Search

Background and Objectives: Predicting the development of adjacent segment disease (ASD) after lumbar spine fusion would help guide preoperative and postoperative therapies to prevent reoperation. We sought to evaluate whether sarcopenia predicts the development of early ASD after transforaminal lumbar interbody fusion (TLIF)., Methods: Retrospective data were collected from 109 patients who underwent TLIF from 2013 to 2023. Patients older than 18 years who underwent elective posterior midline approach TLIF were included. Patients with prior lumbar instrumented fusions, cases of trauma, central nervous system infection, cancer, or long-construct thoracolumbar deformity corrections and those who lacked sufficient follow-up were excluded. The primary outcome was radiographic ASD development within 3 years of surgery. Psoas volumetric measurements were recorded from the most recent preoperative MRI. Odds ratios were calculated with logistic regression analyses., Results: In 109 patients undergoing elective TLIF, 22 (20.2%) developed ASD within 3 years. Gender, body mass index, and extent of surgery were not associated with ASD development. Multivariate analysis showed left/right psoas cross-sectional area, and psoas:vertebral body ratio (P:VBR) predicted early ASD (P < .0001). Sarcopenia was further categorized as having bilateral P:VBR ≥1 SD below gender mean (T-score -1). Of 18 sarcopenic patients, 15 developed early ASD (83.33%) vs 7 of 91 nonsarcopenic patients (7.69%; P < .0001). Postoperative mismatch between pelvic incidence and lumbar lordosis was predictive of ASD on univariate (P = .0480) but not multivariate analysis. Pelvic tilt and lumbar lordosis postoperatively were not associated with early ASD., Conclusion: Sarcopenia, measured by decreased psoas area and P:VBR, predicts ASD formation within 3 years of surgery. Morphometric analysis of psoas size is a simple tool to identify patients at risk of developing ASD. This information can potentially guide preoperative and postoperative therapies, affect surgical decision making, and effectively counsel patients on risks of reoperation., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Pancreas transplantation is the most effective treatment to improve quality of life and overcome complications in patients with end-stage renal disease and diabetes mellitus. One of the main approaches for concurrent renal disease and diabetes mellitus which has been underutilized during the past decade is a pancreas transplant after kidney transplantation. Our study aimed to quantify outcomes following pancreas after kidney transplants (PAKs) in the United States from 2001 to 2020 with an emphasis on graft and patient survival., Methods and Materials: A retrospective registry analysis was performed by accessing the OPTN/UNOS database for PAKs that were performed in the United States from January 2001 to April 2020. The study population was divided into two subgroups: patients receiving a pancreas transplant between 2001 and 2010 and those receiving a pancreas transplant between 2011 and 2020., Results: The study examined a total number of 3706 PAK recipients; patients who received a PAK from January 2001 through December 2010 (n = 2892) and those who received a PAK from January 2011 to April 2020 (n = 814). The selection process of transplant recipients did not drastically change throughout the 2001-2010 and 2011-2020 periods. Length of stay at the hospital after the transplantation improved significantly in the 2011-2020 group relative to the 2001-2010 group (8.48 vs. 10.08 days, mean, p < 0.01). Additionally, more transplantation with 4-6 human leukocyte antigen mismatch occurred in the 2011-2020 group than in the 2001-2010 group (80.6% vs. 71.4%, p < 0.01). The pancreas preservation time of 13.35 h in the 2001-2010 group decreased significantly to 11.17 h in the 2011-2020 group (p < 0.001). The mean donor's amylase and lipase also decreased significantly in the 2011-2020 cohort. Significant graft survival improvement was observed in the 2011-2020 group compared to the 2001-2010 group after a long-term follow-up (p < 0.001). The mean Calculated Pancreas Donor Risk Index was 1.08 for the 2001-2010 group and 0.99 for the 2011-2020 group with a significant difference (p < 0.001)., Conclusion: The beneficial results and improved outcomes observed in PAK patients demonstrate the effectiveness of the operation for individuals in need of a pancreas transplant. PAKs can prove to be a meaningful solution to overcome long waiting times, decrease the donor-recipient imbalance, expand the donor pool, and overcome the current underutilization in order to improve the short- and long-term quality of life in the groups of interest., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Background: C5 palsy (C5P) is a recognized potential postoperative complication of cervical spine surgery but has rarely been reported following an open esophageal diverticulectomy., Methods: A 61-year-old underwent an open esophageal diverticulectomy for symptomatic Zencker's diverticulum., Results: Postoperatively, she presented with right upper extremity weakness and sensory deficits consistent with a C5P that was later confirmed by electromyography., Conclusion: The potential for C5P after esophageal diverticulectomy for symptomatic Zencker's diverticulum is rare. Postoperative recognition and appropriate management are critical to recovery., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Objectives  We sought to perform a systematic review and meta-analysis of outcomes after surgical resection of jugular foramen schwannomas (JFSs). Design  A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Setting  PubMed, Scopus, and Embase databases were searched. Participants  Case series of at least five patients undergoing surgical resection of JFSs were included. Main Outcome Measures  Primary outcomes included gross total resection (GTR) and near total resection (NTR) rates, as well as a composite of the two (GTR + NTR). Additional outcomes included new or worsening cranial nerve (CN) palsies and cerebrospinal fluid (CSF) leak. Random effects models were used to generate pooled outcomes. Results  A total of 25 studies comprising 567 patients were included in the study. The proportions of each tumor grade were the following: grade A (33.1%), grade B (16.1%), grade C (9.2%), and grade D (41.6%). The pooled rate of GTR was 81% (95% confidence interval [CI]: 70-88; I 2  = 78.9%) and the composite GTR + NTR rate was 88% (95% CI: 81-93; I 2  = 66.4%). Rates of new or worsening CN palsies were the following: 12% hearing loss (95% CI: 7-20; I 2  = 69.4%), 27% dysphagia (95% CI: 20-36; I 2  = 66%), 20% hoarseness (95% CI: 14-28; I 2  = 62.6%), and 19% facial palsy (95% CI: 13-28; I 2  = 64.6%). The pooled rate of CSF leak was 9% (95% CI: 6-15; I 2  = 43.9%). Conclusion  The literature suggests high GTR rates of JFSs can be achieved. However, new CN deficits are not uncommon., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

Purpose: To determine the changes in game performance during tournament play of elite 3×3 basketball., Methods: A total of 361 men and 208 women competing in selected international tournaments had game demands assessed by wearable technology (global positioning system, inertial sensor, and heart rate) along with postgame blood lactate and perceived responses. Differences in the means for selected variables between games were compared using magnitude-based inferences and reported with effect size and associated confidence limits (CL), along with the percentage difference (ES; ±90% CL, %difference) of log-transformed data., Results: No clear differences were seen over a tournament period in PlayerLoad™ or PlayerLoad·minute-1. Tournament competition elicits variable changes between games for all inertial measures. Average peak heart rate was 198 (10) and 198 (9) beats·min-1, and average game heart rate was 164 (12) and 165 (18) beats·min-1 for men and women, respectively, with no change between games. Average game lactate was 6.3 (2.4) and 6.1 (2.2) mmol·L-1 for men and women, respectively. Average game ratings of perceived exertion were 5.7 (2.1) and 5.4 (2.0) AU for men and women, respectively. Although lactate and ratings of perceived exertion were variable between games, there was no difference over a tournament., Conclusions: The physical and physiological demands of elite 3×3 games over the duration of a tournament are similar regardless of pool or championship rounds. This may imply that maintaining technical and strategic aspects leads to success rather than minimizing fatigue through superior physical preparation. However, the physiological responses are high; caution is warranted in being underprepared for these demands in tournament play.

Purpose: To determine the demands of elite male and female 3 × 3 basketball games and compare these between various competition levels., Methods: A total of 361 males and 208 females competing in the Under-18 World, Senior European, and World Championships and selected professional tournaments had game demands assessed by wearable technology (global positioning system, inertial measurement, heart rate) along with postgame blood lactate and perceived responses. Differences in the means were compared using magnitude-based inferences and reported with effect size and 90% confidence limits, along with the percentage difference (effect size; ±90% confidence limits, %) of log-transformed data., Results: PlayerLoad™ and PlayerLoad·min -1 during play was 127.5 (31.1) and 6.7 (1.5) for males and 128.5 (32.0) and 6.5 (1.4) for females, respectively, with small differences between junior, senior, and professional levels. There were small differences in accelerations >3.5 m·s -1 between competition levels up to 0.31; ±0.20, 6.9% for males and 0.29; ±0.19, 10.8% for females and for decelerations >3.5 m·s -1 , 0.29; ±0.19, 15.6% for males and 0.26; ±0.19, 5.4% for females, with European Championships generally greater than other levels. Average game heart rate was 165 (18) and 164 (12) beats·min -1 for males and females, with no difference between levels. Average rating of perceived exertion was 5.7 (2.1) and 5.4 (2.0) for males and females., Conclusions: 3 × 3 basketball games require high-speed inertial movements within limited distance, creating a relatively high physiological response. Practitioners working with 3 × 3 players should endeavor to focus on the attributes that will improve these player characteristics for greater success.