ethical, Care, and Client-Caregiver Relationship Impacts Resulting From Introduction of Digital Communication and Surveillance Technologies in the Home Setting: Qualitative Inductive Study.

BACKGROUND: Embedding communication and surveillance technology into the home health care setting has demonstrated the capacity for increased data efficiency, assumptions of convenience, and smart solutions to pressing problems such as caregiver shortages amid a rise in the aging population. The race to develop and implement these technologies within home care and public health nursing often leaves several ethical questions needing to be answered. OBJECTIVE: The aim of this study was to understand the ethical and care implications of implementing digital communication and surveillance technologies in the home setting as perceived by health caregivers practicing in the region of Halland in Sweden with clients receiving home care services. METHODS: A questionnaire was completed by 1260 home health caregivers and the written responses were evaluated by qualitative inductive content analysis. The researchers reviewed data independently and consensus was used to determine themes. RESULTS: This study identified three main themes that illustrate ethical issues and unintended effects as perceived by caregivers of introducing digital communication and surveillance technologies in the home: (1) digital dependence vulnerability, (2) moral distress, and (3) interruptions to caregiving. This study highlights the consequences of technology developers and health systems leaders unintentionally ignoring the perspectives of caregivers who practice the intuitive artistry of providing care to other humans. CONCLUSIONS: Beyond the obtrusiveness of devices and impersonal data collection designed to emphasize health care system priorities, this study discovered a multifaceted shadow side of unintended consequences that arise from misalignment between system priorities and caregiver expertise, resulting in ethical issues. To develop communication and surveillance technologies that meet the needs of all stakeholders, it is important to involve caregivers who work with clients in the development process of new health care technology to improve both the quality of life of clients and the services offered by caregivers.

Alcohol use during the COVID-19 pandemic: gender, parenthood, intimate partner violence, and stress.

Some preliminary work during the COVID-19 pandemic indicates that adult alcohol use increased, particularly for parents. This cross-sectional study examined the quantity and frequency of adults' alcohol use during the early stages of the pandemic. Additionally, the influences of gender, parenthood, COVID-19-related stressors and intimate partner violence (IPV) on alcohol consumption were examined. The sample consisted of 298 adults (98 parents) from across the United States who completed self-report surveys through Qualtrics at the beginning of the pandemic in May 2020. In the present study, all men reported higher levels of drinking compared to all women. Although stress levels did not impact alcohol consumption, findings indicate that increased IPV experiences were associated with higher levels of heavy drinking during the pandemic. Results also suggested that having children in the home particularly impacted drinking levels during the pandemic, above and beyond the influence of gender, IPV, and stress levels. These findings suggest that parenthood may have had a cascading influence on drinking experiences during the COVID-19 pandemic. Implications and recommendations for further research are discussed.

GABRA2 genotype, impulsivity, and body mass.

BACKGROUND: The goal of this study was to test a hypothesis associating impulsivity with an elevated body mass index (BMI). METHODS: To this end, we examined associations of BMI with putative genetic, neurophysiological, psychiatric, and psychological indicators of impulsivity in 78 women and 74 men formerly dependent on alcohol or drugs. A second analysis was designed to test the replicability of the genetic findings in an independent sample of 109 women and 111 men with a similar history of substance dependence. RESULTS: The results of the first analysis showed that BMI was positively correlated with Total and Nonplanning Scale Scores on the Barratt Impulsiveness Scale and the number of childhood symptoms of Attention-Deficit/Hyperactivity Disorder in women. It was also positively correlated, in women, with a GABRA2 variant previously implicated as a risk factor for substance dependence and an objective electroencephalographic feature previously associated with GABRA2 and relapse risk. The second analysis confirmed that the correlation between BMI and the substance-dependence-associated GABRA2 genotype was reliable and sex-specific. CONCLUSIONS: We conclude that an elevated BMI is associated with genetic, neurophysiological, psychiatric, and psychological indicators of impulsivity. The sex difference may be explained by greater opportunities to eat and overeat, a preference for higher calorie foods, a longer duration of alcohol/drug abstinence, or previous pregnancies in women.

Ethics and New Health Technologies: An Innovative Descriptive Analysis of the State of the Literature.

The exponential advancement of health technologies has led to an increasing need for awareness and critical thinking about the potential unintended consequences and ethical dilemmas that may arise from using new technologies. Unfortunately, many ethical issues arise post-implementation. Few researchers preemptively consider the ethical implications of health technologies. The current study located more than 24 million articles in PubMed that discussed common health technologies. Of these, 0.07% (n = 17,816) articles deeply considered the technology's potential ethical implications. Critical thinking and ethics are the mainstays of nursing practice. Thus, critically thinking about the potential ethical implications of relevant technologies should be at the forefront of research; we contend that this is not common practice. We hope to shed light on this issue to remind researchers to think like nurses when researching new health technologies.

Examining how Ethics in Relation to Health Technology is Described in the Research Literature: Scoping Review.

BACKGROUND: Given the increased use of technology in health care, both in extent and application, the importance of understanding the ethical implications of new health technologies increases. Profound insight into the possible ethical implications of new health technologies enhances the research and development of such technologies and the likelihood of eventual successful implementation in clinical practice. OBJECTIVE: This study aimed to gain an understanding of how and if researchers focused on health technologies describe the actual or possible ethical aspects of their research findings. METHODS: An established framework for scoping reviews was used to guide the methodology. Studies published in PubMed over the last 10 years were included if they study or refer to ethics in relation to health technology as defined by established frameworks. In total, 14,532 articles were screened, 692 were retained for full-text evaluation, and 227 were included for data extraction. RESULTS: In total, 250 (80.9%, N=309) studies were conducted in North America and Europe; literature review studies were dominant. Most studies (52.9%, 120/227) had no direct reference to any of the 4 basic ethical principles: beneficence, nonmaleficence, autonomy, and justice. In cases where studies referenced ethical theory, consequentialism dominated. CONCLUSIONS: When research about technology and ethics is published, the predominant focus is on its intent rather than its actual effect on patients. This lack of insight is problematic considering the vast advancement of technology in which ethics cannot keep up with understanding and offer insights on addressing ethical issues. This finding has implications for practice, research, and education.

Holocord spontaneous pneumorrhachis in the setting of refractory emesis.

BACKGROUND: Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly iatrogenic or traumatic in nature. Treatment is dependent on underlying cause and physical exam. CASE DESCRIPTION: Herein, we describe the second case in the literature of spontaneous holocord PNR in a young patient without risk factors. A 22-year-old male with no past medical history presented to the hospital for 2 days of vomiting and cramping in his hands and feet secondary to severe dehydration. He recently started a new job as a manual laborer and had to leave work early 2 days prior due to overexertion working outside in heat ranging from 100 to 120 degrees Fahrenheit. CT abdomen and pelvis demonstrated spontaneous pneumomediastinum and extramedullary PNR extending upward from L3 throughout the thoracic spine to the upper limit of the scan. Subsequent CT cervical and thoracic spine showed the full length of the extradural air from C2-T12 and again at L3. CONCLUSION: Spontaneous PNR is an uncommon, typically self-limited condition in which air is introduced into the spinal axis. Anatomic predisposition makes the extradural, dorsal cord in the cervicothoracic region the most common location. Patients are rarely symptomatic, and treatment is supportive in nature once secondary causes with high rates of morbidity and mortality are ruled out.

The Financial and Radiation Burden of Early Reimaging in Neurosurgical Patients: An Original Study and Review of the Literature.

The computed tomographic (CT) scanner has become ubiquitous in healthcare. When trauma patients are imaged at facilities not equipped to care for them, imaging is often repeated at the receiving institution. CTs have clinical, financial, and resource costs, and eliminating unnecessary imaging will benefit patients, providers, and institutions. This paper reviews patterns of repetition of CT scans for transferred trauma patients and motivations underlying such behaviors via analysis of our Trauma Registry database and literature published in this area. Neurosurgeons are fundamentally impactful in this decision-making process. The most commonly repeated scan is a CT head (CTH). More than » of our patients receiving a clinically indicated repeat CTH also had a repeat scan of their cervical spine with no reason given for the cervical scan. Herein, we discuss our findings that both non-trauma center practitioners and non-neurosurgical staff at trauma centers cite a lower level of comfort with neuroradiology and fear of litigation as motivators in overzealous neuroimaging. As a result, inappropriate neurosurgical imaging is routinely ordered prior to transfer and again upon arrival at trauma centers. Education of non-neurosurgical staff is essential to prevent inappropriate neuroaxis imaging.

Stereoelectroencephalography versus Subdural Electrode Implantation to Determine Whether Patients with Drug-resistant Epilepsy Are Candidates for Epilepsy Surgery.

Epilepsy is a chronic condition that affects about 50 million individuals worldwide. While its challenges are profound, there are increasing instances where antiepileptic drugs (AEDs) fail to provide relief to epileptic manifestations. For these pharmacoresistant cases, epilepsy surgery often is an effective route for treatment. However, the complexity and challenges associated with presurgical evaluations have prevented more widespread utilization of epilepsy surgery in pharmacoresistant cases. While preliminary work-ups and non-invasive diagnostic imaging have allowed for limited identification of the epileptogenic zone (EZ), there is yet to be an established pre-determined algorithm for surgical evaluation of patients with epilepsy. However, two modalities are currently being used for localization of the EZ and in determining candidates for surgery: stereoelectroencephalography (SEEG) and subdural electrodes (SDEs). SDE has been used in the United States for decades; however, SEEG now provides a less invasive option for mapping brain regions. We seek to address which intracranial monitoring technique is superior. Through a review of the outcomes of various clinical studies, SEEG was found to have greater safety and efficiency benefits than SDE, such as lower morbidity rates, lower prevalence of neurological deficits, and shorter recovery times. Moreover, SEEG was also found to have further functional benefits by allowing for deeper targeting of cerebral tissue along with bilateral hemispheric monitoring. This has led to increased rates of seizure freedom and control among SEEG patients. Nevertheless, further studies on the limitations and advancements of SEEG and SDE are still required to provide a more comprehensive understanding regarding their application.

Traumatic Spinal Injury Associated with All-Terrain Vehicle (ATV) Accidents: A 10-Year Retrospective Analysis of the Coachella Valley.

OBJECTIVE: The use of all-terrain vehicles (ATVs) and associated injuries have significantly increased in the last decade. This study aimed to determine the frequency of ATV-associated spinal cord injuries (SCIs) in the Coachella Valley, California, and provide recommendations for data reproducibility in other areas with a similarly substantial level of ATV usage and injuries. METHODS: This retrospective analysis included data obtained through screening the trauma database of a level II trauma center for ATV-related injuries between January 1, 2010 and January 1, 2020. RESULTS: Our data suggest that more than one-third of patients admitted to the trauma center over a 10-year period suffered from spinal injury. Injuries to the spine were further categorized as including the spinal cord (radiographically or clinically) or only including the bony or ligamentous elements of the spine. Injury was more common in men and predominantly located in the thoracic spine. Injuries such as epidural hematoma, vertebral artery, and cord contusion were common, with many patients requiring neurosurgical intervention. CONCLUSION: Highlighting the implicit dangers of ATV accidents on the spine could help identify outcomes and variables predictive of spinal injuries and spinal cord injuries necessary for patient management. Additionally, our study sets the framework by which legislating bodies could replicate the study for proper legislation and recommendations that may help prevent such injuries.

Retro-Odontoid Pseudotumor Formation in the Context of Various Acquired and Congenital Pathologies of the Craniovertebral Junction and Surgical Techniques.

Retro-odontoid pseudotumor formation consists of an abnormal growth of granulation tissue typically posterior to the odontoid process, resulting as a manifestation of atlantoaxial instability. This instability can occur as a result of conditions ranging from severe mechanical trauma to metabolic disease or autoimmune conditions such as rheumatoid arthritis. A pseudotumor may impinge on the spinal nerves or even the spinal cord and brainstem, manifesting symptoms from severe neck pain to cervicomedullary compression or myelopathy, and in some cases even sudden death. The objective of this review is to consolidate the findings in published case reports and relevant prior literature reviews regarding the formation of retro-odontoid pseudotumor. We address the pathophysiology involved in acquired and congenital pseudotumor formation, including those associated with rheumatoid arthritis (panni). Additionally, we discuss past and current operative techniques designed to curtail and ultimately regress a retro-odontoid pseudotumor and pannus. Surgical techniques that are addressed include ventral decompression (both transoral and transnasal), dorsal decompression, and indications for posterior instrumentation in pannus formation, particularly in cases that may be sufficiently treated in lieu of an anterior approach. Finally, we will examine the role of external orthoses as both a method of conservative treatment as well as a potential adjunct to the aforementioned surgical procedures.

Prevalence of sports-related spinal injury stratified by competition level and return to play guidelines.

Spinal injury is among the most severe and feared injuries an athlete may face. We present an up-to-date review of the recent literature, stratifying recommendations based on injury location (cervical, thoracic, and lumbar spine) and type, as well as, the level of competitive play (high school, collegiate, professional). A literature search was completed to identify all publications reporting return to play guidelines for athletic injuries or injury-related surgery irrespective of the study design. Publication dates were not restricted by year. Search terms used included "return to play" and "spinal injury" on National Library of Medicine (PubMed) and Google Scholar. Selection criteria for literature included axial spine injury guidelines for athletic participation post-injury or post-surgery. Literature found from the search criteria was sorted based on level of competition and location of axial spine injury involved. It was found that professional athletes are more likely to suffer severe spinal injuries, require surgery, and necessitate a longer return to play (RTP), with high school and college athletes usually returning to play within days or weeks. Injuries occur mainly within contact sports and concordance exists between initial and subsequent spinal injuries. Adequate rest, rehabilitation, and protective equipment alongside the education of athletes and coaches are recommended. In conclusion, a multidisciplinary approach to patient management is required with consideration for the emotional, social, and perhaps financial impact that spinal injury may have upon the athlete. Consensus from the literature states that in order for an athlete to safely return to play, that athlete should not be actively suffering from pain, should have a full range of motion, and complete return of their strength in the absence of neurological deficit.