Enhanced Recovery in Spine Surgery and Perioperative Pain Management
Enhanced recovery after surgery is an interdisciplinary, multimodal approach to improve postoperative outcomes by applying multiple evidenced-based interventions. It has been adapted at multiple institutions for patients undergoing spine surgery to combat the rising rate of opioid consumption. Various preoperative, intraoperative, and postoperative pharmacologic and nonpharmacologic interventions have been introduced to augment patient care with the goal to decrease hospital length of stay and improve postoperative outcomes. Future studies will focus on health care-related quality of life outcomes to evaluate the effective...
Source: Neurosurgery Clinics of North America - November 16, 2019 Category: Neurosurgery Authors: Vikram Chakravarthy, Hana Yokoi, Mariel R. Manlapaz, Ajit A. Krishnaney Source Type: research

Imaging Technologies in Spine Surgery
This article presents a comprehensive review of the evolution of both invasive and noninvasive imaging technologies that are part of the arsenal of spinal diagnostics and surgical therapy. The text provides not only a historical lens to the evolution of the imaging technologies that are part of routine contemporary practice but also provides a detailed sketch of emerging imaging technologies, such as endoscopic and exoscopic systems. Augmented reality, virtual reality, and mixed reality are new technologies that have enhanced the preparation of surgery and provide excellent case-specific training modules to break down each...
Source: Neurosurgery Clinics of North America - November 16, 2019 Category: Neurosurgery Authors: Vikram Chakravarthy, Shehryar Sheikh, Eric Schmidt, Michael Steinmetz Source Type: research

Cell and Gene Therapy for Spine Regeneration
This article provides an evidence-based personal perspective on the future of cell and gene therapy for degenerative diseases of the intervertebral disc. This paper focuses on how mammalian protein production platforms and transfected and irradiated protein packaging cell lines may be used as “cellular factories” for overproduction of therapeutic proteins and proanabolic growth factors, particularly in the context of regenerative therapies. This paper also speculates on future opportunities and challenges in this area of research and how new innovations in biotechnology affect cell a nd gene therapy for degener...
Source: Neurosurgery Clinics of North America - November 16, 2019 Category: Neurosurgery Authors: Ali Mobasheri, Stephen M. Richardson Source Type: research

New Technologies in Spine Surgery
NEUROSURGERY CLINICS OF NORTH AMERICA (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - November 16, 2019 Category: Neurosurgery Authors: Nathaniel P. Brooks, Michael Y. Wang Source Type: research

Copyright
ELSEVIER (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - November 16, 2019 Category: Neurosurgery Source Type: research

Contributors
RUSSELL R. LONSER, MD (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - November 16, 2019 Category: Neurosurgery Source Type: research

Contents
Nathaniel P. Brooks and Michael Y. Wang (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - November 16, 2019 Category: Neurosurgery Source Type: research

Forthcoming Issues
Spinal Oncology (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - November 16, 2019 Category: Neurosurgery Source Type: research

Robotic-Assisted Spinal Surgery
In this study, pedicle screw placement with the recently introduced Excelsius GPS robot (Globus) was similarly found to be accurate in a cohort of patients undergoing both open and minimally invasive fusion. Potential applications of the spinal robot ’s navigation capability are demonstrated. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - October 25, 2019 Category: Neurosurgery Authors: Clay M. Elswick, Michael J. Strong, Jacob R. Joseph, Yamaan Saadeh, Mark Oppenlander, Paul Park Source Type: research

Minimally Invasive Advances in Deformity
Adult spinal deformity is a major contributor to pain and disability. It is a degenerative disease with a rigid spine. Spinopelvic parameters have been identified that outline goals of operative intervention, as they have shown to significantly improve patient outcomes. Previously, this was accomplished with large, open fusions. Unfortunately, the adult spinal deformity population is often elderly with significant comorbidities. These extensive fusions have a high rate of morbidity and mortality. Technological advances have allowed minimally invasive approaches to be developed. These techniques have decreased operative mor...
Source: Neurosurgery Clinics of North America - October 25, 2019 Category: Neurosurgery Authors: David J. Mazur-Hart, Khoi D. Than Source Type: research

Lateral Lumbar Interbody Fusion
Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that allows access to the lumbar spine from L1/2 to L4/5 for placement of wide interbody devices. This technique is used in the treatment of degenerative conditions, deformity, and infectious, neoplastic, and traumatic thoracolumbar pathology. LLIF allows placement of interbody devices across the apophysis, which leads to powerful coronal deformity correction and indirect decompression from restoration of disk height. Literature shows equivalent to superior outcomes of the LLIF technique to anterior or posterior techniques in the treatment of degenera...
Source: Neurosurgery Clinics of North America - October 24, 2019 Category: Neurosurgery Authors: Houtan A. Taba, Seth K. Williams Source Type: research

Surface Technologies in Spinal Fusion
Patients with symptomatic instability of the spine may be treated surgically with interbody fusion. Cost and complexity in this procedure arises owing to the implanted materials involved with facilitating fusion such as titanium or polyetheretherketone. Surface modifications have been developed to augment these base materials such as plasma-spraying polyetheretherketone with titanium or coating implants with hydroxyapatite. Although some evidence has been gathered on these novel materials, additional study is needed to establish the true efficacy of surface modifications for interbody fusion devices in improving long-term ...
Source: Neurosurgery Clinics of North America - October 24, 2019 Category: Neurosurgery Authors: Jacob J. Enders, Daniel Coughlin, Thomas E. Mroz, Shaleen Vira Source Type: research

Cervical Disc Replacement
Anterior cervical disc replacement (arthroplasty) has gained momentum over the past 2  decades. The ball-and-socket prosthesis design of arthroplasty has been shown to simulate normal motion in all 3 rotation planes at the level of surgery and replicates physiologic motion. Anterior cervical discectomy and fusion has been shown to be a safe and effective surgery over decades; cervic al disc replacement counters some secondary effects owing to its preservation of segmental mobility, the potential to reduce adjacent segment degeneration, and the lack of plating or harvesting bone graft. The literature is growing in supp...
Source: Neurosurgery Clinics of North America - October 24, 2019 Category: Neurosurgery Authors: Jeremy Steinberger, Sheeraz Qureshi Source Type: research

Full-Endoscopic Lumbar Discectomy
Full-endoscopic spine surgery has been developed to decrease approach-related morbidity and provide superior visualization. Using a working channel endoscope, lumbar disc herniations can be approached via two complementary corridors: the transforaminal approach and the interlaminar approach. Indications, contraindications, surgical technique, complications, and outcomes are discussed in this article. Multiple published studies have demonstrated the feasibility, safety, and efficacy of full-endoscopic lumbar discectomies. Emerging evidence suggests that full-endoscopic discectomies result in similar functional outcomes comp...
Source: Neurosurgery Clinics of North America - October 24, 2019 Category: Neurosurgery Authors: Sananthan Sivakanthan, Saqib Hasan, Christoph Hofstetter Source Type: research

Posterior Endoscopic Cervical Foraminotomy
Unilateral cervical nerve root compression causing radiculopathy, which does not improve with conservative measures, is safely and effectively treated with surgery. Both anterior and posterior approaches have been described. Overall results from either of these broad categories of approaches are equivalent. Posterior approaches target the cervical root compression directly and allow decompression by widening the neural foramen and/or removing a lateral disc fragment. Following success of the open technique, variations of this technique were introduced to minimize approach-related complications. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - October 23, 2019 Category: Neurosurgery Authors: Sanjay Bhatia, Nathaniel P. Brooks Source Type: research

Robotic Tissue Manipulation and Resection in Spine Surgery
Spine surgery has evolved from the advent of imaging and navigation guidance, particularly with the rise of robotic surgical assistance. Navigation guidance has demonstrated potential for increased accuracy of transpedicular screw placement and resecting primary and metastatic spinal tumors. Robotic surgery is widely accepted in other surgical fields because laparoscopic techniques applied to robots can increase operator dexterity and improve visualization. Robotic assistance with spinal tumors has enjoyed rising interest owing to the potential for safe and minimally traumatic resection. We discuss available robots used fo...
Source: Neurosurgery Clinics of North America - October 23, 2019 Category: Neurosurgery Authors: S. Joy Trybula, Daniel E. Oyon, Jean-Paul Wolinsky Source Type: research

Emerging Percutaneous Ablative and Radiosurgical Techniques for Treatment of Spinal Metastases
This article reviews emerging percutaneous ablative and radiosurgical techniques for the treatment of spinal metastases. The percutaneous ablative techniques discussed are laser interstitial thermal therapy, radiofrequency ablation, and cryoablation. Stereotactic radiosurgery also is reviewed as an adjuvant to surgical resection or separation surgery. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - October 21, 2019 Category: Neurosurgery Authors: Muhamed Hadzipasic, Alexandra M. Giantini-Larsen, Claudio E. Tatsui, John H. Shin Source Type: research

Endoscopic Lumbar Interbody Fusion
Spine surgeons have recently developed more advanced and less invasive techniques. One significant example of recent surgical innovation is the advent of endoscopic-assisted spine surgery. Endoscopic lumbar interbody fusions are increasingly used to treat lumbar degenerative disease in a minimally invasive approach that minimizes pain and maximizes outcomes. Numerous technical refinements to ultraminimally invasive approaches have occurred since their initial use, which has resulted in substantial clinical benefit for patients that remains stable over time. Serious complications can occur and thus, the spine surgeon adopti...
Source: Neurosurgery Clinics of North America - October 15, 2019 Category: Neurosurgery Authors: G. Damian Brusko, Michael Y. Wang Source Type: research

Endoscopic Lumbar Decompression
This article describes the technique for the full-endoscopic decompression of the lumbar spine. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - October 15, 2019 Category: Neurosurgery Authors: Sebastian Ruetten, Martin Komp Source Type: research

Novel Intervertebral Technologies
This article reviews novel intervertebral implant technologies that have the potential to significantly impact elective spine surgery for degenerative spine disease. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - October 15, 2019 Category: Neurosurgery Authors: Mohamad Bydon, Anshit Goyal, Yagiz U. Yolcu Source Type: research

Retropleural Thoracic Approach
This article outlines preoperative workup and planning, intraoperative steps, tips, and postoperative care. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - October 11, 2019 Category: Neurosurgery Authors: Joshua T. Wewel, Juan S. Uribe Source Type: research

New Technologies in Spine Surgery
The techniques and technologies employed in  spine surgery are in a continuous state of evolution because surgeons, scientists, and patients are in a constant quest for technologies that will allow easier, less painful surgery with faster recoveries. The ideal technologies would allow painless procedures, requiring no recovery and reversing the effects of disease. Have we achieved these goals? No. Are we closer to these goals than we were 20 years ago? 50 years? Yes and yes. This issue of Neurosurgery Clinics of North America includes a collection of articles from world-renowned experts describing the newest tech...
Source: Neurosurgery Clinics of North America - October 8, 2019 Category: Neurosurgery Authors: Nathaniel P. Brooks, Michael Y. Wang Tags: Preface Source Type: research

Stem Cells and Spinal Fusion
This article reviews the clinical studies available with use in spinal fusion. Preliminary results demonstrate that stem cells can provide high rates of fusion, comparable to autograft, without associated morbidity. Autologous and allogeneic stem cell sources showed similar rates of fusion in this review. Further research is required to evaluate which clinical situations are the optimum for stem cell use. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - September 23, 2019 Category: Neurosurgery Authors: Vivek P. Shah, Wellington K. Hsu Source Type: research

Introduction to Pituitary Adenomas
Pituitary adenomas are the third most common intracranial neoplasm in adults, accounting for about 10% of all intracranial tumors. Pituitary adenomas can be functional adenomas that cause hormone hypersecretion and associated symptoms or nonfunctional adenomas that do not secrete excess hormones. Either of these 2 types of pituitary adenomas can cause symptoms of mass effect, such as vision loss, hypopituitarism, or headaches. Pituitary adenomas are occasionally detected on imaging studies performed for unrelated reasons. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - August 28, 2019 Category: Neurosurgery Authors: Manish K. Aghi, Lewis S. Blevins Tags: Preface Source Type: research

Pituitary Adenomas
NEUROSURGERY CLINICS OF NORTH AMERICA (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - August 28, 2019 Category: Neurosurgery Authors: Manish K. Aghi, Lewis S. BLEVINS Source Type: research

Copyright
ELSEVIER (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - August 28, 2019 Category: Neurosurgery Source Type: research

Contributors
RUSSELL R. LONSER, MD (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - August 28, 2019 Category: Neurosurgery Source Type: research

Contents
Manish K. Aghi and Lewis S. Blevins Jr (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - August 28, 2019 Category: Neurosurgery Source Type: research

Forthcoming Issues
New Technologies in Spine Surgery (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - August 28, 2019 Category: Neurosurgery Source Type: research

Management of Nonfunctioning Recurrent Pituitary Adenomas
This article reviews the natural history of recurrent adenomas and emerging biomarkers predictive of clinical behavior as well as the outcomes associated with the various treatment modalities for these challenging tumors, with an emphasis on the surgical treatment. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - August 7, 2019 Category: Neurosurgery Authors: Christopher J. Farrell, Tomas Garzon-Muvdi, Judd H. Fastenberg, Gurston G. Nyquist, Mindy R. Rabinowitz, Marc R. Rosen, James J. Evans Source Type: research

Pituitary Apoplexy
Pituitary apoplexy is a clinical condition with acute-onset headaches, vision loss, and/or pituitary dysfunction associated with a hemorrhagic or infarcted pituitary tumor or cyst. Treatment varies based on clinical presentation, although often urgent or emergent surgical resection is indicated. Conservative treatment strategies tend to be applied for more mild conditions of apoplexy. Overall outcomes may be similar in this less severe cohort. Acute-onset vision loss with apoplexy should be treated with urgent or emergent surgical evacuation of hematoma and resection of tumor when possible. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - August 7, 2019 Category: Neurosurgery Authors: Garni Barkhoudarian, Daniel F. Kelly Source Type: research

Visual Outcomes After Pituitary Surgery
Visual signs and symptoms are a common manifestation of pituitary adenomas from compression or ischemia of the optic nerves and optic chiasm. Although bitemporal hemianopsia is a classic presenting visual field deficit, additional visual disturbances can result from these tumors. After endoscopic endonasal pituitary surgery, most patients have improvement in visual symptoms. Preoperative factors including retinal nerve fiber layer thickness, severity of preoperative deficit, duration of visual symptoms, tumor size, extent of resection, and patient age serve as possible predictors of postoperative visual outcomes. (Source: ...
Source: Neurosurgery Clinics of North America - August 5, 2019 Category: Neurosurgery Authors: Benjamin Uy, Bayard Wilson, Wi Jin Kim, Giyarpuram Prashant, Marvin Bergsneider Source Type: research

Intraoperative Fluorescent Visualization of Pituitary Adenomas
Tumor recurrence in pituitary adenomas is as high as 20% after surgery. Conventional neuronavigation and white light visualization are not sufficiently accurate in detecting residual neoplastic tissue. Fluorescence-guided surgery offers accurate, real-time visualization of neoplastic tissue. The authors ’ group has explored the use of near-infrared imaging, which is superior to visible-light fluorescence in both signal contrast and tissue penetration, in transsphenoidal endoscopic surgeries for pituitary adenomas using 2 techniques: second window indocyanine green, in which indocyanine green pass ively accumulates in...
Source: Neurosurgery Clinics of North America - July 27, 2019 Category: Neurosurgery Authors: Steve S. Cho, John Y.K. Lee Source Type: research

Sodium Perturbations After Pituitary Surgery
Sodium perturbations are a common complication after pituitary surgery, with hyponatremia being the most frequent. Postoperative assessments should be tailored to the early and late periods, and monitoring sodium perturbations is recommended. Cerebral salt wasting is rare after pituitary surgery, and diagnosis and management can be challenging. Providing patient counseling and close postoperative follow-up is important to effectively manage diabetes insipidus and reduce hospital readmissions due to sodium perturbations. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - July 27, 2019 Category: Neurosurgery Authors: Kevin C.J. Yuen, Adnan Ajmal, Ricardo Correa, Andrew S. Little Source Type: research

The Role of Three-Dimensional Endoscopy in Pituitary Adenoma Surgery
This article discusses the history and development of 3D endoscopes, addresses theoretic advantages and disadvantages of using these devices for EES, reviews recent studies of EES for adenoma outcomes using 3D endoscopes, examines possible implications for neurosurgical training, and discusses personal experience with 3D devices. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - July 18, 2019 Category: Neurosurgery Authors: Kumar Vasudevan, Hassan Saad, Nelson M. Oyesiku Source Type: research

Management of Pituitary Adenomas Invading the Cavernous Sinus
Cavernous sinuses are complex dural venous sinuses that house important neurovascular structures, which often preclude full surgical access for tumor resection. Neuro-imaging and anatomic grading scales have corroborated that more invasive tumors are less likely to undergo gross total resection and biochemical remission. Endoscopic approaches are increasingly favored over microsurgical techniques. Direct transcavernous approaches have yielded even greater degrees of resection. Radiosurgery is a powerful adjuvant therapy for residual, recurrent, and/or inaccessible cavernous sinus disease that provides excellent tumor contr...
Source: Neurosurgery Clinics of North America - July 16, 2019 Category: Neurosurgery Authors: Martin Rutkowski, Gabriel Zada Source Type: research

Endocrine Outcomes After Pituitary Surgery
Although removal of pituitary tumors yields excellent surgical outcomes, perturbations in the hypothalamic-pituitary axis are not uncommon. Careful assessment of postoperative hormone status with supplementation or further medical therapy is critical to successful outcomes. Although many centers routinely use perioperative steroids, they can be associated with worse outcomes in the absence of intact preoperative adrenal function or damage to the pituitary gland or stalk during surgery. Postoperative assessment of prolactin, cortisol, and growth hormone can be prognostic of surgical cure. Hormonal axes should be reevaluated...
Source: Neurosurgery Clinics of North America - July 13, 2019 Category: Neurosurgery Authors: Anshu Buttan, Adam N. Mamelak Source Type: research

Management of Giant Pituitary Adenomas
This article reviews the current literature and attempts to define the role and outcomes of the endoscopic endonasal surgical approach for giant pituitary adenomas. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - July 10, 2019 Category: Neurosurgery Authors: Miguel Marigil Sanchez, Claire Karekezi, Joao Paulo Almeida, Aristotelis Kalyvas, Vitor Castro, Carlos Velasquez, Fred Gentili Source Type: research

Molecular Biology of Pituitary Adenomas
Pituitary adenomas are benign tumors, but still cause significant morbidity and in some cases increases in mortality. Surgical resection is not without risks, and approximately 40% of adenomas are incompletely resected. Medical therapies such as dopamine agonists, somatostatin analogues, and growth hormone antagonists are associated with numerous side effects. Understanding the molecular biology of pituitary adenomas may yield new therapeutic approaches. Additional studies are needed to help determine which genes or pathways are “drivers” of tumorigenesis and should be therapeutic targets. Further studies may a...
Source: Neurosurgery Clinics of North America - July 5, 2019 Category: Neurosurgery Authors: Claire M. Faltermeier, Stephen T. Magill, Lewis Blevins, Manish K. Aghi Source Type: research

Medical Management of Cushing Disease
Medical therapy for Cushing disease is primarily used to control hypercortisolism in patients whose disease persists or with recurrent disease after pituitary surgery, including those awaiting the salutary effects of radiation therapy. In can also be used to control hypercortisolism preoperatively, and in patients who decline surgery or whose tumor location is unknown. Steroidogenesis inhibitors, centrally acting agents, and glucocorticoid receptor antagonists are currently available to treat hypercortisolism, and several novel agents are in development. Given the absence of head-to-head clinical trials, choice between tre...
Source: Neurosurgery Clinics of North America - July 5, 2019 Category: Neurosurgery Authors: Nicholas A. Tritos, Beverly M.K. Biller Source Type: research

Surgery for Pediatric Pituitary Adenomas
Pituitary adenomas are a rare but important central nervous system tumor in children. Because of differences in growth and development, the manifestations of pituitary adenomas in children may differ from those seen in adults. Unlike adult patients, the pediatric population more often presents with clinically secretory adenomas. Although medical management is first-line treatment of prolactinomas, transsphenoidal surgery is appropriate for most children with Cushing disease and gigantism. Although some pediatric patients present surgical challenges because of small anatomic dimensions or an incompletely developed sphenoid ...
Source: Neurosurgery Clinics of North America - July 5, 2019 Category: Neurosurgery Authors: Alexandria C. Marino, Davis G. Taylor, Bhargav Desai, John A. Jane Source Type: research

Intraoperative MRI for Pituitary Adenomas
Since the 1990s, MRI scanners have been incorporated into the operating room environment. Studies of the use of intraoperative MRI (iMRI) for pituitary adenomas have shown that images are highly sensitive and specific for residual tumor detection, especially at higher Tesla magnet strengths. Given this accuracy, iMRI also increases the rates of achieving gross total resection (GTR). Owing to the slow-growing nature of pituitary adenomas, comparison of long-term control rates with and without use of iMRI remains to be studied, but the increased rates of GTR with this technology are promising for improved long-term outcomes....
Source: Neurosurgery Clinics of North America - July 2, 2019 Category: Neurosurgery Authors: Pamela S. Jones, Brooke Swearingen Source Type: research

The Role of Surgery in the Management of Prolactinomas
Prolactinomas are the most common functional pituitary adenoma. Many prolactinomas can be treated with medication, but all patients should be evaluated at a neuroendocrine center including experienced neurosurgeons trained in transsphenoidal surgery. Surgery for prolactinomas is feasible and can be performed with low morbidity. Patients never previously treated with dopamine agonists should be considered for surgery if they have neurologic deficits, pituitary apoplexy, an uncertain diagnosis, or a significantly cystic prolactinoma. Patients previously treated with dopamine agonists should be considered for surgery in cases...
Source: Neurosurgery Clinics of North America - July 2, 2019 Category: Neurosurgery Authors: Daniel A. Donoho, Edward R. Laws Source Type: research

High-Grade Lumbar Spondylolisthesis
Most high-grade spondylolistheses are resultant from isthmic spondylolisthesis, as complete discontinuity of the pars is typically necessary to allow for this degree of anterior vertebral translation, although can occur less commonly in other scenarios. Higher-grade slips can affect the global sagittal balance of the patient and often result in altered gait patterns and compensatory posturing. Management usually entails surgical decompression and fusion with instrumentation. The addition of anterior column support carries many advantages, including greater surface area for fusion, dynamic compression load sharing at the lu...
Source: Neurosurgery Clinics of North America - May 9, 2019 Category: Neurosurgery Authors: Aaron W. Beck, Andrew K. Simpson Source Type: research

Degenerative Lumbar Spondylolisthesis
Degenerative lumbar spondylolisthesis is one of the most common causes of low back pain and is defined as displacement of one vertebra over subjacent vertebra, associated with degenerative changes, without an associated disruption or defect in the vertebral ring. Undersetanding natural history of degenerative spondylolisthesis is important to tailor an individualized management plan for each patient. A trial of conservative therapy may be considered for patients with low-grade spondylolisthesis presenting with radiculopathy and/or pseudoclaudication. These options may include physical therapy, epidural steroid injection, a...
Source: Neurosurgery Clinics of North America - May 9, 2019 Category: Neurosurgery Authors: Mohamad Bydon, Mohammed Ali Alvi, Anshit Goyal Source Type: research

Lateral Approaches for the Surgical Treatment of Lumbar Spondylolisthesis
This article focuses on lateral lumbar interbody fusion (LLIF). It represents a minimally invasive approach that affords surgeons an increased ability to restore disc height, indirectly decompress the neural elements, and affect global spinal alignment. As the role for circumferential minimally invasive spine surgery continues to expand, the use of LLIF in the setting of spondylolisthesis —and other pathologies—will continue to represent a robust fusion option. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - May 9, 2019 Category: Neurosurgery Authors: Jason E. McGowan, Adam S. Kanter Source Type: research

Summary of Guidelines for the Treatment of Lumbar Spondylolisthesis
This article summarizes the guidelines for the treatment of lumbar spondylolisthesis. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - May 9, 2019 Category: Neurosurgery Authors: Andrew K. Chan, Viraj Sharma, Leslie C. Robinson, Praveen V. Mummaneni Source Type: research

Artificial Intelligence for the Treatment of Lumbar Spondylolisthesis
Multiple registries are currently collecting patient-specific data on lumbar spondylolisthesis including outcomes data. The collection of imaging diagnostics data along with comparative outcomes data following decompression versus decompression and fusion treatments for degenerative spondylolisthesis represents an enormous opportunity for modern machine-learning analytics research. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - May 9, 2019 Category: Neurosurgery Authors: Zoher Ghogawala, Melissa Dunbar, Irfan Essa Source Type: research

Preface
The treatment of degenerative lumbar spondylolisthesis with lumbar stenosis has become controversial in the wake of the publication of the results of two randomized clinical trials in the New England Journal of Medicine in 2016. The two trials reached different conclusions regarding the utility of adding a fusion when performing a decompression of the spinal canal in these patients. Since fusion is widely utilized in the United States for degenerative spondylolisthesis, it is necessary to consider the existing evidence and prepare for new methods of analyzing data in order to know how to evaluate the utility of lumbar fusi...
Source: Neurosurgery Clinics of North America - May 9, 2019 Category: Neurosurgery Authors: Zoher Ghogawala Source Type: research

Lumbar Spondylolisthesis
NEUROSURGERY CLINICS OF NORTH AMERICA (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - May 9, 2019 Category: Neurosurgery Authors: Zoher Ghogawala Source Type: research