Using a national registry, the authors compared the relative efficacies of decompression alone and decompression plus fusion in patients with grade I lumbar spondylolisthesis, for which ideal surgical management has not been determined despite extensive investigation. After adjusting for differences between groups, fusion remained independently associated with Oswestry Disability Index (ODI) score improvement and achieving the minimal clinically important difference in ODI score at the 24-month follow-up. The results suggest that decompression plus fusion offers superior outcomes at 24 months posttreatment compared to decompression alone for grade I lumbar spondylolisthesis.
Hemifacial spasm is a debilitating neuromuscular disorder with limited treatment options. Here the authors have described and examined the clinical efficacy of awake CT-guided radiofrequency ablation of the facial nerve to treat hemifacial spasm. Their data indicated that this approach is a precise and minimally invasive procedure that can provide effective and sustained relief for patients with hemifacial spasm, with minimal side effects.
After demonstrating that noninvasive low intensity focused ultrasound directed at the L5 dorsal root ganglion (DRG) reduces allodynia for days in rodents, the authors advanced this treatment toward clinical use in humans by adapting the probe to treat a DRG 5 cm below the skin's surface in domestic swine. Allodynia was reduced for 5 days and pain guarding for up to 1 month after a one-time noninvasive treatment.
To develop an isolated neuropathic pain model in domestic swine, the authors created a common peroneal nerve injury that caused mechanical allodynia and leg-guarding behavior and induced demyelination of the nerve. Because of the genetic and anatomical similarities between humans and swine, this model, to the authors′ knowledge the first of its kind, will help move experimental neuropathic pain treatments developed in rodents toward clinical implementation in humans with chronic pain.
Despite proven efficacy in the management of selected brain aneurysms, flow-diverter stents (FDSs) are not generally used in patients with acutely ruptured aneurysms, since full aneurysm angiographic exclusion is delayed and dual-antiplatelet therapy is required. In this study, the authors found that FDSs can be safely used to manage acutely ruptured small uncoilable aneurysms in conjunction with early ventriculostomy and a strong proven antiplatelet effect. This strategy prevented aneurysm rebleeding and avoided serious procedural thromboembolic complications, with high long-term occlusion rates.
In this conversation, Dr. Caitlin Hoffman (Weill-Cornell) and Dr. Shelly Timmons (Indiana University) discuss Dr. Hoffman and colleagues' paper, "Increases in female academic productivity and female mentorship highlight sustained progress in previously identified neurosurgical gender disparities” published in the March 2021 issue of Neurosurgical Focus. Co-moderated by Drs. Katharine Drummond (Royal Melbourne Hospital, Melbourne, Australia), Mary Murphy (National Hospital for Neurology and Neurosurgery, London, UK), and Erica Bisson (University of Utah). With Drs. Aaron Cohen-Gadol (Associate Editor, Neurosurgical Focus) and William Couldwell (EIC, Neurosurgical Focus).
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AANS members enjoy a discount on annual subscriptions to the Journal of Neurosurgery. To find out more please visit the member subscriptions webpage:
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