Pub Date : 2019-05-01DOI: 10.1097/01.CNE.0000833300.24099.2c
G. Brusko, Michael Y. Wang
cantly since the turn of the century. Between 1998 and 2008, the annual number of spinal fusion discharges increased 137%, a higher rate than other common inpatient procedures such as laminectomy and hip arthroplasty. Moreover, the average age of patients undergoing spine surgery is increasing. In the Medicare population, rates of complex fusions in particular are increasing at a staggering rate. The growing number of surgical procedures and rising patient age are also associated with increases in morbidity and mortality, which contribute to longer length of stay (LOS) and rising costs. Furthermore, spine procedures have a high incidence of severe pain, especially on the first postoperative day, and lumbar fusions have been rated in the top 6 of most painful surgical procedures. Most commonly, opioid medications are used to manage postoperative and chronic pain for spine patients. However, opioid-related deaths skyrocketed from 0.4% in 2001 to 1.5% in 2016, representing a 292% increase. Thus, the ever-growing national concern regarding opioid usage poses a challenge to spine surgeons attempting to provide the most appropriate pharmacotherapy to manage their patients’ pain. A solution for this constellation of current challenges will likely not arise solely from new surgical technologies or techniques, but rather in an approach that improves upon all aspects of patient care. Spine surgeons should begin examining the patient experience as a whole to identify methods of decreasing pain and shortening hospital stays, thus improving outcomes for all patients. One notable approach that has gained international momentum during the last several decades is Enhanced Recovery After Surgery (ERAS), and applications within spine surgery seem promising.
{"title":"Enhanced Recovery After Spinal Surgery: A Multimodal Approach to Patient Care","authors":"G. Brusko, Michael Y. Wang","doi":"10.1097/01.CNE.0000833300.24099.2c","DOIUrl":"https://doi.org/10.1097/01.CNE.0000833300.24099.2c","url":null,"abstract":"cantly since the turn of the century. Between 1998 and 2008, the annual number of spinal fusion discharges increased 137%, a higher rate than other common inpatient procedures such as laminectomy and hip arthroplasty. Moreover, the average age of patients undergoing spine surgery is increasing. In the Medicare population, rates of complex fusions in particular are increasing at a staggering rate. The growing number of surgical procedures and rising patient age are also associated with increases in morbidity and mortality, which contribute to longer length of stay (LOS) and rising costs. Furthermore, spine procedures have a high incidence of severe pain, especially on the first postoperative day, and lumbar fusions have been rated in the top 6 of most painful surgical procedures. Most commonly, opioid medications are used to manage postoperative and chronic pain for spine patients. However, opioid-related deaths skyrocketed from 0.4% in 2001 to 1.5% in 2016, representing a 292% increase. Thus, the ever-growing national concern regarding opioid usage poses a challenge to spine surgeons attempting to provide the most appropriate pharmacotherapy to manage their patients’ pain. A solution for this constellation of current challenges will likely not arise solely from new surgical technologies or techniques, but rather in an approach that improves upon all aspects of patient care. Spine surgeons should begin examining the patient experience as a whole to identify methods of decreasing pain and shortening hospital stays, thus improving outcomes for all patients. One notable approach that has gained international momentum during the last several decades is Enhanced Recovery After Surgery (ERAS), and applications within spine surgery seem promising.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"43 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44401554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-01DOI: 10.1097/01.CNE.0000557788.67992.93
P. González-López, Inmaculada Palomar, María Dolores Coves, J. A. Olivas, S. Elbabaa, P. López
{"title":"Insular Brain Tumor Surgery: Part 2—Preoperative Planning","authors":"P. González-López, Inmaculada Palomar, María Dolores Coves, J. A. Olivas, S. Elbabaa, P. López","doi":"10.1097/01.CNE.0000557788.67992.93","DOIUrl":"https://doi.org/10.1097/01.CNE.0000557788.67992.93","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000557788.67992.93","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42946318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1097/01.CNE.0000832200.40753.5b
Barrett S. Boody, Rishi Sharma, W. Bronson, Glenn S. Russo, A. Segar, A. Vaccaro
The application of stem cells for spine fusion, degenerative disc disease, and spinal cord injury displays significant promise for improvement upon current techniques. Stem cells possess both the ability to divide indefinitely while remaining in an undifferentiated state and either pluripotency or multipotency to divide into a variety of cell types or lineages. Embryonic stem cells are harvested from the inner mass of the blastocyst, occurring approximately 4 to 5 days after fertilization and can differentiate into cells of any germ or somatic lineage. Although their pluripotency may make them a useful therapeutic candidate, the ethical controversy and regulations concerning embryonic stem cells limit their clinical use. However, the recent use of adult stem cell lines provides an alternative. Adult stem cells can be harvested from living donors and more commonly demonstrate multipotency, as they have begun differentiation toward somatic lineages. Adult stem cells are prevalent within bone marrow (BM) where 2 types are present: hematopoietic stem cells, which divide into various blood components, and mesenchymal stem cells (MSCs), which can produce bone, cartilage, and adipose tissue. Adipose stem cells are another popular source of adult stem cells. Their abundance in many patients, and their relative ease of har-vest, has led to their wide usage in clinical treatment. Spine fusion, Stem cells Learning Objectives : After participating in this CME activity, the neurosurgeon should be better able to: Describe the recent research investigating and evaluating the use of stem cells in spinal fusion, degenerative disc disease, and spinal cord injury.
{"title":"Update on Stem Cell Applications in Spine Surgery","authors":"Barrett S. Boody, Rishi Sharma, W. Bronson, Glenn S. Russo, A. Segar, A. Vaccaro","doi":"10.1097/01.CNE.0000832200.40753.5b","DOIUrl":"https://doi.org/10.1097/01.CNE.0000832200.40753.5b","url":null,"abstract":"The application of stem cells for spine fusion, degenerative disc disease, and spinal cord injury displays significant promise for improvement upon current techniques. Stem cells possess both the ability to divide indefinitely while remaining in an undifferentiated state and either pluripotency or multipotency to divide into a variety of cell types or lineages. Embryonic stem cells are harvested from the inner mass of the blastocyst, occurring approximately 4 to 5 days after fertilization and can differentiate into cells of any germ or somatic lineage. Although their pluripotency may make them a useful therapeutic candidate, the ethical controversy and regulations concerning embryonic stem cells limit their clinical use. However, the recent use of adult stem cell lines provides an alternative. Adult stem cells can be harvested from living donors and more commonly demonstrate multipotency, as they have begun differentiation toward somatic lineages. Adult stem cells are prevalent within bone marrow (BM) where 2 types are present: hematopoietic stem cells, which divide into various blood components, and mesenchymal stem cells (MSCs), which can produce bone, cartilage, and adipose tissue. Adipose stem cells are another popular source of adult stem cells. Their abundance in many patients, and their relative ease of har-vest, has led to their wide usage in clinical treatment. Spine fusion, Stem cells Learning Objectives : After participating in this CME activity, the neurosurgeon should be better able to: Describe the recent research investigating and evaluating the use of stem cells in spinal fusion, degenerative disc disease, and spinal cord injury.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"43 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44763462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1097/01.CNE.0000554568.47876.ed
P. González-López, N. Gunness, J. A. Olivas, S. Elbabaa, M. Caffo, P. López
{"title":"Insular Brain Tumor Surgery: Part 1—Insular Lobe Anatomy","authors":"P. González-López, N. Gunness, J. A. Olivas, S. Elbabaa, M. Caffo, P. López","doi":"10.1097/01.CNE.0000554568.47876.ed","DOIUrl":"https://doi.org/10.1097/01.CNE.0000554568.47876.ed","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000554568.47876.ed","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44006219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1097/01.CNE.0000554061.08341.31
J. Whitaker, K. Almefty
neuroma, is a benign nerve sheath tumor that arises from the Schwann cells of the superior and inferior branches of the vestibular nerve (cranial nerve [CN] VIII). VS accounts for 80% of cerebellopontine angle tumors and 8% of all intracranial tumors. VS has a clinical incidence of 1 case per 100,000 population. The increased availability of MRI has resulted in an increased incidence of VS, a smaller average tumor size at diagnosis, and an improved baseline hearing status at diagnosis. In addition, recent studies have improved our understanding of the natural history of these tumors. The results of the widespread application of radiosurgery as a primary treatment modality are becoming available, and the microsurgical technique has reached maturity. These variables, and the successes and shortcomings of the various available treatment options, require a nuanced approach to the management of patients with VS, particularly those with small tumors limited to the internal auditory meatus or less than 1.5 cm in greatest dimension. Treatment paradigms for small tumors are focused on the preservation of neurologic function. Presenting symptoms of patients with VS typically include hearing loss, tinnitus, vertigo, and unsteadiness. Although vestibular dysfunction can result in significant disability, comparative data are sparse regarding vestibular outcomes among treatment options. Most studies focus on tumor control, facial nerve (CN VII) function, and hearing outcomes. Recent studies have also included quality-of-life surveys. This article summarizes outcomes for the 3 management options of microsurgery, radiosurgery, and observation, and it suggests a management algorithm for patients with a small VS.
{"title":"Management of Small Vestibular Schwannomas","authors":"J. Whitaker, K. Almefty","doi":"10.1097/01.CNE.0000554061.08341.31","DOIUrl":"https://doi.org/10.1097/01.CNE.0000554061.08341.31","url":null,"abstract":"neuroma, is a benign nerve sheath tumor that arises from the Schwann cells of the superior and inferior branches of the vestibular nerve (cranial nerve [CN] VIII). VS accounts for 80% of cerebellopontine angle tumors and 8% of all intracranial tumors. VS has a clinical incidence of 1 case per 100,000 population. The increased availability of MRI has resulted in an increased incidence of VS, a smaller average tumor size at diagnosis, and an improved baseline hearing status at diagnosis. In addition, recent studies have improved our understanding of the natural history of these tumors. The results of the widespread application of radiosurgery as a primary treatment modality are becoming available, and the microsurgical technique has reached maturity. These variables, and the successes and shortcomings of the various available treatment options, require a nuanced approach to the management of patients with VS, particularly those with small tumors limited to the internal auditory meatus or less than 1.5 cm in greatest dimension. Treatment paradigms for small tumors are focused on the preservation of neurologic function. Presenting symptoms of patients with VS typically include hearing loss, tinnitus, vertigo, and unsteadiness. Although vestibular dysfunction can result in significant disability, comparative data are sparse regarding vestibular outcomes among treatment options. Most studies focus on tumor control, facial nerve (CN VII) function, and hearing outcomes. Recent studies have also included quality-of-life surveys. This article summarizes outcomes for the 3 management options of microsurgery, radiosurgery, and observation, and it suggests a management algorithm for patients with a small VS.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"41 1","pages":"1–5"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000554061.08341.31","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48229761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-01DOI: 10.1097/01.cne.0000553507.58193.01
Nathan D. Todnem, Ayobami L. Ward, C. Alleyne
continue to evolve rapidly. The neurosurgeon’s armamentarium has grown tremendously with a vast array of microsurgical and endovascular techniques. Advancements in knowledge and technology have helped to reduce the high morbidity and mortality historically associated with this disease. To take full advantage of our modern technology, technical skill, and clinical knowledge, the training of neurosurgeons who treat aneurysms has also become more complex. In our opinion, the modern-day neurosurgeon best equipped to treat cerebrovascular disease is going to be one who has obtained hybrid or dual training in both endovascular and microsurgical techniques. Neurosurgeons comfortable with both open microsurgical and endovascular techniques can use these skills interchangeably and safely to treat a broad spectrum of disease and hopefully reduce complications by not leaning too far toward to one particular treatment strategy. Historically, the term “aneurysm” has been attributed to Galen in ad 2, who combined the 2 Greek words, ana (across) and eurys (broad). It was Buimi of Milan in 1765 who gave the fi rst documented clinical account and autopsy report of the disease. After clinical medicine became more sophisticated, Hutchinson in 1875 accurately diagnosed an aneurysm in a live patient followed by Quincke in 1891, who demonstrated blood in cerebrospinal fl uid after subarachnoid hemorrhage. As neurosurgical techniques improved, the ligation of ruptured aneurysms became feasible but remained technically challenging with very high morbidity and mortality rates. The fi eld continued to advance as Harvey Cushing fi rst described a metal clip for aneurysms not amenable to suture ligation in 1921, and Walter Dandy operated on a 43-year-old woman with a right third nerve palsy and an unruptured aneurysm in 1937. As clip ligation techniques were refi ned, the fi eld of angiography began to blossom with Moniz, who performed the fi rst angiogram in 1927 and then later, in 1933, reported angiographic localization of a ruptured aneurysm. By 1954, angiograms began to be described as routine procedures for diagnosis and localization of aneurysms. A decade later interventional techniques were already being used to treat aneurysms, such as balloon occlusion of aneurysms in 1964 by Luessenhop and Velasquez, and in 1965 J. F. Alksne reported using a magnetic fi eld to guide iron microspheres into aneurysms. The precursor to today’s coil
继续快速发展。随着显微外科手术和血管内技术的广泛应用，神经外科医生的装备也得到了极大的发展。知识和技术的进步有助于降低这种疾病历来的高发病率和死亡率。为了充分利用我们的现代技术、技术技能和临床知识，治疗动脉瘤的神经外科医生的培训也变得更加复杂。在我们看来，现代最有能力治疗脑血管疾病的神经外科医生将是在血管内和显微外科技术方面获得混合或双重训练的人。熟悉开放显微手术和血管内技术的神经外科医生可以安全地交替使用这些技术来治疗广泛的疾病，并希望通过不过于倾向于一种特定的治疗策略来减少并发症。从历史上看，“动脉瘤”一词被认为是由公元2年的盖伦发明的，他将两个希腊单词ana(横跨)和eurys(宽阔)结合在一起。1765年，米兰的Buimi第一次给出了这种疾病的临床记录和尸检报告。在临床医学变得更加成熟之后，1875年，Hutchinson准确地诊断出了一位活着的病人的动脉瘤，1891年，Quincke证实了蛛网膜下腔出血后脑脊液中有血。随着神经外科技术的进步，动脉瘤破裂的结扎变得可行，但在技术上仍然具有很高的发病率和死亡率。1921年，哈维·库欣首次描述了一种用于治疗无法缝合的动脉瘤的金属夹，1937年，沃尔特·丹迪为一名患有右第三神经麻痹和未破裂动脉瘤的43岁妇女进行了手术，这一领域继续发展。随着夹子结扎技术的不断完善，血管造影领域随着Moniz开始蓬勃发展，他于1927年进行了第一次血管造影，随后在1933年报道了动脉瘤破裂的血管造影定位。到1954年，血管造影开始被描述为诊断和定位动脉瘤的常规程序。十年后，介入技术已经被用于治疗动脉瘤，比如1964年Luessenhop和Velasquez用球囊闭塞动脉瘤，1965年J. F. Alksne报道使用磁场引导铁微球进入动脉瘤。今天线圈的前身
{"title":"How Hybrid/Dual Training Influences Cerebral Aneurysm Management","authors":"Nathan D. Todnem, Ayobami L. Ward, C. Alleyne","doi":"10.1097/01.cne.0000553507.58193.01","DOIUrl":"https://doi.org/10.1097/01.cne.0000553507.58193.01","url":null,"abstract":"continue to evolve rapidly. The neurosurgeon’s armamentarium has grown tremendously with a vast array of microsurgical and endovascular techniques. Advancements in knowledge and technology have helped to reduce the high morbidity and mortality historically associated with this disease. To take full advantage of our modern technology, technical skill, and clinical knowledge, the training of neurosurgeons who treat aneurysms has also become more complex. In our opinion, the modern-day neurosurgeon best equipped to treat cerebrovascular disease is going to be one who has obtained hybrid or dual training in both endovascular and microsurgical techniques. Neurosurgeons comfortable with both open microsurgical and endovascular techniques can use these skills interchangeably and safely to treat a broad spectrum of disease and hopefully reduce complications by not leaning too far toward to one particular treatment strategy. Historically, the term “aneurysm” has been attributed to Galen in ad 2, who combined the 2 Greek words, ana (across) and eurys (broad). It was Buimi of Milan in 1765 who gave the fi rst documented clinical account and autopsy report of the disease. After clinical medicine became more sophisticated, Hutchinson in 1875 accurately diagnosed an aneurysm in a live patient followed by Quincke in 1891, who demonstrated blood in cerebrospinal fl uid after subarachnoid hemorrhage. As neurosurgical techniques improved, the ligation of ruptured aneurysms became feasible but remained technically challenging with very high morbidity and mortality rates. The fi eld continued to advance as Harvey Cushing fi rst described a metal clip for aneurysms not amenable to suture ligation in 1921, and Walter Dandy operated on a 43-year-old woman with a right third nerve palsy and an unruptured aneurysm in 1937. As clip ligation techniques were refi ned, the fi eld of angiography began to blossom with Moniz, who performed the fi rst angiogram in 1927 and then later, in 1933, reported angiographic localization of a ruptured aneurysm. By 1954, angiograms began to be described as routine procedures for diagnosis and localization of aneurysms. A decade later interventional techniques were already being used to treat aneurysms, such as balloon occlusion of aneurysms in 1964 by Luessenhop and Velasquez, and in 1965 J. F. Alksne reported using a magnetic fi eld to guide iron microspheres into aneurysms. The precursor to today’s coil","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"41 1","pages":"1–8"},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.cne.0000553507.58193.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43020023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-01DOI: 10.1097/01.CNE.0000553249.11352.d5
Avery L. Buchholz, J. Quinn, Thomas J. Buell, C. Yen, R. Haid, C. Shaffrey, Justin S. Smith
{"title":"TLIF: A Review of Techniques and Advances","authors":"Avery L. Buchholz, J. Quinn, Thomas J. Buell, C. Yen, R. Haid, C. Shaffrey, Justin S. Smith","doi":"10.1097/01.CNE.0000553249.11352.d5","DOIUrl":"https://doi.org/10.1097/01.CNE.0000553249.11352.d5","url":null,"abstract":"","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000553249.11352.d5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47784750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1097/01.CNE.0000552867.05285.23
J. Quinn, Avery L. Buchholz, Thomas J. Buell, R. Haid, S. Bess, V. Lafage, F. Schwab, C. Shaffrey, Justin S. Smith
Proximal junctional kyphosis (PJK) is a specifi c form of adjacent segment pathology (ASP) that most commonly occurs after long-segment fusions for spine deformity treatment. Junctional kyphosis at the transition from fused to mobile segments is a common radiographic fi nding. In adult spinal deformity surgery, the reported incidence ranges from 11.0% to 52.9%; however, the description and criteria for defi ning PJK and its clinical impact vary in the literature. Although many initial reports suggested that PJK was a benign radiographic fi nding with minimal clinical signifi cance, more recent reports suggest it can be associated with greater pain and poorer function and increased likelihood of reoperation. Proximal junctional failure (PJF) represents a more severe form of junctional pathology associated with mechanical failure, increased risk of neurologic injury, deformity, and pain, and frequently requires revision surgery. In the second section of this 3-part series, we reviewed general concepts in the prevention and treatment of ASP after lumbar spine surgery. In this section, we review specifi c strategies for the prevention and management of PJK and/or PJF, a subtype of ASP, which may occur following surgery for spine deformity.
{"title":"Proximal Junctional Kyphosis and/or Failure—Part 3: Prevention and Treatment","authors":"J. Quinn, Avery L. Buchholz, Thomas J. Buell, R. Haid, S. Bess, V. Lafage, F. Schwab, C. Shaffrey, Justin S. Smith","doi":"10.1097/01.CNE.0000552867.05285.23","DOIUrl":"https://doi.org/10.1097/01.CNE.0000552867.05285.23","url":null,"abstract":"Proximal junctional kyphosis (PJK) is a specifi c form of adjacent segment pathology (ASP) that most commonly occurs after long-segment fusions for spine deformity treatment. Junctional kyphosis at the transition from fused to mobile segments is a common radiographic fi nding. In adult spinal deformity surgery, the reported incidence ranges from 11.0% to 52.9%; however, the description and criteria for defi ning PJK and its clinical impact vary in the literature. Although many initial reports suggested that PJK was a benign radiographic fi nding with minimal clinical signifi cance, more recent reports suggest it can be associated with greater pain and poorer function and increased likelihood of reoperation. Proximal junctional failure (PJF) represents a more severe form of junctional pathology associated with mechanical failure, increased risk of neurologic injury, deformity, and pain, and frequently requires revision surgery. In the second section of this 3-part series, we reviewed general concepts in the prevention and treatment of ASP after lumbar spine surgery. In this section, we review specifi c strategies for the prevention and management of PJK and/or PJF, a subtype of ASP, which may occur following surgery for spine deformity.","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"41 1","pages":"1–8"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000552867.05285.23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61651223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-01DOI: 10.1097/01.CNE.0000550405.45473.05
J. Quinn, Avery L. Buchholz, Thomas J. Buell, R. Haid, S. Bess, V. Lafage, F. Schwab, C. Shaffrey, Justin S. Smith
Adjacent Segment Disease and Proximal Junctional Kyphosis Based on recently proposed terminology, degeneration that develops at mobile segments above or below a previously operated spinal level is known as adjacent segment pathology (ASP). Within the heading of ASP, radiologic ASP refers to the radiologic changes that occur at the adjacent segment, and clinical ASP refers to the clinical symptoms and signs that occur at the adjacent segment. ASP can occur after any spine surgery and in any region of the spine, including simple decompressions and shortor long-segment fusion surgical procedures. The development of ASP is problematic because it can necessitate further surgical intervention and adversely affect functional outcomes. The fi rst section of this 3-part series focused on description of the risk factors for development of ASP and proximal junctional kyphosis (PJK), and the classifi cation systems that have been developed as a means of creating a more standardized approach for diagnosing and treating these conditions. In part 2 of this review, the focus is on important general concepts in the prevention and treatment of ASP after lumbar spine surgery. As a basis for understanding specifi c methods for prevention and treatment strategies, we also discuss important principles that underlie the pathologic processes involved in the development of these
{"title":"Adjacent Segment Disease after Lumbar Spine Surgery—Part 2: Prevention and Treatment","authors":"J. Quinn, Avery L. Buchholz, Thomas J. Buell, R. Haid, S. Bess, V. Lafage, F. Schwab, C. Shaffrey, Justin S. Smith","doi":"10.1097/01.CNE.0000550405.45473.05","DOIUrl":"https://doi.org/10.1097/01.CNE.0000550405.45473.05","url":null,"abstract":"Adjacent Segment Disease and Proximal Junctional Kyphosis Based on recently proposed terminology, degeneration that develops at mobile segments above or below a previously operated spinal level is known as adjacent segment pathology (ASP). Within the heading of ASP, radiologic ASP refers to the radiologic changes that occur at the adjacent segment, and clinical ASP refers to the clinical symptoms and signs that occur at the adjacent segment. ASP can occur after any spine surgery and in any region of the spine, including simple decompressions and shortor long-segment fusion surgical procedures. The development of ASP is problematic because it can necessitate further surgical intervention and adversely affect functional outcomes. The fi rst section of this 3-part series focused on description of the risk factors for development of ASP and proximal junctional kyphosis (PJK), and the classifi cation systems that have been developed as a means of creating a more standardized approach for diagnosing and treating these conditions. In part 2 of this review, the focus is on important general concepts in the prevention and treatment of ASP after lumbar spine surgery. As a basis for understanding specifi c methods for prevention and treatment strategies, we also discuss important principles that underlie the pathologic processes involved in the development of these","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":"40 1","pages":"1–7"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000550405.45473.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43607762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-01DOI: 10.1097/01.CNE.0000547765.47045.88
T. Sorenson, J. M. Korducki, Charles R. Watts
Osteoporosis (OPO) is defi ned as a disease process characterized by low bone mineral density (BMD) with accompanying microarchitectural deterioration of osseous tissue, leading to increased bone fragility and consequent increased fracture risk. The World Health Organization (WHO) originally defined 4 categories of BMD with the following criteria: normal (T-score, ≥−1.0), osteopenia (OP) (T-score, −2.5 to ≤−1.0), OPO (T-score, ≤−2.5), and severe OPO (T-score, ≤−2.5, with history of fragility fracture). Fragility fractures (FFs) are defi ned as fractures that result from a fall from standing height or less or that present in the absence of trauma. The most common sites of FF are femoral neck/hip, wrist, spine (thoracic/lumbar most common), humerus, pelvis, and forearm. Because the risk of FF is an important aspect of patient management, the WHO revised its criteria to include BMD and the patient-specifi c 10-year probability of sustaining a major FF. The 10-year probability of FF can be assessed using the Fracture Risk Assessment Tool (FRAX), which stratifi es risk according to ethnicity, age, sex, weight, height, fracture history, family history of femoral neck/hip fracture, current smoking status, history of glucocorticoid use, history of rheumatoid arthritis, history of secondary OPO, history of alcohol consumption 3 units or more (beverages)/day, and femoral neck/hip BMD (g/cm3). WHO criteria for intervention, which is defi ned as medical/pharmacologic management of BMD, are history of femoral neck/hip or spine FF at 40 years and older, BMD T-score −2.5 or less, or BMD T-score −2.5 to −1.0 or less, with an elevated FRAX of 20% or more for nonfemoral neck/hip major FF and/or 3% or more for femoral neck/hip FF. With an aging population, OPO poses an immense public health problem, with 16.2% of adults (5.1% men and 24.5% women) 65 years and older affected (2010 data, www. cdc.gov). With 47.8 million people 65 years and older living in the United States (2015 data, www.census.gov), a potential
{"title":"Comprehensive Management of Osteoporotic Thoracic and Lumbar Vertebral Compression Fractures","authors":"T. Sorenson, J. M. Korducki, Charles R. Watts","doi":"10.1097/01.CNE.0000547765.47045.88","DOIUrl":"https://doi.org/10.1097/01.CNE.0000547765.47045.88","url":null,"abstract":"Osteoporosis (OPO) is defi ned as a disease process characterized by low bone mineral density (BMD) with accompanying microarchitectural deterioration of osseous tissue, leading to increased bone fragility and consequent increased fracture risk. The World Health Organization (WHO) originally defined 4 categories of BMD with the following criteria: normal (T-score, ≥−1.0), osteopenia (OP) (T-score, −2.5 to ≤−1.0), OPO (T-score, ≤−2.5), and severe OPO (T-score, ≤−2.5, with history of fragility fracture). Fragility fractures (FFs) are defi ned as fractures that result from a fall from standing height or less or that present in the absence of trauma. The most common sites of FF are femoral neck/hip, wrist, spine (thoracic/lumbar most common), humerus, pelvis, and forearm. Because the risk of FF is an important aspect of patient management, the WHO revised its criteria to include BMD and the patient-specifi c 10-year probability of sustaining a major FF. The 10-year probability of FF can be assessed using the Fracture Risk Assessment Tool (FRAX), which stratifi es risk according to ethnicity, age, sex, weight, height, fracture history, family history of femoral neck/hip fracture, current smoking status, history of glucocorticoid use, history of rheumatoid arthritis, history of secondary OPO, history of alcohol consumption 3 units or more (beverages)/day, and femoral neck/hip BMD (g/cm3). WHO criteria for intervention, which is defi ned as medical/pharmacologic management of BMD, are history of femoral neck/hip or spine FF at 40 years and older, BMD T-score −2.5 or less, or BMD T-score −2.5 to −1.0 or less, with an elevated FRAX of 20% or more for nonfemoral neck/hip major FF and/or 3% or more for femoral neck/hip FF. With an aging population, OPO poses an immense public health problem, with 16.2% of adults (5.1% men and 24.5% women) 65 years and older affected (2010 data, www. cdc.gov). With 47.8 million people 65 years and older living in the United States (2015 data, www.census.gov), a potential","PeriodicalId":91465,"journal":{"name":"Contemporary neurosurgery","volume":" ","pages":"1–7"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CNE.0000547765.47045.88","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46790323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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