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Background: Cubital tunnel syndrome is the second most common entrapment neuropathy of the upper extremity in the United States. Most cases are idiopathic and symptoms consist of a combination of weakness, pain, and sensory disturbances ranging from paresthesias and dysesthesias to numbness or complete anesthesia. The purpose of this study is to report results of a novel, minimally invasive surgical procedure for cubital tunnel syndrome with comparison to existing interventions including full open or endoscopic approaches., Methods: A total of 41 consecutive patients underwent the procedure, their ages ranged from ages 36 to 81 with an average age of 60.52±12.18 years. The procedure consists of a 1.0-2.0-cm incision with decompression of the ulnar nerve under direct visualization proximally with Metzenbaum scissors as a dilator for distal decompression. Patients were evaluated for improvements in pain, numbness, paresthesias, weakness, and muscle atrophy and was measured utilizing the Gabel/Amadio scale., Results: Fifty-three point two percent (n=25) of patients were found to have excellent outcomes, 36.2% (n=17) had good outcomes, 8.5% (n=4) had fair outcomes, and 2.1% (n=1) had poor outcomes as determined by the Gabel/Amadio scale. The greatest improvement in all patients was the reduction in sensory symptoms: pain, numbness, and paresthesia. There were no operative or postoperative complications., Conclusions: This novel procedure provided symptom relief comparable to the most effective existing techniques without significant complications, and with rapid recovery and minimal scar formation. The authors assert that this technique demonstrates optimal results for patients with relative ease of adoption for surgeons., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: Symptomatic thoracic disc herniation (TDH) is rare, and for those patients that fail conservative treatment, two main categories of surgical approaches exist-anterior and posterolateral. In many cases either approach would be considered equally appropriate. Recommendations in support of either anterior or posterolateral approaches are currently based on case series and expert opinion. Here, we utilize National Surgical Quality Improvement Program (NSQIP) database to determine and compare the rates of complication associated with anterior or posterolateral approaches in the treatment of TDH., Methods: An analysis of NSQIP data from 2005 to 2014 was conducted. Patients were included based on a combination of a postoperative diagnosis of TDH. Patients were then grouped according to anterior or posterior approaches on the basis of Current Procedural Terminology (CPT) codes. Propensity score matching was performed to account for baseline demographics [sex, race, age, obesity, diabetes, smoking, history of chronic obstructive pulmonary disease (COPD), history of CHF, and American Society of Anesthesiologists (ASA) class]. The 30-day outcome measures of these patients were analyzed., Results: A total of 432 patients were identified, 80.3% underwent posterolateral and 19.7% anterior interventions. There were no significant differences in 30-day outcome measures between the anterior or posterior intervention groups. Within the matched group of 170 patients, the anterior group had significantly longer lengths of stay (5.49±3.96 vs. 4.01±4.81, P<0.0001), but there were no observed significant differences in the rate of occurrences of UTIs, pneumonias, sepsis, bleeding, intubation, or death., Conclusions: Posterolateral and anterior approaches carry an equal non-neurological perioperative complication profile. Posterolateral approaches may carry shorter hospital stays compared to anterior interventions., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: Subfascial drains are routinely used after multi-level anterior cervical discectomy and fusion (ACDF) procedures despite little evidence to support their use. Proponents of drain use argue that drain placement reduces the incidence of post-operative hematomas and surgical site infections (SSI). The aim of this study is to determine whether the use of subfascial drains after multi-level ACDFs are associated with a decreased incidence of hematomas and SSIs., Methods: This is a retrospective study of 321 consecutive adult patients (18 years and older) with degenerative cervical stenosis that undergoing an index multi-level ACDF procedure. Only patients undergoing multilevel ACDF were included in the study. Patients were separated into one of two groups depending whether a subfascial drain was placed during surgery. The decision to place a drain was based on surgeon preference. Baseline characteristics, operative details, as well as rates of hematoma formation and SSIs were gathered by direct medical record review., Results: Of the 321 patients enrolled in the study, 58 (18%) patients had subfascial drains placed at the time of surgery. Baseline demographics and co-morbidities were similar between both cohorts; however, on average, patients in the "Drain Use" cohort were older when compared to those in the "No Drain" cohort (64 vs. 56 years old, P<0.0001). There was no observed difference between both groups in the incidence of post-operative hematoma formation (P=0.99) or SSI (P=0.99). Five percent of patients in the "Drain Use" cohort required a post-operative allogenic blood transfusion compared to less than 1% (0.4%) in the comparison cohort. The duration of hospital stay was almost 2-fold longer in the in the "Drain use" cohort compared to the comparison cohort ("Drain Use": 2.82 days vs. "No Drain": 1.58 days, P<0.0001)., Conclusions: The use of subfascial drains after multi-level ACDF procedures were not associated with a decreased incidence of hematoma formation or SSIs. In fact, patients in which a subfascial drain was used were 14 times more likely to require a post-operative blood transfusion and with an almost 2-fold increase in the duration of in-hospital stay., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.