Comparison of functional outcomes and patient satisfaction in patients with lumbar canal stenosis with and without concomitant obesity following lumbar decompression surgery and their correlation with BMI.

BACKGROUND: Obesity is an important predictor of development of Lumbar canal stenosis (LCS) and its symptoms. LCS further restricts the mobility of the patient and a vicious cycle develops. The operative decision on patients with LCS and obesity is a matter of debate. Hence, we attempted to compare changes in body mass index and patient satisfaction in patients with LCS with and without concomitant obesity, undergoing spinal decompression surgery. METHODS: Patients undergoing decompression for LCS between 1st June 2019 to 31st May 2020 were included. Baseline characteristics including age, sex, co-morbidities, BMI, self-recorded maximal walking distance (SR-MWD) and Oswestry disability index score (ODI) were recorded. All patients were followed up prospectively at 1 year post surgery. Satisfaction was recorded on a five-point Likert scale. Participants were classified into non obesity (group 1) and obesity (group 2) groups according to JAPI and WHO classification and compared. RESULTS: 55 patients met the inclusion criteria, 23 in group 1 and 32 in group 2. Group 2 showed a mean decrease in BMI of 0.95 ± 1.32 kg/m2 while other group had an increase of 0.14 ± 1.31 kg/m2 (p = 0.021). Significant weight change was seen in 31.3 % group 2 vs 8.7 % group 1 patients which was significant (p = 0.046). Pre operative BMI positively correlated with change in BMI after surgery (r = 0.406, p = 0.001) and with percentage weight reduction (r = 0.321, p = 0.017). Both the groups were comparable in improvement in ODI and SR-MWD scores and patient satisfaction. CONCLUSION: Patients with obesity achieve significant reduction in weight and BMI following decompression surgery for LCS. It will further prevent other health conditions attributed to obesity. Both the groups were comparable in ODI, SR-MWD and satisfactory outcome following surgery. Hence obesity should not be a deterring factor for surgical consideration for patients with lumbar canal stenosis.

Beyond Traditional Training: Exploring the Benefits of Virtual Reality Simulator in Lumbar Pedicle Screw Insertion - A Randomized Controlled Trial.

INTRODUCTION: This study compares the effectiveness of virtual reality simulators (VRS) and a saw bone model for learning lumbar pedicle screw insertion (LPSI) in neurosurgery. METHODS: A single-center, cross-sectional, randomized controlled laboratory investigation was conducted involving residents and fellows from a tertiary care referral hospital. Participants were divided into two groups (A and B). Group A performed 3 LPSI tasks: the first on a saw bone model, the second on VRS, and the third on another saw bone model. Group B completed 2 LPSI tasks: the first on a saw bone model and the second on another saw bone model. The accuracy of LPSI was evaluated through noncontrast computed tomography scans for the saw bone models, while the in-built application of VRS was utilized to check for accuracy of screw placement using the simulator. RESULTS: The study included 38 participants (19 in each group). Group A participants showed reduced mean entry point error (0.11 mm, P 0.024), increased mean purchase length (4.66 cm, P 0.007), and no cortical breaches (P 0.031) when placing the second saw bone model screw. Similar improvements were observed among group A participants in PGY 1-3 while placing the second saw bone model screws. CONCLUSIONS: Virtual reality simulators (VRS) prove to be an invaluable tool for teaching complex neurosurgical skills, such as LPSI, to trainees. This technology investment can enhance the learning curve while maintaining patient safety.

Role of Stereotactic Radiosurgery for Cavernous Sinus Hemangiomas - An Individual Patient Data-Based Meta-Analysis.

Context: Cavernous sinus haemangiomas (CSHs) are rare vascular malformations arising from the micro-circulation of the cavernous sinus. The current treatment options are micro-surgical excision of CSH, stereotactic radiosurgery (SRS), and fractionated radiation therapy (FRT). Aims: We conducted a meta-analysis assessing the effect and complications of SRS in CSH and compared the pooled results after surgical excision of CSH. The aim of the study is to provide valuable insight into the role of SRS in the treatment of CSHs. Materials and Methods: The literature search revealed a total of 21 articles with 199 patients who met our inclusion criteria, and these were analyzed for this study. Results: There were 138 (69.3%) female and 61 (30.7%) male patients. The mean age at the time of radiosurgery was 48.4 ± 14.9 years. The mean tumor volume at the time of SRS was 17.4 cm3 (range 0.3-138 cm3). Fifty (25%) patients had undergone surgery before SRS, whereas 149 (75%) patients received standalone SRS. A total of 186 (93.5%) patients were treated by gamma knife radiosurgery (GKRS), whereas 13 got treated by Cyberknife. The mean tumor volume in CK-F, GKRS, and GKRS-F groups was 36.6 ± 26.3, 15.4 ± 18.4, and 86.0 ± 19.5 cm3, respectively. The mean marginal dose was 21.8 ± 2.9 Gy, 14.0 ± 1.9 Gy, and 25 ± 0.0 Gy in CK-F, GKRS, and GKRS-F groups, respectively. The mean marginal dose of SRS was 14.6 ± 2.9 Gy. The mean follow-up period after SRS was 35.8 ± 31.6 months. Significant clinical improvement was seen in 106 patients out of 116 (91.4%) after SRS with remarkable shrinkage, 22 patients out of 27 (81.5%) with minimal shrinkage, and nine patients out of 13 (69.2%) with stationary tumor shrinkage. The sixth cranial nerve (CN6) was the most commonly involved nerve in 73 patients (36.7%). 30/65 (89%) experienced an improvement in the abducent nerve function following SRS. 115/120 (95.8%) patients primary treated with SRS experienced clinical improvement, whereas the rest of the five patients remained clinically stable. Conclusion: Radiosurgery SRS is a safe and effective option in patients with CSHs and resulted in more than 50% decrease in tumor volume in 72.4% of the patients.