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In the light of our results, it can be concluded that autogenous bone grafts in combination with rhVEGF can, potentially, enhance neovascularization and bone regeneration.

The goal of endoscopic treatment for craniosynostosis is to remove the fused suture and achieve calvarial remodeling with external orthosis. To reduce the need for secondary surgery and to minimize blood loss, instruments that maximize bone removal while minimizing blood loss and risk of dural injury are evolving. The authors therefore assess the safety and efficacy of the Sonopet Ultrasonic Bone Aspirator (UBA) (Stryker, Kalamazoo, MI) for endoscopic suturectomy compared to traditional instrumentation at our institution.

Retrospective chart review of consecutive endoscopic suturectomies performed from 2011 to 2019 at Weill Cornell Medical Center was conducted, including demographics, cephalic index, surgical indications, operative time, cosmetic and functional results, complications, estimated blood loss (EBL), re-operation rate, length of stay, and length of helmet therapy. These variables were then compared between the Sonopet and non-Sonopet cohorts.

Of the 60 patients who underwent endoscopic suturalso seen. This modality should be considered a safe and effective adjunct in appropriate endoscopic craniosynostosis cases.

The use of the Sonopet resulted in a mean decrease in operative time at our institution (P = 0.18). Lower EBL and reoperation rates with comparable LOS and helmet therapy duration were also seen. This modality should be considered a safe and effective adjunct in appropriate endoscopic craniosynostosis cases.

This cohort study aimed to assess how age at repair affects outcomes in nonsyndromic patients with and without Robin Sequence using a national database of commercial healthcare claims.

Children under 4 years of age undergoing palatoplasty were identified in the IBM MarketScan Commercial Database based on ICD-9-CM and CPT procedure codes. They were divided into Robin and non-Robin cleft palate groups, and further divided by time of initial cleft palate repair Robin Sequence into 2 groups age ≤10 months or >10 months; non-Robin cleft palate into 3 groups age ≤10 months, >10-14 months, or >14 months age. Time to cleft palate revision within each group was assessed using Cox proportional-hazard models.

A total of 261 patients with Robin Sequence and 3046 with non-Robin cleft palate were identified. In patients with Robin, later repair was associated with decreased risk of secondary procedures compared with early repair (Hazard Ratio (HR) 0.19, 95%CI 0.09-0.39, P < 0.001). In patients with non-Robin cleft palate, decreased risk of revision compared to early repair was associated both with repair at >10-14 months (adjusted HR 0.40, 95%CI 0.31-0.52, P < 0.001) and > 14 months (adjusted HR 0.71, 95%CI 0.57-0.88, P = 0.002). Adjusting for timing of repair, patients with non-Robin cleft palate were at significantly increased risk of secondary procedure if diagnosed with failure to thrive or anemia in the 30 days prior to palatoplasty.

In patients with and without Robin sequence, cleft palate repair at or before 10 months of age was associated with higher risk for secondary procedures.

In patients with and without Robin sequence, cleft palate repair at or before 10 months of age was associated with higher risk for secondary procedures.Mixed reality (MR) merges virtual information into the real world through computer technology, in which the real environment and virtual objects can get spliced in the same image or space at real time so that it can effectively express and integrate the virtual and real worlds and allow high feedback interaction. This technology combines the many advantages of virtual realityand augmented reality, and has a promising future in the medical field. At present, MR technology is just at the beginning stage in the medical field in the world, whose application in neurosurgery is also rarely reported. Given this, the authors described the research progress of MR in neurosurgery including preoperative planning and intraoperative guidance, doctor-patient communication, teaching rounds, physician training, and so on.The rationale and outcomes for reconstruction of complex maxillectomy and midfacial defects using a folded multi-island vertical rectus abdominis myocutaneous free flap (MI-VRAM) are analyzed in this study.A retrospective review of prospectively collected database was conducted on all VRAM free flaps used in head and neck reconstruction from 2013 to 2019. A total of 39 cases were identified, of which 21 patients underwent immediate VRAM flap reconstruction for complex maxillectomy and midfacial defects. Variables including age, sex, pathologic subtypes, tumor staging, type of resection, defect classification, adjuvant therapy, complications, follow-up time, and reconstructive details were collected.Single skin-island VRAM was used in 10 (47.6%) patients. Eleven (52.4%) patients required the use of folded MI-VRAM flap. In 6 (28.6%) patients a triple skin-island VRAM was used and 5 (23.8%) received a double skin-island VRAM. The average size of harvested skin paddle was 15 × 7.2 cm. Secondary flap contouring was required in 6 (28.6%) patients. There were no cases of total flap loss and no major donor site complications recorded.Folded MI-VRAM flap is a reliable method for reconstruction of complex maxillectomy and midfacial defects. Clozapine N-oxide in vitro It provides multiple independent skin islands with excellent plasticity and abundant volume of tissue for restoration of facial contours.

This was a national database study.

The objective of this study was to assess the impact of prior bariatric surgery (BS) on altering 90-day postoperative outcomes following elective anterior cervical discectomy and fusions (ACDFs).

Though obesity has previously been shown to be linked with adverse outcomes following elective spine surgical procedures, the effectiveness of weight-loss strategies such as BS has not been explored.

The PearlDiver program was used to query the 2007-2013 100% Medicare Standard Analytical Files (SAF100) for patients undergoing an elective ACDF. The study cohort was divided into 2 groups-(1) obese ACDF patients (body mass index ≥35 kg/m) receiving a BS procedure within 2 years before an ACDF and (2) obese ACDF patients (body mass index ≥35 kg/m) without a known history of a BS procedure within the last 2 years. Multivariate regression analyses were used to assess the impact of a BS procedure on postoperative outcomes following ACDF while adjusting for age, sex, region, and Elixhauser Comorbidity Index.

A total of 411 ACDF patients underwent BS within the 2 years before an ACDF. Multivariate analysis showed that undergoing BS before an elective ACDF was associated with a significantly reduced risk of pulmonary complications [odds ratio (OR)=0.53; P=0.002], cardiac complications (OR=0.69; P=0.012), sepsis (OR=0.69; P=0.035), renal complications (OR=0.54; P=0.044), and 90-day readmissions (OR=0.53; P=0.015).

Surgery-induced weight loss before an ACDF in obese patients is associated with reduced 90-day complication and readmission rates. Orthopaedic and bariatric surgeons should counsel obese patients on the benefits of BS following ACDFs.

Surgery-induced weight loss before an ACDF in obese patients is associated with reduced 90-day complication and readmission rates. Orthopaedic and bariatric surgeons should counsel obese patients on the benefits of BS following ACDFs.

This was a prospective cohort study.

The aim was to explores whether fear-avoidance is associated with altered gait patterns in cervical spinal myelopathy (CSM) patients.

Fear-avoidance is associated with activity restriction and emotional distress in chronic pain patients and with poorer spine surgery outcomes. In adults with spinal deformity, fear and avoidance correlates with gait pattern disruptions. Patients having CSM also display distorted gait.

Ninety CSM patients completed the Tampa Scale for Kinesiophobia (TSK) questionnaire, and the Fear-avoidance Beliefs Questionnaire (FABQ). Each patient performed a series of gait trials. Pearson's product correlation analysis was used to determine the relationship between the self-reported fear of movement measures and the objective gait biomechanical data.

The TSK total score was correlated with walking speed (P=0.003), cadence (P=0.012), stride (P=0.010) and step (P=0.036) time, and stride (P=0.018) and step (P=0.035) length. The FABQ physical dimens a framework for further investigation of the relationship between psychosocial factors and objectively measured function in patients with CSM. This study demonstrates a strong correlation between fear and avoidance of movement, as measured with the TSK and FABQ and multiple biomechanical gait parameters, as measured with gait analysis. The current results may imply that fear and avoidance may compound and worsen functional deficits arising from CSM, and strongly suggest that fear and avoidance beliefs should be included as a component of presurgical diagnostic process for CSM patients.

This was a retrospective consecutive cohort analysis.

This study aimed to examine the association between commonly prescribed medications and outcomes following posterior lumbar spine surgery.

Postoperative complications and prolonged length of stay significantly increase costs following posterior lumbar spine surgery and worsen patient outcomes. To control costs and complications, providers should focus on modifiable risk factors, such as preoperative medications. Antihypertensive and anticholinergic drugs are among the most commonly prescribed medications but can carry significant risks in the perioperative period.

This study was a retrospective cohort analysis of patients undergoing posterior lumbar spine surgery from January 2014 through December 2015 at a large tertiary care center. The variable selection followed by multivariable logistic and negative binomial regressions were performed. An α threshold of 0.0056 was used for significance after correction for multiple comparisons. A secondary analysis was performed to evaluate confounding or effect modifying variables.

This study included 1577 patients. Postoperative urinary retention risk was increased in patients taking loop diuretics. Acute kidney injury risk was increased for patients on nondihydropyridine calcium-channel blockers. Surgical site infection risk was increased for patients on aldosterone receptor blockers. Urinary tract infection risk was increased for patients on anticholinergics for urinary incontinence. Length of stay was decreased for patients on angiotensin II antagonists and angiotensin-converting enzyme inhibitors.

A care path should be established in the perioperative period for patients who are deemed to be at higher risk due to medication status to either modify medications or improve postoperative monitoring.

Level III.

Level III.

A retrospective comparative study.

The present study aims to compare the surgical outcomes between bilateral partial laminectomy (BPL) and posterior lumbar interbody fusion (PLIF) in patients with mild degree of slippage.

To date, there have not been established surgical procedures for patients with mild degree of slippage. link2 Moreover, sufficient studies that have compared surgical outcomes between BPL and PLIF are very few.

In this retrospective study, the authors enrolled 202 consecutive patients with degenerative spondylolisthesis with slippage at L3 or L4 of >3% who underwent spine surgery between 2005 and 2015. Patients were grouped into those who underwent single-segment PLIF (n=106) and those who underwent BPL (n=51). To adjust for potential confounders, the inverse probability of treatment weighting based on the propensity score was used. Surgical outcomes were compared between the BPL and PLIF groups. link3 The threshold age for the final recovery rate of >70% was evaluated using receiver operating characteristic curve analyses to assess the limit of age to achieve good outcomes.