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Algorithmic Patient Selection for Minimally Invasive Versus Open Lumbar Interbody Fusion Surgery
Evidenced-based data-driven decision-making algorithms guide patient and approach selection for adult spinal deformity surgery. Algorithms are continually refined as surgical goals and intraoperative technology evolve. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - July 26, 2023 Category: Neurosurgery Authors: Jacob L. Goldberg, Ibrahim Hussain, Kai-Ming Fu, Michael S. Virk Source Type: research

The MIS PSO
This article discusses the surgical steps of the MIS PSO and reviews our experience. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - July 26, 2023 Category: Neurosurgery Authors: Oliver G.S. Ayling, Michael Y. Wang Source Type: research

Posterior-based Osteotomies for Deformity Correction
Posterior-based osteotomies are crucial to the restoration of lordosis in adult spinal deformity. Posterior-column osteotomies are suited for patients with an unfused anterior column and non-focal sagittal deformity requiring modest correction in lordosis. When performed on multiple levels, posterior-column osteotomy may provide significant harmonious correction in patients who require more extensive correction. Pedicle subtraction osteotomy and vertebral column resection are appropriate for patients with a fused anterior column and more severe deformity, particularly focal and/or multiplanar deformity. The power of pedicl...
Source: Neurosurgery Clinics of North America - July 23, 2023 Category: Neurosurgery Authors: Evan F. Joiner, Praveen V. Mummaneni, Christopher I. Shaffrey, Andrew K. Chan Source Type: research

Management of High-Grade Dysplastic Spondylolisthesis
The Meyerding classification grades the degree of slippage in the sagittal plane on lateral standing neutral imaging: 0% to 25% Grade I, 25% to 50% Grade II, 50% to 75% Grade III, 75% to 100% Grade IV, and greater than 100% Grade V (Spondyloptosis). Grades I and II are considered low-grade and Grades III-V are considered high-grade. There are several etiologies of spondylolisthesis. A classification system of the most common causes: Type I – Dysplastic, Type II – Isthmic (including subtypes: A – Lytic, B – Elongation, and C – Acute fracture), Type III – Degenerative, Type IV – Traumatic, Type V – Pathologic...
Source: Neurosurgery Clinics of North America - July 23, 2023 Category: Neurosurgery Authors: David W. Polly, Jason J. Haselhuhn, Paul Brian O. Soriano, Kari Odland, Kristen E. Jones Source Type: research

Anterior Column Realignment
This article focuses on the treatment of sagittal spinal deformity using a minimally invasive technique, anterior column realignment. Traditional methods to address sagittal spine deformity have been associated with high morbidity, long operative times, and excessive blood loss. This technique uses a minimally invasive lateral retroperitoneal approach to release the anterior longitudinal ligament and apply a hyperlordotic implant for interbody fusion to restore lumbar lordosis and sagittal alignment. (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - July 23, 2023 Category: Neurosurgery Authors: Gregory M. Mundis, Robert Kenneth Eastlack, Amber LaMae Price Source Type: research

Measuring Outcomes in Spinal Deformity Surgery
Outcome assessment in adult spinal deformity has evolved from radiographic analysis of curve correction to patient-centered perception of health-related quality-of-life. Oswestry Disability Index and the Scoliosis Research Society-22 Patient Questionnaire are the predominantly used patient-reported outcome (PRO) measurements for deformity surgery. Correction of sagittal alignment correlates with improved PRO. Functional outcomes and accelerometer measurements represent newer methods of measuring outcomes but have not yet been widely adopted or validated. Further adoption of a minimum set of core outcome domains will help f...
Source: Neurosurgery Clinics of North America - July 23, 2023 Category: Neurosurgery Authors: Stephen M. Bergin, Muhammad M. Abd-El-Barr, Oren Gottfried, C. Rory Goodwin, Christopher I. Shaffrey, Khoi D. Than Source Type: research

Transpsoas Approaches to the Lumbar Spine
The lateral transpsoas approach has become fundamental to minimally invasive spine surgery. The large interbody grafts that can be placed through this approach allow for robust arthrodesis of the anterior column, indirect decompression, and restoration of lordosis without disrupting the posterior musculature or ligamentous structures. The lateral decubitus position has traditionally been used for this approach but the prone position has gained popularity because it can reduce operating times for patients who also require posterior pedicle screw fixation. The transpsoas approach can be effectively performed in either positi...
Source: Neurosurgery Clinics of North America - July 21, 2023 Category: Neurosurgery Authors: Michael D. White, Juan S. Uribe Source Type: research

Spinal Deformity Update
The management of spinal deformity is characterized by significant variability between providers. An evidence-based approach to care requires systems-based optimization across the continuum of care from preoperative optimization to intraoperative standardization through postoperative rehabilitation. Prospective, multicenter research efforts have led to significant advances in our evidence-based approach to the management of spinal deformity. The purpose of this issue of Neurosurgery Clinics of North America is to provide an update on information regarding the management of spinal deformity that will guide an optimal, evide...
Source: Neurosurgery Clinics of North America - July 20, 2023 Category: Neurosurgery Authors: Sigurd Berven, Praveen Mummaneni Tags: Preface Source Type: research

Complications and Avoidance in Adult Spinal Deformity Surgery
Adult spinal deformity (ASD) is a complex disease that can result in significant disability. Although surgical treatment has been shown to be of benefit, the complication rate in the perioperative and postoperative periods can be as high as 70%. Some of the most common complications of ASD surgery include intraoperative cerebrospinal fluid leak, high blood loss, new neurologic deficit, hardware failure, proximal junctional kyphosis/failure, pseudarthrosis, surgical site infection, and medical complications. For each of these complications, one or more strategies can be utilized to avoid and/or minimize the consequences. (S...
Source: Neurosurgery Clinics of North America - July 19, 2023 Category: Neurosurgery Authors: Joseph R. Linzey, Jock Lillard, Michael LaBagnara, Paul Park Source Type: research

Enhanced Recovery After Surgery Protocols and Spinal Deformity
The authors outline a review of preoperative, intraoperative, and postoperative considerations surrounding adult spinal deformity. Preoperative management topics include imaging, hemoglobin A1c levels before spine surgery, osteoporotic management, and prehabilitation. Topics surrounding intraoperative management include the use of antibiotics, liposomal bupivacaine, and Foley catheters. The authors also discuss postoperative questions surrounding analgesia, nausea and vomiting, thromboembolic prophylaxis, and early mobilization. Throughout their discussion, the authors incorporate enhanced recovery after surgery protocols ...
Source: Neurosurgery Clinics of North America - July 15, 2023 Category: Neurosurgery Authors: Omar Sorour, Mohamed Macki, Lee Tan Source Type: research

Proximal Junctional Kyphosis and Failure: Strategies for Prevention
Proximal junctional kyphosis (PJK) and proximal junctional failure/fractures (PJF) are common complications following long-segment posterior instrumented fusions for adult spinal deformity. As progression to PJF involves clinical consequences for patients and requires costly revisions that may undermine the utility of surgery and are ultimately unsustainable for health care systems, preventative strategies to minimize the occurrence of PJF are of tremendous importance. In this article, the authors present a detailed outline of PJK and PJF with a focus on surgical strategies aimed at preventing their occurrence.. (Source: N...
Source: Neurosurgery Clinics of North America - July 15, 2023 Category: Neurosurgery Authors: Ayush Arora, Zachary T. Sharfman, Aaron J. Clark, Alekos A. Theologis Source Type: research

Spinopelvic Alignment
Sagittal spinal malalignment can lead to pain, decreased function, dynamic imbalance, and compromise of patient-reported health status. The goal of reconstructive spine surgery is to restore spinal alignment parameters, and an understanding of appropriate patient-specific alignment is important for surgical planning and approaches. Radiographic spinopelvic parameters are strongly correlated with pain and function. The relationship between spinopelvic parameters and disability in adult spinal deformity patients is well-established, and optimal correction of sagittal alignment results in improved outcomes regarding patient h...
Source: Neurosurgery Clinics of North America - July 11, 2023 Category: Neurosurgery Authors: Christine Park, Nitin Agarwal, Praveen V. Mummaneni, Sigurd H. Berven Source Type: research

Robotic-Assisted Surgery and Navigation in Deformity Surgery
Deformity surgery is advancing quickly with the use of three-dimensional navigation and robotics. In spinal fusion, the use of robotics improves screw placement accuracy and reduces radiation, complications, blood loss, and recovery time. Currently, there is limited evidence showing that robotics is better than traditional freehand techniques. Most studies favoring robotics are small and retrospective due to the novelty of the technology in deformity surgery. Using these systems can also be expensive and time-consuming. Surgeons should use these advancements as tools, but not rely on them to replace surgical experience, an...
Source: Neurosurgery Clinics of North America - June 26, 2023 Category: Neurosurgery Authors: Christine Park, Saman Shabani, Nitin Agarwal, Lee Tan, Praveen V. Mummaneni Source Type: research

Meningioma
NEUROSURGERY CLINICS OF NORTH AMERICA (Source: Neurosurgery Clinics of North America)
Source: Neurosurgery Clinics of North America - May 19, 2023 Category: Neurosurgery Authors: Randy L. Jensen, Gabriel Zada Source Type: research

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Source: Neurosurgery Clinics of North America - May 19, 2023 Category: Neurosurgery Source Type: research